Tuesday, July 23, 2013

Dr. Orthochick: Suturing

During my intern year, I got a consult on a woman who had flipped over the handlebars on her bike without wearing a helmet. Considering what could have happened, she actually looked pretty good. The patient had a laceration right near her eye. It was bleeding a not insignificant amount, so my attending Dr. Goy told me to suture it up but if I couldn't do it, to call ophtho.

I'm not a particularly confident suture-er in the best of times. By "best of times" I mean, clean incision on the leg of about an inch in a guy who's covered in prison tattoos and doesn't really care what his skin looks like. Not "5mm bleeding laceration right near the lower eyelid of a young woman." Plus eyes make me squeamish. Just the though of ocular trauma makes me squirm. Like that time back when I was volunteering in the ER and there was that patient who had a screwdriver stuck in his eye. If nothing else, he did remember that when you get something stuck in your body, you're not supposed to try and pull it out on your own.

I got everything set up and numbed up the woman's eye, which involved sticking a needle right near her eyeball. i would say this was probably as terrifying for me as it was for her, since I was one muscle twitch away from stabbing her right in the cornea. And when you haven't eaten or drank anything all day and you've never actually sutured anything near an eye before, you tend to get a tad shaky. So I stuck the needle in as best as I could, she attempted to turn her head because I'm pretty sure that's the natural response to pointy objects coming at your eye, and I wound up injecting her about a centimeter distal from where I wanted to. Which meant I had to try again. And again.

Me: OK, so let's talk about something else so you don't think about this needle. Do you like clouds? Or ducklings? How about baby seals? Or wait--baby penguins!

Woman: I--

Me: Did you see "March of the Penguins?"

Woman: No, I didn't--

And at that point I stabbed her in the right place. Because baby penguins are so adorable that just thinking about them can make you forget that you've got a needle headed straight for your eyeball.

Once I thought I had gotten enough of her face numbed, I attempted to suture her. But I really didn't want to suture her eye closed, and the laceration was pretty close to the lower eyelid. As in, close to the point where I think my first pass through the skin would have sutured her lids closed if I hadn't pulled it out. But the stupid cut kept on bleeding, so I didn't have a great view, plus she had blood on her eyelashes so every time she blinked, blood got into different parts of her lower eye. Also, when she had her eye shut I really couldn't see anything, but with her eye open, any time I lunged at her with the suture needle, she closed her eye. As one does when one is being approached by a needle wielded by a shaky intern.

I made another stitch and tied it before I realized I had only gone through the skin on one side. So I cut it out.

And around that time, I decided it would be a good idea to call an ophthalmologist.

(The ophthalmologist on call was really nice. He came to the ER to see her, decided that we shouldn't suture her because there would be too much tension in the area, and did a full eye exam on her to make sure her eye was OK. Then he called me to tell me the results. Then he called me about 30 minutes later to say he had forgotten to write for her to get erythromycin ointment to the eye and could i please do it? Seeing as how I had dragged him out there on a crap consult, I graciously agreed. Also, he said "bye bye" both times when he was getting off the phone with me, which was kind of cute.)

I don't think Dr. Goy was all that surprised when I told him that I had called the friendly local eye doctor to come in to examine the patient.

6 comments:

  1. Hehe cute story. :)

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  2. wow, the way that you wrote that I was on the edge of my seat anticipating what would happen. The eye area does sound very difficult. I kept imagining what you were doing. I kept blinking a lot. haha

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  3. too bad it was not a guy you were working on, he would have just focused on your boobs

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    1. someone's obsessed with Dr. Orthochick's boobs...

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  4. Love this story and the way you tell it! I can't believe your attending suggested an intern suture a periorbital laceration. Definitely a job for Ophtho or Plastics (if it's my face, anyway).

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