Cath Lab Digest

It is almost a year since America shared a collective wince/gasp as Barbaro took his fatal misstep at the Preakness last May 20. That moment (particularly, the fear that they would have to immediately put him down) was especially painful for me. I knew within the hour, in a gesture of love and respect (oh, how I hope he understood), I would say goodbye to Casey Jones, our beloved 15-year-old retriever mix, to preclude his continued suffering with pervasive cancer. For me, the confluence of those two events signified the need, not only to struggle valiantly to restore and maintain health, not only to know when do no harm means having to admit defeat, but also to learn from such experiences.

For many, Barbaro’s 8-month battle — first to heal his injuries and then with laminitis — was symbolic of athletic fortitude, of all fortitude, in the face of overwhelming obstacles. The outpouring of sympathy and gifts, interpreted at times as excessive and misdirected, captured the (dare I say it?) incredibly American, “little-engine-that-could” mentality that affirms hope, that champions determination, that underscores every desperate entreaty to “Do something!” Despite the best of care, Barbaro did not prevail. But with what seemed to be equal parts devastation and resolve, Barbaro’s owners and clinicians pulled a positive thread from the warming blanket of love and care he had received: how much wisdom, clinical and spiritual, was gleaned from their efforts.

Some might say this is an instance of winning the battle (finding a way to address the injury) but losing the war (the horse ultimately died). If anything, the converse is true — the battle may have been lost, but giant steps were taken in the quest for health. There is a take-away message for all clinicians — that is, every patient, because of his/her individuality and unique combination of symptoms and comorbidities, is a test case, a soldier in the healthcare revolution, a pedagological marvel, regardless of whether treatment is “successful.” Nowhere else in the healthcare arena, because of the inherent mix of art and science, is this more affirmed than in wound care.

Not only are people often, pardon me, guinea pigs, but so are guinea pigs. And horses. And mice. So are the pigs and cows that provide porcine and bovine skin. So are shrimp (in a recent article, chitosan, a polysaccharide extracted from the exoskeletons of shrimp, was hailed as an instrument in wound healing). So are maggots, despite the yuck factor. We have much to learn from our fellow Earth-dwelling creatures. Throwing creationism caution to the winds, I sometimes wonder if humans are not the subjects of an experiment conducted by a more advanced life form. At the very least, learning from experience is the basis for evidence-based medicine.

Because every living thing is an original combination of DNA and environmental influence, each approach to care comes with indications; hence, the potential for learning. In this issue of OWM, we are taught about the tenacious nature of biofilms, the ability of “power-washing” to cleanse and débride wounds, and the importance of restoring the matrix platform in filling wound dead space. Most relevant to this editorial topic, we are shown we can learn from the dead — in this instance, about deep tissue injury — proving that even as decedents, we provide vital healthcare information.