The First Cut Is The Deepest

It’s my first time suturing.

My entire clinical group is huddled around my patient’s bed, eyes wide in anticipation–none of us have ever sutured before.

My calm facade is dissolving. The first point of any practical exam is to make organization overt. I am fumbling on this most basic of principles.

I almost contaminate my sterile field. I forget that I need a sharp componant to the apparatus into which I insert my vial of lignocane. I have to change sterile gloves because I adjusted the overhead light myself.

Everyone is throwing instructions at me at once, pointing out things I’ve forgotten, pointing out things that I am just about to do. Too many cooks, I think more than once.

Eventually I take a deep breath, close my eyes and say a prayer. Then I open my eyes, think for a minute, and ask everyone to leave.

Shocked eyes meet mine. But my face must look as crazed as I feel because they leave without much more than a murmur. And a, “Seriously?”

“No, wait. Can you stay please?” I ask a fellow third year who is not in my group but has the look of experience and patience.

He nods.

“Take a minute,” he says as the others leave. “You can do this, just give yourself a chance.”

You’re suturing a person’s face, I remind myself. Get it together.

After another deep breath and silent prayer, I begin.

The patient is drunk so he won’t sit still, and I don’t know his status so I’m not trying to poke myself with these sharps. I soothe him in his mother tongue and when that doesn’t work I take on the tone the nurses use and start scolding him. He calms down.

Enter and inject as you withdraw, I tell myself. My last-minute mentor is silent but attentive. He tells me his formula for where to inject but tells me there are no hard and fast rules. I remember that I once heard someone say to ensure that wherever you might suture will be covered. No one will hate you for over-anaesthetising.

After a good amount of time has passed for the patient to become numb, I explain what I plan to do. My mentor edits for me, explaining that the more specific I am, the better for my own procedural recall. I nod.

I’ve forgotten the names of my instruments, but I know exactly which ones I need. Time to penetrate skin.

Suturing is nothing like sowing. And nothing like what they teach us in Skill’s Lab. The skin is tougher than the sponges they make us practice on. I’ve known this since we started doing cannulations and stuff, but I’m suddenly so much more aware of it. Maybe facial skin is tougher?

When it’s time to knot up, my mentor is giving patient words of advice and instruction, he corrects my technique and then let’s me be. By the end of that first suture, he is telling me my suture looks better than his do. He’s just being nice, but the thought calms me nonetheless.

Then he shocks me. He leaves.

“Where are you going?” I say, trying to mask the panic in my voice for the sake of my inebriated patient.

“You need to do the rest alone. You’ll be fine, trust me.”

Strangely, I do trust him. And after some initial fumbling I realize that he was right. I’m fine. My patient’s fine. We’ll both survive this.

I even manage some banter with the drunken, bleeding man while I move on to his next laceration.

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4 Comments

Filed under Surgery, Trauma

4 responses to “The First Cut Is The Deepest

  1. Ah, this is a lovely description! I am terrible at suturing and need a LOT more practice. In fourth year Derms they give us (fresh) pig skin to practise on. It is way more helpful than sponges.

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