Sunday, November 9, 2008

The suture room

As a first year medical student my favorite Friday night activity was volunteering in the emergency room. A county hospital in a city of three million is busy anytime but on Friday night the "suture room" easily accommodated three or four medical students learning to repair lacerations. We were encouraged to sign up for a four hour shift immediately upon beginning medical school.

After sitting all day five days a week in a classroom listening to lectures, taking notes, and fighting back the fear that I would never know enough, the excitement of the emergency room along with the activity was therapeutic. A shift in the suture room made me remember why I had come to medical school.

That first night in the ER I change into the required clothing. The outfit, matching short sleeved, V necked top and baggy draw string pants looked like pajamas. Scrub suits as they are called were color coded to decrease bacterial contamination of the operating rooms. Green scrubs only could be worn in the OR but they were not to be worn any where else in the hospital. In the remaining parts of the hospital such as the emergency room everyone was suppose to be in white. There was a specific changing room for the students and residents. I quickly found a locker and changed into the suit.

Next I reported to the second year surgery resident who was in charge of the suture room. Patients came into the suture room from all over the ER. Anyone who had a laceration that did not need to be admitted to the hospital ended up there for repair. From the motorcyclist who was is shorts and a T shirt when he laid his bike down on the freeway to the two women who got into an argument at a restaurant and went after each other with steak knives, all of my patients had at least one cut and a story to go with it.

On that first evening I remember watching the surgery intern carefully clean a wound with betadine scrub before anesthetizing it with local anesthetic. He was very careful to explain to me the dosages that I could use and how not to inject directly into a vein. Next the cut must be probed for foreign bodies such as stones or glass. Then the wound could be sutured closed. This particular wound required three separate layers as the gash was deep, exposing muscle and even bone, when a drunken man fell out of the back of his friends pickup truck. Sobering up a bit the guy was very grateful for the care this young doctor provided. The laceration looked great as the final layer of sutures, all tiny blue nylon, went in to the skin pulling it together in a neat row. After applying a bandage and giving verbal and written instructions for care to the patient and his friend, the intern looked at me and said, "Next one's yours."

"What! I have only watched one repair." came my astonished reply.

"See one, do one, teach one! That is the motto here," came my young mentor's enthusiastic reply. About that time a teenager with bloody towel wrapped around his arm and filthy from head to toe walked into the room. "Here you go."

I was speechless. Not wanting to scare this poor kid by showing my inexperience I guided him to a table and stretched the arm out to take a look. Under the towel was a jagged wound, oozing blood with small pieces of rock embedded in the skin. "What happened?" I ask pulling on sterile gloves.

"I laid my dirt bike down as I turned off the highway," replied the young man dressed in a sleeveless t-shirt and cut off blue jeans. We were probably about the same age so I did not offer the advice that he should have been wearing more clothing. From experiences of my own I was sure that would come from a parent.

After getting the young man positioned comfortably on the exam table, I began to systematically clean the wound as I had been previously instructed. My mentor watch me carefully but allowed me to fill the syringe with lidocaine and injected carefully as I had been instructed. I had pulled the appropriate sutures on my own also under his careful watchful eye.

By the time I was finishing the final layer a man who looked like an older version of my patient showed up. "There you are!" he exclaimed, viewing the now also repaired laceration. He seemed glad to see his son but I also got the impression that this kind of reunion had occurred before. "What happened this time?"

After a brief explanation by my patient and following the admonishment that I withheld, the young man's father said, "Nice work doc. Thank you for taking such good care of my son."

Today, just as then, those words "Thank you," make me glad to have chosen this profession.
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