Monday, August 30, 2010

The finer points of wound closure

When recounting the same half-baked story about how I cut myself roughly half a dozen times to various nurses and doctors and x-ray technicians, the story becomes even more so and by this time even I don't believe a word of it.  If I'm on the other side listening to a story like this I would never believe that things happened that way, even though I told it pretty convincingly.  Even when I told the story a hundred more times to co-workers and friends who noticed the giant bandage on my thumb, I could see that they were thinking "why the hell were you whittling sticks?"  I would imagine that everyone I recounted the tale to attributed my recklessness to booze, which if it were the case I would be happy to admit.  Unfortunately I just wanted to cut things and my thumb got in the way. 

The first doctor that examined the wound told me that she was about to go off duty and if she could quickly throw a few stitches in it and be done she would do so in order to expedite things.  When she pulled off the half-assed dressing the triage nurse had put on the guyser of blood was back.  The good doctor immediately realized this was not the sort of thing she would be able to handle quickly and pawned me off to the night shift doc.  She also mentioned that the doctor would have to pull back the flap the terminator had created and assess for tendon damage.  She also wanted to get an x-ray.  The prospect of finger surgery caused a chain reaction resulting in the dynamic duo of my liver and kidneys quickly filtering out any remaining alcohol out of my system.  I was sober, they had my attention. 

Luckily the wait for the next doctor was short.  This one was  a surgeon so I was assured proper wound closure by the previous doctor.   To stitch a cut like the one I inflicted on myself, the entire thumb must be numbed.  In order for this to occur, an approximately two inch needle filled with lidocaine is inserted into the base of the thumb around the entire circumference.  The needle goes in until it touches the bone.  Bone pain is the worst kind of pain.  The numbing process hurt far worse than any other part of this ordeal.  Even after the thumb is numb and the doctor begins to put humpty dumpty back together, you live the next thirty minutes in fear, thinking what if the lidocaine loses its effectiveness and suddenly I can feel everything.  It's not a rational fear per se, but it's certainly a prevalent one, particularly when the flap is gripped with a clamp and lifted from the rest of your thumb.  The doctor assures you that he can give you more lidocaine at the drop of a hat if need be, which in and of itself means more pain, but if the feeling suddenly rushed back he wouldn't be able to give me the medicine quickly enough.  I keep thinking I'll be able to finish this, but I keep running out of room.  I'll try again next time.

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