So, TINS©, TIWFDASL© at Rural Community Hospital ED one fine summer afternoon, nothing exciting (for me, at least: the folks who were here for sutures, or chest pain, likely thought that their dilemmas were entirely more exciting than they would otherwise desire!).
So, this fellow trotted in, carrying a crying child. He announced that the child had cut his head. Our nurse aid escorted the gentleman to one of the carts, and started to look into the problem. I tagged along.
Quick witted, she promptly determined that stapling this child’s head would likely result in a net minima of drama and caterwauling, so she plucked up a surgical stapler, and some betadine, and began to clean up the lac.
The physician arrived, and she briefed him on her findings. Me? I occupied myself trying to get vitals, allergies/meds/medical history on the child from the (clueless) dad. Doc began to perform his own assessment, as the mother arrived.
This elicited another chorus of wailing, tears, and general drama. Predominantly from the child, although the mother contributed her own share. The physician informed the parents that he was planning to staple the wound, once my friend the nurse aid had completed her task of cleaning things up.
“Is that going to hurt him?” was the mother’s question.
My bad, I answered her truthfully. “Yeah, but it will only be 4 pokes. If we stitch it, there will be 8 or more pokes to numb it, and then another 8 or so pokes to sew it up.”
Likely, it was lost when I used the word “numb”. I suspect that she stopped listening at the word “numb”, and failed to do the math. “Oh, I don’t want him to hurt! Can’t you numb him?”
The aid tried her hand. “Well, yeah, but that will require 8 needle sticks, whereas if the doctor simply staples it, there will only be 4 pokes”.
Mom had One Thing on her mind. “I don’t want him to hurt!”
The physician tried. “Ma’am, nobody wants him to hurt. In fact, if I simply staple the cut closed, he will avoid something like 12 additional punctures, and the discomfort associated with those 12 punctures.”
“Please, numb him up! I don’;t want him to hurt!”
Resigning ourselves to our fate, I collected the lidocaine, syringe and needle, and my friend the aid swaddled the child in a blanket.
The kid promptly figured out where this was going, and he wanted NO PART of this ride. So, I set up the doctor’s suture set and lido, and joined the rodeo.
The kid screamed, and he flipped, and he flopped, and he writhed, and he twisted, and he turned. He shook his head, so I was detailed to seize his head, and immobilize it. Mom, to her credit, laid across her child’s legs, and dad laid across his torso, so the doctor only had to zig and zag over roughly 30 degrees of motion as he was injecting the local anesthetic into the margins of the wound.
Did you know that lidocaine, injected into your skin, burns? Yep, burns like a sonuvabitch, for a minute or two. Now, may I watch YOU explain to an 8 year old, that the burning will go away soon, and then things will be numb? Because, he was not listening to me at all, which, of course, assumes that any earthly creature could distinguish my speech over his screams, and cries, and shrieks, and general high volume protestations. Because, I could not.
So, once the doctor had established that the process was going to be pain free (because, of course, the anesthesia had been SO! MUCH! FUN!), the child was going to lay very still for the suturing?
Totally! And, the Democrat candidates for President are not vying to convince the electorate that they, only they, will be the BEST! At providing free stuff to non citizens, as well as college graduates who find themselves in the food industry.
Of course, no. Just, NO! More rodeo nursing, more Brahma Bull On the Suture Table.
Finally, at long last, we were done. The aid unwrapped the (limp)(sweaty)(hoarse voiced) child from the blanket, and we all stepped away, so Mom could hug the child.
She looked at us all, and said, “That was awful! Ohmigawd! I should have listened to you guys!”
I bit my tongue, and shuffled off to the nursing station, to complete my charting. The aid sat down next to me, and said, “Hey! I did my best!”
“That you did.” I replied. Then, taking on a stereotypical hillbilly voice, I continued. “Hyuck, hyuck! Ah’ve bin doin’ this here ‘mergency nursin’ thang for might’ near six, mebe seven weeks now! Speck’ ah got all figgerred out!”
3 thoughts on ““Speck’ ah got it figgerred out!””
I’m a layman and have no medical training at all. Not even first aid. Question Mr. McFee, If there’s already an open wound, why not dribble the lidocaine into the open wound before suturing or stapling? In the several instances that I can remember requiring me to be stitched, I got poked as you describe, right along the margins of the wound which numbed up a much larger margin around the wound. It would seem to me that capillaries exposed by the wound would conduct the lidocaine dribbled into the wound to the nerves in the surrounding tissue. Or am I missing that blood pressure will keep blood flowing into the wound and defeat any migration of lidocaine beyond the wound margin?
Reasonable question. The pain of suturing is not so much at the wound margins, as at the tissue next to the wound (in a non layered closure). THAT is the tissue you Pierce, and draw the suture through, so as to draw, and hold, the margins together.
That tissue will not be numbed by topical application of an anesthetic agent. At least, not circa 20 years ago, when this took place.