My First Stitch
Sewing is one of the more common things a surgical PA must do. My employment requires me to work with suture as thin as hair and as strong as cable; the later being called "Fiber Wire", and if you were to pull it with all your strength, it would neatly slice into the skin of your fingers. Using a curved needle, a pair of pickups (similar to tweezers), and a needle holder (specialize clamp to hold the little needle), I have put in too many stitches to count, from heart muscle to thin bone, and of course, skin.
The other night, having had a little too much java juice and too little food, I found myself fighting a fine motor tremor while sewing a skin incision. I had the shakes. It's never a problem regarding patient outcome, but it can slow you down and wear you out with the concentration it takes to overcome it. Watching the tip of the needle quiver as I sought the perfect pinpoint of tissue I needed to poke made me recall the very first time I stuck a stitch into a person.
He was about 9 years old and pretty tough. He had been trying to bench press on his dad's universal machine, and the stack of rectangular weights slammed down behind his head. They must have grazed his forehead as he lay there on his back with just enough force to tear open his skin because an inch long vertical laceration presented right above the bridge of his nose. He would have a noticeable scar for the rest of his life unless either I did a perfect job, or he grew his bangs long. Let's hope he now has long hair.
Unfortunately for the boy, it was my first rotation, and being on the other side of the caregiver/patient relationship was still alien to me. In fact, I truly felt like an imposter while talking to or examining patients. I had done nothing to a patient until this kid and his family walked into the office except for one nervous shot and the world's most awkward pap smear, so you can imagine my surprise when my fruity preceptor MD simply asked if I'd be "OK" and walked out the door.
Literally walked out the front door, leaving me alone with his experienced staff and this kid's family staring at me. It was the end of the day, and he apparently got the impression that my recent training in school was enough to allow me full independence when stitching. I excused myself from the room, fought the urge to run to my car, and calmly walked upstairs to gather my thoughts. The office was actually a suburban house in a little farming community along the Allegheny river, and the upstairs section contained your typical boxes and other discarded medical stuff. I sat on one of those boxes drinking warm Sprite and wondered if I should just tell the family to go to the Hospital.
Linda, an old nurse who could probably remember the influenza epidemic, had come up the stairs and was suddenly standing in front of me asking if I was alright. I had turned pale and my forehead was moist, but she told me the patient was ready. I could describe to you in detail what Linda looked like, from her short stature to her patient wrinkly eyes, but it would honestly be easier to sum her up in one word. Yoda. And to my inexperienced perception, she was equally wise if not wiser than that little guy.
The situation wasn't right, and I knew it. I had excitedly listened to students from the year above me tell their virgin stitch stories, and they were nothing like this. Theirs had surgeons or emergency room docs in them, and patients were under general anesthesia or half dead in the ER - not little nine year old boys and his entire family.
In that instant I remembered all the times I had forgotten to use the word please when addressing Linda over the past 30 days. You see, she was it. There was no back-up, no preceptor, no professor to tell me what to do - it was just me, what I had been taught, and Linda's experience. At that point I realized that the letters after your name or the type of white coat you wear means little in relation to what you are actually supposed to do, and the knowledge that you've retained - whether it be from school or from years of experience in a country Doc's office.
I must have asked her twenty questions on the way down those steps, as I was unsure of even how to set up the sterile field. Linda had done it while I was upstairs freaking out, because when I walked into the room, the little boy was lying on the exam table with both his parents next to him holding his hands, and a neat little mayo tray stand next to him with all the stuff I needed. The lidocaine syringes were even drawn up.
The family was rural - this was evident by appearance as well as accent. I walked up to the mom and dad and introduced myself as the PA who would be sewing up their child's head.
"The what?"
This was one of the first of many times I would have to explain what a PA is, and they answered with the typical, "oh - sorta like a doctor". It's usually that or "oh - sorta like a nurse". My detailed explanation of a PA fell on deaf ears - in fact, half way through my nervous soliloquy, the parents interrupted me with, "tell him", and pointed at their bored child lying on the bed. Because I was standing behind him as he lay on his back, he had to look directly up at me, over his messy forehead. He didn't give a hoot if I was a taxi driver, he wasn't going to trust me worth a damn. Towards the end of my practiced speech, I found myself explaining the legal aspects of what a PA can do in the state of Pennsylvania to only Linda, who politely smiled and nodded through the embarrassing moment.
After feeling confident Linda knew what a PA was, I turned again to the parents and fumbled through an explanation of what I was about to do to their son. I went on and on, until their looks of suspicion and attentiveness melted away to vague concern and apathy. Procrastination through discussion was clearly the order of the night since I didn't know where to start.
Thankfully, Linda stepped in.
