Today I did my first laceration sutures!
I wondered for a long time just how anyone ever gets to put sutures in without prior experience. Medical school is famous for its education model of see one, do one, teach one – which medical students joke about being see one, screw one, do one. Though I’ve heard of it being done, it’s unethical to perform a procedure for the first time without securing the patient’s permission. And who’s going to let you use them as a guinea pig with their very own skin? So how does THAT work?
Well, the answer is that people trust doctors. I was observing Dr. S., my preceptor, while he examined a patient’s leg laceration from a shard of broken glass My clinic is Urgent Care – like a mini, subacute Emergency Room, so we see this kind of thing on a regular basis. Dr. S. put the first suture in at the midpoint of the 1.5″ wound, then paused.
“Would it be okay with you if Paul put the next few stitches in?” he asked the patient. “That’s how we learn, you know.”
Ugh. I wasn’t expecting that, and I suddenly wanted a little demerol for myself.
But when the patient said “Fine. He’s gotta learn somehow, I guess.” it was no time for me to crumble. So I grabbed a pair of size 8 gloves, put them on using sterile technique (something that used to seem tough :), and sat down in front of the draped leg. I know how to do this, I told myself. So I picked up the needle and needle driver, took a deep breath, and pushed the little C-shaped needle into the patient’s skin. I placed it just right, turning my wrist instead of forcing it.
That’s when I went blank.
This is a common story told by my classmates when talking about their preceptorships. By your second year, you know plenty of things in a book and exam way, but when faced with them in the clinic for the first time, you stammer and hesitate, looking like a fool.
But after a few seconds of befuddlement, I remembered how to tie suture knots, and I got to work. I only put in two stitches (you start out small, right?), but it was great fun. When I finished up, I had to wipe the beads of sweat from my forehead. My patient seemed to get a kick out of seeing me do it, and I gave him a big thank you as he walked out.
One more thing to cross off my bucket list!