One last ER post
I've been meaning to post this for a while, but my Internet access has been sporadic at best until I got the computer set up in lab. And since I lack the necessary training/clearance to be able to do anything useful yet, here is my long-overdue last post about the ER.
When I got to the ER at 08:00 on the last Sunday of my internship, there was a subintern (= 4th-year med student) from ortho stitching up a young woman who had cut her arm deep enough to cut a tendon (that's why ortho was called down to deal with it), and he was very nice about letting me watch and explaining things to me. As he and his supervising resident were finishing up, another patient was brought into the other half of the trauma room, so I went over there to watch after the ortho case left.
This second case was a guy that had some serious facial lacerations from a broken beer bottle. And when I say serious, I mean that the whole right side of his face was cut up, and it looked like there were huge chunks of his face missing. The ER doctors had called up whoever was in charge of dealing with facial lacerations that week, which happened to be the otorhinolaryngology (called ENT for short, which stands for ear-nose-throat) people. There was a senior resident (who had been about to go off shift when they got paged) and a junior resident (who had just come on shift and was thanking his lucky stars that the senior was still around to help him get started), and they noticed me watching in the corner, after a few minutes. After the usual explanation (I'm an undergrad, working as a research associate, do you mind if I watch, no of course not, etc.), the senior asked if I would mind helping them by putting on some sterile gloves and cutting the thread for them as they finished each suture -- sure, no problem. Easy enough.
What I wasn't expecting was the conversation that followed a few minutes later.
Resident: Have you ever sutured before?
Me: Ha, no.
Resident: Well, have you ever done any sewing?
Me: Yes...?
Resident: OK, we'll have you throw some sutures later.
Me: I... what??
The deal with this case was that because the cuts were so deep, they had to stitch the deeper muscle layers using dissolvable sutures before stitching the skin together, so that all the layers would heal properly. Otherwise the muscles may not knit together as they heal, leaving behind gaps once the swelling goes down -- this would result in dents in the face, which are undesirable for obviously aesthetic reasons. Plus, it's so much easier to piece the skin layer together once the deep sutures are in. At some point the junior resident got paged to consult for another ER patient, so the senior resident explained to me how to throw a suture, and the difference between deep and superficial sutures. I'd spent all summer watching residents suture, so I had a pretty good grasp of how to hold the instruments, how to tie the knots, etc., but this was the most detailed explanation anyone had given me. He had me do a few deep sutures, followed by some superficial ones, and told me that I was very good.
After the junior resident came back, the senior resident talked to him to make sure he knew what he was doing, then left, since he'd been on shift for over 28 hours by that point. The junior resident had me do some running sutures on some smaller (but tricky, because they were weirdly shaped) cuts on the cheek while he worked closer to the eye. He checked on me from time to time, and said that I was very neat- and steady-handed, and that I have a future as a surgeon. Ha I wish.
Now, in defense of these doctors and the CUMC and teaching hospitals in general, suturing is the easiest part of this job; it's also the most tedious and time-consuming. All the hard work -- making sure there was nothing else seriously wrong with the patient, interpreting the CT scan to make sure there weren't any broken bones, figuring out how all the cuts fit together, checking for pieces of glass in the cuts, etc. -- were done by the residents. All they had me do was the last step, which only requires some manual dexterity, and they made sure I knew what I was doing before leaving me semi-unsupervised.
So anyway, that took several hours, and it was very very exciting for me. My first sutures! I may or may not have jumped around the attendings' office for a few minutes when I went to grab a quick bite of lunch before returning to watch the ophtho residents examine this patient's vision and then stitching up the cuts closer to the eye.
When I got to the ER at 08:00 on the last Sunday of my internship, there was a subintern (= 4th-year med student) from ortho stitching up a young woman who had cut her arm deep enough to cut a tendon (that's why ortho was called down to deal with it), and he was very nice about letting me watch and explaining things to me. As he and his supervising resident were finishing up, another patient was brought into the other half of the trauma room, so I went over there to watch after the ortho case left.
This second case was a guy that had some serious facial lacerations from a broken beer bottle. And when I say serious, I mean that the whole right side of his face was cut up, and it looked like there were huge chunks of his face missing. The ER doctors had called up whoever was in charge of dealing with facial lacerations that week, which happened to be the otorhinolaryngology (called ENT for short, which stands for ear-nose-throat) people. There was a senior resident (who had been about to go off shift when they got paged) and a junior resident (who had just come on shift and was thanking his lucky stars that the senior was still around to help him get started), and they noticed me watching in the corner, after a few minutes. After the usual explanation (I'm an undergrad, working as a research associate, do you mind if I watch, no of course not, etc.), the senior asked if I would mind helping them by putting on some sterile gloves and cutting the thread for them as they finished each suture -- sure, no problem. Easy enough.
What I wasn't expecting was the conversation that followed a few minutes later.
Resident: Have you ever sutured before?
Me: Ha, no.
Resident: Well, have you ever done any sewing?
Me: Yes...?
Resident: OK, we'll have you throw some sutures later.
Me: I... what??
The deal with this case was that because the cuts were so deep, they had to stitch the deeper muscle layers using dissolvable sutures before stitching the skin together, so that all the layers would heal properly. Otherwise the muscles may not knit together as they heal, leaving behind gaps once the swelling goes down -- this would result in dents in the face, which are undesirable for obviously aesthetic reasons. Plus, it's so much easier to piece the skin layer together once the deep sutures are in. At some point the junior resident got paged to consult for another ER patient, so the senior resident explained to me how to throw a suture, and the difference between deep and superficial sutures. I'd spent all summer watching residents suture, so I had a pretty good grasp of how to hold the instruments, how to tie the knots, etc., but this was the most detailed explanation anyone had given me. He had me do a few deep sutures, followed by some superficial ones, and told me that I was very good.
After the junior resident came back, the senior resident talked to him to make sure he knew what he was doing, then left, since he'd been on shift for over 28 hours by that point. The junior resident had me do some running sutures on some smaller (but tricky, because they were weirdly shaped) cuts on the cheek while he worked closer to the eye. He checked on me from time to time, and said that I was very neat- and steady-handed, and that I have a future as a surgeon. Ha I wish.
Now, in defense of these doctors and the CUMC and teaching hospitals in general, suturing is the easiest part of this job; it's also the most tedious and time-consuming. All the hard work -- making sure there was nothing else seriously wrong with the patient, interpreting the CT scan to make sure there weren't any broken bones, figuring out how all the cuts fit together, checking for pieces of glass in the cuts, etc. -- were done by the residents. All they had me do was the last step, which only requires some manual dexterity, and they made sure I knew what I was doing before leaving me semi-unsupervised.
So anyway, that took several hours, and it was very very exciting for me. My first sutures! I may or may not have jumped around the attendings' office for a few minutes when I went to grab a quick bite of lunch before returning to watch the ophtho residents examine this patient's vision and then stitching up the cuts closer to the eye.