She handed me gloves. Once those were on she handed me alcohol pads. I wiped around the laceration and tried to get some of the dried blood off his head. He just lay quietly with his eyes closed until the alcohol dripped into the laceration. Then he squinted his eyes in pain and made a quiet high pitched squeaking sound as his nerve endings came in contact with the alcohol and lit up with stinging fire. The mom, dad and Linda looked around, not knowing what the noise was, but me and the boy knew. His face was so contorted in pain that it didn't look like he was making the sound, but he was. Not until the incredibly high pitched, quiet noise broke into ripples of whimpering and crying did they know where it came from, and then it was all about damage control.
His mother kept on telling him to be brave, and his dad kept on telling him to be quiet. I figured it was time to give the lidocaine, so I put down the alcohol and picked up a syringe.
And then I started to shake.
This wasn't a jittery vibration that is noticed only when staring at the hands. This was full-on shaking. My hands were moving on their own. You could see this shaking from not just across the room, but across the street. The parents asked if I had done this before, and my voice cracked when I told them I had. I refrained from letting them know it was only on pigskin while in class. And the pig's parents weren't staring at me asking questions, either.
Imagine yourself as a nine year old, already crying in pain, lying on your back and looking up into the light to see a dripping, shaking needle slowly coming down on your forehead. The kid knew it was "go time", and stopped crying. Kid's can be surprisingly brave sometimes - typically more so than adults. His eyes squinted shut and his mouth puckered up to brace for the pain which he was about to endure, and I stuck the needle right into the smooth skin of his forehead.
I should have put the needle into the laceration, under surface of the skin. This sounds painful, but it's a trick experienced practitioners utilize to minimize the pain. I did not bypass these skin's gazillion nerve endings, and instead stuck the boy a couple times with what looked like a horse syringe right through his smooth, soft forehead at least five times.
The lidocaine began to make the skin edges swell a little bit as I was injecting, which was good. Then, to my horror, the lidocaine pooled up in the middle of the laceration and overflowed. Little rivulets of anesthesia trickled down right into his eyes. I immediately withdrew the needle and cursed. Apologizing and about to throw in the towel by telling the family to PLEASE get as far away as possible from my clumsiness, I was cut off by Linda.
She said, "yes, yes, this happens sometimes. There, there, it's alright.", and immediately absorbed the lidocaine in his shut eye sockets with a 4x4 gauze she had at the ready. Instantly the problem was solved. I asked the kid if he was alright, and he said it stings a little and he couldn't feel himself blink. I was more worried about whether or not I had blinded him for life, but he was looking at me and seemed alright for getting two eyefuls of strong anesthetic.
At that time in my training, I didn't have the knowledge to request the perfect size suture. It didn't matter anyway since Linda handed me what I was going to use. It seemed right at the time, but looking back, I probably used 3-0 nylon. I might as well have used baling twine this stuff was so thick. If I were to use 3-0 nylon on a kid's forehead at my current job, I would almost certainly be fired. But this is how things are done when the family pays their medical bills with baskets of fresh produce and not Blue Cross/Blue Shield. Anyway this is what Yoda was handing me, and it's what I used that evening on the poor kid's head.
Sympathy was in Linda's eyes as she looked at my hands taking the needle holder from her. There was absolutely nothing I could do to stop shaking. The parents must have been pretty wide-eyed as they stood there watching my hands descend upon his forehead, but they were half as wide as their son's, who couldn't believe his own parents were about to let this epileptic idiot put his skin back together. I won't ever forget his scared eyes looking into mine and then closing as I touched his skin with my needle and pushed it through.
What would now be about 3 minutes of sewing took me probably 15 that night. My shaking never got better. Halfway through I realized I kept holding my breath and was becoming dizzy. Because I wimped out with the lidocaine fiasco, he didn't get enough since the last stitch I put in made him really start crying again. I figured he will either get a stick from the syringe or the suture needle, so I just stabbed the kid's unanesthetized skin and tied the knot.
The moment I was done my hands stopped shaking. It was infuriating. I almost wanted to keep going to prove I could control myself, but I was done. I clumsily slapped a bandaid on his head and stood there. Linda offered me a seat, which I took very quickly, and the kid hopped off the bed and ran out of the room for a lollipop. He had four of the biggest, ugliest sutures I have ever seen in a person's forehead, and the parents just thanked me. His dad even started showing me all the places he had sutures put in and how he removed them himself. I realized he wasn't going to bring his kid all the way into town again just for suture removal, so I told him when to take them out of his head.
That was about 7 years ago, and I still think about that kid. Now he's at least 16, and his looks are pretty important to him. No doubt he's noticing girls are noticing him, in fact, he should have a girlfriend by now.
I really hope he doesn't have Frankenstein traintracks on his head, although I fear he might. Maybe with the Harry Potter lightning bolt thing he got some positive attention, but whatever the case, I just hope he's ok with it.
