Com’n Doc you can do it.

03/29/2009 at 6:32 AM 1 comment

It was a Saturday Morning when he showed up with a mashed up finger tip. It was still oozing blood and I was having a hard time stopping it.

He had put his finger in a snowblower before it had stopped. Why one would do such a thing remained undiscussed. But as much as I enjoy hands on medicine and a challenge and as aggressive as I tend to be, this wound was worrying me. It was the weekend, I would not be able to follow it the next day and the darned thing would not stop bleeding.

So I mentioned to the patient, “George, I think you should go to the ER, I can’t get this to stop bleeding.

“Com’n Doc you can do it. I am sure you can. Just sew it up or something. I don’t have the time to go to the ER. They will make me wait forever.”

He was right of course, they would make him wait. We went through this  process a few more times, me hedging, he reasuring me.

I finally decided that with that much positive Karma, who was I to resist.

I thought about my surgical rotations and tried to imagine what some of the surgeons might do. And it came to me  that a purse string suture might just do the trick. Now I had seen  a few done, but had never done one before and it had only been done inside a patient’s belly during major surgery, but I understood the principle and it should work. And by the way the guy’s finger tip was gone anyway so why not?

I remember visualizing the technique while trying to project utter calm and confidence. At the end you pull up on both ends of the suture and if done right, it pulls the tissue together and pinches off the severed end of the tiny arteries.

Voila! the bleeding stopped, my heart slowed down, the patient was happy.

I met him at a party a month or two later and you could not tell which finger had been damaged. Sometimes Good Karma, Good Luck, confidence and the right patient is all you need.

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Entry filed under: true story. Tags: , , .

The never reachable moving bar. elephant in the exam room.

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