I STITCHED UP A GUY’S HEAD.
It was pretty much the coolest thing ever. Last night, I shadowed a doctor who moonlights at the after-hours clinic at the pediatric hospital here. The patients there are the ones who aren’t emergent or “urgent,” but can’t really wait until tomorrow for their regular pediatrician. Most patients were kids with high fevers, babies throwing stuff up, ear infections, etc. I was about to head home a little early (it was a slow night) when a patient popped up on the dashboard with “HEAD LAC” written as the complaint.
Hmm. Maybe I’ll stick around and look interested.
A few minutes later, the doctor assigned to the patient came over and asked, “Have you sutured yet?” <self-fist bump>
“Do you know how? Did they teach you yet?”
Uh, no. (Note to the faculty who read this: pleeeease?!)
“Great, come with me. What size sterile gloves are you?”
Audible sigh. I have a flashback to my first time ever in a clinic back in September, when the fourth-year student, exasperated by my newness/idiocy, exclaimed, “Do you even know how to wipe your own ass?”
We matched palms and figured out I’m a 7 ½. Look, mom, I learned something!
The doctor ripped open a suturing kit and laid out all the instruments – hemostat, tweezers, scissors, stitches. Grabbing a napkin, she drew an imaginary cut and walked me through how to suture – you grab the needle with the hemostat like this, it’s all in the wrist, then you loop and grab this thing and then pull and loop and boom you’re done – and handed me the needle.
I was open-mouthed. “Um, you lost me at the looping part.”
She gave me a look. Then showed me again. This was the world’s most patient pediatrician.
After a few tries, it became apparent that stitching a napkin wasn’t the best proxy for human skin. We hunted around for something more, uh, meaty. After a minute, the doctor lit up and said, “Oh! I had a banana earlier. We can use the peel!”
She headed for the trash can and started sorting through. The nearby orderly, who had been watching the charade with interest, started laughing. An attending physician, rummaging through the garbage at the ER for an old banana peel. (You should know this is typically a job reserved for the medical student.)
Triumphantly, she returned with the peel and showed me how to do it again. I threw my first stitch on poor Chiquita Banana.
Massive sense of accomplishment.
“Okay, let’s go see the patient. I’ll do the first few sutures, since they’re the hardest, and then you do the rest. Ready?”
I had just made one clumsy knot, my first ever, on a decaying banana peel. No.
I wondered how I should present myself to the patient. This is an old problem in medical training – no one really wants to let a student practice on themselves or a family member, but without that practice, you can’t make new doctors (Robin Cook, in The Year of the Intern, wrote extensively about this paradox).
In the room was the 18-year-old who had fallen on concrete steps, his mother, brother, and two sisters. Oh, great, an audience. The doctor introduced herself. “Hi, I’m Dr. G, and this is Nate, who is working with me today. We’re going to fix up your head.” (We! Massive sense of accomplishment.)
I stood awkwardly next to the doctor as she washed out the wound and shot in lidocaine. Expertly, she threaded the needle through one edge of the cut, then the other. Slowly at first, then picking up speed, she looped the thread into square knots four, five, six times. The edges of the cut came together with ease. Like tying shoelaces.
The patient’s mom took out her cameraphone and started snapping pictures. “I’m sending these to Grandma,” she told her son, who was engrossed in the Disney Channel. Not kidding. Lidocaine is amazing.
Looking over at me, probably because I was in the picture, the mom said, “Does he stitch, too?”
“Yep!” replied the doctor (true, as of five minutes ago). “I’ve been a doctor for five years, and Nate here is working on his medical license, which is why we’re tag-teaming today.”
I thought that was the most elegant way of saying “HE KNOWS NOTHING RUN WHILE YOU CAN” that I’ve heard yet. It’s a neat side-step away from identifying me as a student; instead, I’m “working on my medical license.”
You can’t lie, of course: that would be a major ethical violation. But if you come out with, “I have been in school six months, know nothing, and one time I tried and failed to sew a button back onto my jeans. I have no idea what I am doing here,” no one will let you touch them. And you can’t learn. (End soapbox.)
Four or five stitches in, Dr. G ran out of thread. “Okay, switch places with me,” she said. I could feel the sterile gloves – which I had learned to appropriately put on ten minutes ago – sticking to my clammy, shaking hands as she handed me the hemostat. Dr. G nudged my hand toward the fresh pack of stitching. I clamped the hemostat onto the needle.
Gently, Dr. G took the assembly from me and fixed my mistake, attaching everything backwards. Oops. Shades of holding the heart upside-down in pathology lab again. Correctly positioned, I bent over the patient and OH GOD I’M STICKING A NEEDLE INTO A GUY’S HEAD AND HE HAS NO IDEA I KNOW NOTHING.
Whoa. Cool. It is all in the wrist.
With the needle finally through, I looped the suture over the hemostat and grabbed the free end with the tip, just like on the banana. It sounds smooth here, but I was terrified. Everything shook. Blood oozed everywhere. Skin pulled in places it shouldn’t.
Somehow (and with assistance from Dr. G) the knot pulled through and the edges of the cut came gently together. It’s mildly unnerving that stitches are just five or six square knots in series, but okay.
Completing my knots, we trimmed the excess thread and moved on. On the next stitch, I went too deep and couldn’t get the needle through. On the next, I couldn’t find the needle since the cut overlapped the hairline and the colors blended together. I ended up poking around in his hair with tweezers, like one of those impossible arcade games where you try to grab the one good toy with the claw, but it keeps slipping out of the jaws.
After four stitches, the doctor grew impatient and took over, finishing the last three stitches in the time it took me to do half of one.
Done! We cleaned up the wound and checked the edges. You could tell which stitches were hers – evenly spaced, uniform smooth edges, tight knots. You could tell which stitches were mine: the ones that looked like a bad elbow patch job on a worn-through sweater.
I still can’t believe this is allowed. But how else do you learn?
–PS: for those of you that are worried, I’m exaggerating. The patient was completely fine, treated to standard of care, and my stitching was not like a bad elbow patch. He was discharged with no complications.