The other night, having had a little too much java juice and too little food, I found myself fighting a fine motor tremor while sewing a skin incision. I had the shakes. It's never a problem regarding patient outcome, but it can slow you down and wear you out with the concentration it takes to overcome it. Watching the tip of the needle quiver as I sought the perfect pinpoint of tissue I needed to poke made me recall the very first time I stuck a stitch into a person.
He was about 9 years old and pretty tough. He had been trying to bench press on his dad's universal machine, and the stack of rectangular weights slammed down behind his head. They must have grazed his forehead as he lay there on his back with just enough force to tear open his skin because an inch long vertical laceration presented right above the bridge of his nose. He would have a noticeable scar for the rest of his life unless either I did a perfect job, or he grew his bangs long. Let's hope he now has long hair.
Unfortunately for the boy, it was my first rotation, and being on the other side of the caregiver/patient relationship was still alien to me. In fact, I truly felt like an imposter while talking to or examining patients. I had done nothing to a patient until this kid and his family walked into the office except for one nervous shot and the world's most awkward pap smear, so you can imagine my surprise when my fruity preceptor MD simply asked if I'd be "OK" and walked out the door.
Literally walked out the front door, leaving me alone with his experienced staff and this kid's family staring at me. It was the end of the day, and he apparently got the impression that my recent training in school was enough to allow me full independence when stitching. I excused myself from the room, fought the urge to run to my car, and calmly walked upstairs to gather my thoughts. The office was actually a suburban house in a little farming community along the Allegheny river, and the upstairs section contained your typical boxes and other discarded medical stuff. I sat on one of those boxes drinking warm Sprite and wondered if I should just tell the family to go to the Hospital.
Linda, an old nurse who could probably remember the influenza epidemic, had come up the stairs and was suddenly standing in front of me asking if I was alright. I had turned pale and my forehead was moist, but she told me the patient was ready. I could describe to you in detail what Linda looked like, from her short stature to her patient wrinkly eyes, but it would honestly be easier to sum her up in one word. Yoda. And to my inexperienced perception, she was equally wise if not wiser than that little guy.
The situation wasn't right, and I knew it. I had excitedly listened to students from the year above me tell their virgin stitch stories, and they were nothing like this. Theirs had surgeons or emergency room docs in them, and patients were under general anesthesia or half dead in the ER - not little nine year old boys and his entire family.
In that instant I remembered all the times I had forgotten to use the word please when addressing Linda over the past 30 days. You see, she was it. There was no back-up, no preceptor, no professor to tell me what to do - it was just me, what I had been taught, and Linda's experience. At that point I realized that the letters after your name or the type of white coat you wear means little in relation to what you are actually supposed to do, and the knowledge that you've retained - whether it be from school or from years of experience in a country Doc's office.
I must have asked her twenty questions on the way down those steps, as I was unsure of even how to set up the sterile field. Linda had done it while I was upstairs freaking out, because when I walked into the room, the little boy was lying on the exam table with both his parents next to him holding his hands, and a neat little mayo tray stand next to him with all the stuff I needed. The lidocaine syringes were even drawn up.
The family was rural - this was evident by appearance as well as accent. I walked up to the mom and dad and introduced myself as the PA who would be sewing up their child's head.
"The what?"
This was one of the first of many times I would have to explain what a PA is, and they answered with the typical, "oh - sorta like a doctor". It's usually that or "oh - sorta like a nurse". My detailed explanation of a PA fell on deaf ears - in fact, half way through my nervous soliloquy, the parents interrupted me with, "tell him", and pointed at their bored child lying on the bed. Because I was standing behind him as he lay on his back, he had to look directly up at me, over his messy forehead. He didn't give a hoot if I was a taxi driver, he wasn't going to trust me worth a damn. Towards the end of my practiced speech, I found myself explaining the legal aspects of what a PA can do in the state of Pennsylvania to only Linda, who politely smiled and nodded through the embarrassing moment.
After feeling confident Linda knew what a PA was, I turned again to the parents and fumbled through an explanation of what I was about to do to their son. I went on and on, until their looks of suspicion and attentiveness melted away to vague concern and apathy. Procrastination through discussion was clearly the order of the night since I didn't know where to start.
Thankfully, Linda stepped in.
She handed me gloves. Once those were on she handed me alcohol pads. I wiped around the laceration and tried to get some of the dried blood off his head. He just lay quietly with his eyes closed until the alcohol dripped into the laceration. Then he squinted his eyes in pain and made a quiet high pitched squeaking sound as his nerve endings came in contact with the alcohol and lit up with stinging fire. The mom, dad and Linda looked around, not knowing what the noise was, but me and the boy knew. His face was so contorted in pain that it didn't look like he was making the sound, but he was. Not until the incredibly high pitched, quiet noise broke into ripples of whimpering and crying did they know where it came from, and then it was all about damage control.
