Wednesday, May 14, 2008


It seems that most medical disasters happen after the sun goes down.

A corollary of this rule is that if I happen to make any plans when I'm on call, they will get ruined. But if I don't make any plans and decide to just sit at home and wait for my pager to go off, the ER will never call me.

Go figure.

One night I got called in to see a man that fell and sliced his wrist open on some scrap metal. It was a bloody mess, but his artery and nerves were undamaged, so there was nothing to do but clean out the wound and sew him up. A part of me wanted to know what he was doing climbing over a pile of junk at 10pm. Another part of me just wanted to get my job done and get back home.

I often make small talk as I work, especially if its something as dull as stitching up an incision. I use it to both entertain myself and get to know the patient more socially as well as to put the patient's mind someplace else other than the fact that I'm sewing him up like a ripped pair of jeans. But I was tired from a long day, so I quietly stitched up his wrist while I contemplated asking about the circumstances of him being in a junk yard that late.

Besides, the patient was on his cell phone talking to his wife, so I didn't bother.

After I finished, I cleaned up his arm and wrapped it with a clean bandage. The patient had finished talking to his wife and sat there quietly watching me clean up.

Patient: Doc, how many stitches did I get?

I know most people not in the medical field commonly associate the number of stitches placed in a wound as a guide to its severity. But it really has no bearing. It's like me judging a restaurant by the number of bites it took me to eat an omelet. Or the quality of a gift by the number of pieces of tape I used to wrap it.

And just as you don't pay attention to the number of sips it took you to finish that can of soda, neither do I pay attention to the number of stitches I place to close a wound.

I tried explaining this concept to a patient once, but they just stared at me as if I told them I routinely drive blindfolded. I could literally hear my credibility dropping. To me, placing stitches is as mentally challenging as putting on your socks. I think most people expect me to put a lot more thought into it, thus the shocked faces when I tell them I wasn't really paying attention.

So I've learned to just tell them a number, and that seems to satisfy most people. For most small incisions, it's not hard to remember. But for those longer incisions, like the 6-inch gash on this patient, I lose track.

On average I find that an inch long incision requires about 3 to 4 stitches to close, so I use that to roughly guess.

Me: About 20 stitches.

Patient: [Eyeing me] About 20? Or exactly 20?

Me: [Losing credibility] Uh... exactly 20.

This guy is going to remove his bandages in 48 hours, count the number of stitches, and then think of me as a quack that can't count, or didn't really know what he was doing. Well, guess I won't be getting a Christmas card from this guy...