Skin was earth; it was soil. I could see, even on my own skin, the joined trapezoids of dust specks God had wetted and stuck with his spit the morning he made Adam from dirt. Now, all these generations later, we people could still see on our skin the inherited prints of the dust specks of Eden.
~Annie Dillard from An American Childhood
A goodly portion of every clinic day is spent looking at my patients’ skin. Most of the time, it is a quick assessment of color, moisture and texture before I go on to concentrate on the chief complaint that brought the patient in. However, skin concerns frequently are the chief complaint — perhaps as straight forward as an abrasion or laceration, or a puzzling bump, an oozing sore, a total body itch, or an ominous pigmented lesion.
I feel like Sherlock Holmes when I focus on a patient’s outer covering in magnified detail. I assume the identity of detective, inspector and archeologist all at once, trying to discern what is taking place on or beneath a piece of dermatologic geography.
No matter what the diagnosis or the treatment plan, I’m continually awestruck by the topography of skin. This supple landscape is made up of trapezoidal specks connected one to another, just like the soil upon which I tread. Skin cells are in a state of constant renewal, the dead and discarded falling off to rejoin the dust from which it came.
This elaborate matrix of collagen and keratin is the foundation for our scaffolding and our shroud.
His spit provides the superglue: the rivets, the bolts and the nails that bind us together for a lifetime.
We are created to be far more than a mere pile of random dust specks.