His mother kept on telling him to be brave, and his dad kept on telling him to be quiet. I figured it was time to give the lidocaine, so I put down the alcohol and picked up a syringe.
And then I started to shake.
This wasn't a jittery vibration that is noticed only when staring at the hands. This was full-on shaking. My hands were moving on their own. You could see this shaking from not just across the room, but across the street. The parents asked if I had done this before, and my voice cracked when I told them I had. I refrained from letting them know it was only on pigskin while in class. And the pig's parents weren't staring at me asking questions, either.
Imagine yourself as a nine year old, already crying in pain, lying on your back and looking up into the light to see a dripping, shaking needle slowly coming down on your forehead. The kid knew it was "go time", and stopped crying. Kid's can be surprisingly brave sometimes - typically more so than adults. His eyes squinted shut and his mouth puckered up to brace for the pain which he was about to endure, and I stuck the needle right into the smooth skin of his forehead.
I should have put the needle into the laceration, under surface of the skin. This sounds painful, but it's a trick experienced practitioners utilize to minimize the pain. I did not bypass these skin's gazillion nerve endings, and instead stuck the boy a couple times with what looked like a horse syringe right through his smooth, soft forehead at least five times.
The lidocaine began to make the skin edges swell a little bit as I was injecting, which was good. Then, to my horror, the lidocaine pooled up in the middle of the laceration and overflowed. Little rivulets of anesthesia trickled down right into his eyes. I immediately withdrew the needle and cursed. Apologizing and about to throw in the towel by telling the family to PLEASE get as far away as possible from my clumsiness, I was cut off by Linda.
She said, "yes, yes, this happens sometimes. There, there, it's alright.", and immediately absorbed the lidocaine in his shut eye sockets with a 4x4 gauze she had at the ready. Instantly the problem was solved. I asked the kid if he was alright, and he said it stings a little and he couldn't feel himself blink. I was more worried about whether or not I had blinded him for life, but he was looking at me and seemed alright for getting two eyefuls of strong anesthetic.
At that time in my training, I didn't have the knowledge to request the perfect size suture. It didn't matter anyway since Linda handed me what I was going to use. It seemed right at the time, but looking back, I probably used 3-0 nylon. I might as well have used baling twine this stuff was so thick. If I were to use 3-0 nylon on a kid's forehead at my current job, I would almost certainly be fired. But this is how things are done when the family pays their medical bills with baskets of fresh produce and not Blue Cross/Blue Shield. Anyway this is what Yoda was handing me, and it's what I used that evening on the poor kid's head.
Sympathy was in Linda's eyes as she looked at my hands taking the needle holder from her. There was absolutely nothing I could do to stop shaking. The parents must have been pretty wide-eyed as they stood there watching my hands descend upon his forehead, but they were half as wide as their son's, who couldn't believe his own parents were about to let this epileptic idiot put his skin back together. I won't ever forget his scared eyes looking into mine and then closing as I touched his skin with my needle and pushed it through.
What would now be about 3 minutes of sewing took me probably 15 that night. My shaking never got better. Halfway through I realized I kept holding my breath and was becoming dizzy. Because I wimped out with the lidocaine fiasco, he didn't get enough since the last stitch I put in made him really start crying again. I figured he will either get a stick from the syringe or the suture needle, so I just stabbed the kid's unanesthetized skin and tied the knot.
The moment I was done my hands stopped shaking. It was infuriating. I almost wanted to keep going to prove I could control myself, but I was done. I clumsily slapped a bandaid on his head and stood there. Linda offered me a seat, which I took very quickly, and the kid hopped off the bed and ran out of the room for a lollipop. He had four of the biggest, ugliest sutures I have ever seen in a person's forehead, and the parents just thanked me. His dad even started showing me all the places he had sutures put in and how he removed them himself. I realized he wasn't going to bring his kid all the way into town again just for suture removal, so I told him when to take them out of his head.
That was about 7 years ago, and I still think about that kid. Now he's at least 16, and his looks are pretty important to him. No doubt he's noticing girls are noticing him, in fact, he should have a girlfriend by now.
I really hope he doesn't have Frankenstein traintracks on his head, although I fear he might. Maybe with the Harry Potter lightning bolt thing he got some positive attention, but whatever the case, I just hope he's ok with it.
When he eventually has a kid who needs stitches, he'll probably show the Doc or PA his scars just like his dad did to me. I like to think he's prouder of his forehead scar than I am of my handiwork putting them in. Maybe as a farmer's kid he's acquired even better scars and better stories behind them than his accident with his dad's weight machine and the following adventure with me.
Hopefully his memory of the situation has all faded away. I know mine won't.
posted by All Rounder | 2:15 AM
2 Comments:
I thought *I* was your first stitch!
first wasted off my ass stitch
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