Friday, April 15, 2011

The Suturing Story

One of the skills I really wanted to learn in med school was how to suture. It’s just one of those things that I felt like you’re supposed to know if you’re a doctor. How can you be a doctor if you don’t know how to suture?

Anyway, by fourth year of med school, I had totally failed at my goal. I had already done a surgery rotation, but while I was really, really good at cutting sutures that other people had already tied, I couldn’t really tie them on my own.

Moreover, some of my classmates were really experienced. My housemate, a future ER doc, would breeze home from his EM rotation, talking about all the lacs he sewed up that night and also how he reached into some guy’s chest and massaged his heart or something. Meanwhile, I was watching pregnant women deliver babies from the far corner of the room. I don’t think I was aggressive enough.

When I got to my Emergency Med rotation during fourth year, I thought to myself, “FINALLY, I am going to learn how to suture!”

Except again, I was thwarted. I did my EM rotation at a hospital where no lacs were seen in the main ER, only in fast track. And I was only allowed to do two shifts total in fast track. And there were never any lacs. The second I’d leave, apparently five would come in all at once, but it’s like the patients knew to avoid the clueless med student who wanted to stick a needle in them.

On my last day, I got a patient who had sliced his hand with a propeller from a plane and he was totally down with letting me suture him up. I was so psyched. I would love to tell you that I did a fantastic job and was met with glowing adulation, but the truth was that it took me like twenty minutes to put in one stitch before the PA insisted on taking over, and ended up undoing the one stitch I managed to put in.

And that was kind of it for med school.

For the longest time, I was embarrassed to tell this story. I had graduated from med school without learning how to suture. That’s like… graduating from high school without learning how to read (sort of). Luckily, I got to do another EM rotation early in my intern year.

I still remember my first patient with a laceration, who was listed as the victim of domestic violence. I felt a little bad practicing on a domestic violence victim, until I saw the varsity football player whose girlfriend had sliced him up because she caught him cheating on her. I was totally fine with practicing on that guy.

Let me give you a tip: the key to doing something in medicine that you don’t really know how to do is to act totally confident and don’t say things like, “oops” or “whoops” or “uh oh” (you get the idea). The first few stitches took me an eternity to put in, but I continued to act like I wasn’t dropping every stitch, and the guy didn’t seem like he was in a rush. He was just lying there, looking unhappy about the events of the night, so I just took my time. And eventually, I finished sewing him up.

Then on my next shift, I had a patient who had the skin on his hands sliced to shreds by a band saw. It took me two hours, but by the end of that, I felt like a freaking expert at suturing. (And the patient was grateful. After I finished bandaging his fingers up, he told me that his hand looked like “a beautiful flower.”)

So that’s my suturing story. It’s kind of a disgrace that I didn’t learn the skill in med school, but at least I learned it eventually. And then likely forgot it in the subsequent five years, since I was never once asked to suture again.

10 comments:

  1. I agree about how that's a skill that "it feels like something you just need to know as a doctor", along with delivering a baby, checking blood pressure, and splinting/casting.
    I was fortunate in that I did a few shift in the ER in my first year with a guy who was adamant that, despite myself, I would learn how to suture. There are a bunch of people in that small city who are probably walking around with hideous scars because of my handiwork (and one poor woman who was probably traumatized by her experience, because I forgot to switch the "withdrawing" needle head, and tried to inject xylocaine into her face with a 16G needle)

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  2. What you said about saying "whoops" goes double for pelvic exams. Also, "It just won't go in, it's too dry," is not ok either.

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  3. I haven't sutured anything since 1993, in an ER rotation during residency. And don't care.

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  4. I had surgery a few weeks ago and I didn't even get stitches - I got "derma-bond" on the incisions, so apparently you only need to know how to use a bottle of glue now. You'll be fine ;)

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  5. Things you think make you feel like a Dr (and actually do):
    - first time listening to someone's chest with a stethoscope
    - first time suturing
    - first time intubating in theatre (under anaesthetist guidance of course)
    - first time delivering a baby
    - first time getting a diagnosis right for a clerk in

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  6. I am not a Doctor, found your blog via a Follower in Asia. I notice your post times work very well for Asia daylight and North American night light. All Doctors and Mothers-To-Be should write to activate and ground a heart based connection to the world. Mothers-To-Be (MTB) and Doctors-To-Be (DTB) have much in common besides witnessing birth as a detached out-of-body-experience (OBE) from the opposite end of the room. The To Be or Not To Be thread hangs on the delicate dangle of humor. Having lived in many war zones, witness of the human body in various stages of disarray, I would venture to diagnose and prescribe Amusement as a force of Muse - humor is a force of nature that allows a human to adventure into the sublime jungles of abnormal normal uncommon common behavior - and farer still into the realms of non-duality nonlinear revelation. Keep writing and drawing to ensure that you authentically cultivate and develop all aspects of your Being - leaving no doubt that you are a force of To-Be on this planet ... congrats on graduating from the realm governed by the forces of Not-To-Be.

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  7. I don't agree with Mr Mobius.

    The thing that makes you feel like a doctor is when the patient smiles at you and says 'thank you doctor'.

    True about the 'Oops' thing.

    I learned to suture in med school, and had a wide range of lacerations to suture, randing from large leg wounds to fingers to vaginas. Yet, I managed to go through an entire 10-week ER elective, hunting for stuff to suture because I like it, and I only had one headwound to do.

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  8. I love your blog. Your comment about not saying "oops" applies to lots of situations in lots of professions, I think. Projecting confidence inspires confidence. I say this after just getting off the phone and babbling in what I thought was an amusing way with a patron who had a question and I wished I had given just the facts, dull as those were. whoops!

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  9. I completed an Internal medicine residency with the barest requisite of "required" procedures (central and arterial lines, paracenteses, joint aspirations) and my residency directors made me feel so bad about it, like it was my fault, and that I would be a terrible attending as a result. Now, as an internal medicine attending at a large teaching hospital, my only procedures are cryofreezing warts, and occasionally lancing something. My main actions as an attending are to listen, and to think. Gee, come to think of it, I'm not sure residency helped much with those skills....

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  10. Hahaha!! That's so funny. I've wanted to learn how to suture since Day 1 of med school, I actually signed up for a surgery elective (even though I have no real interest in surgery) because the description promised we'd learn how to suture. Of course, suture-day ended up being the only class of the semester that was cancelled, so basically I spent 3hrs/week for an entire semester listening to different guest surgeons recite the same schpeel about "how to get into a surgery residency."

    But Family Med sponsored a suture workshop a few weeks ago, and I got to learn interrupted stitch and running stitch on a pig's foot! :-D An event which, I'm sad to admit, totally made my month.

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