Tuesday, October 27, 2009

in stitches


somehow, i must have known that there would be a gaping wound for me to sew up on my shift last night! as you might have seen on my to-do list, i actually spent a little time reviewing suture technique yesterday -- including the setup, debridement, the ins and outs of which sutures to use, how long to leave each kind in, and the like.

in my pediatrics residency, we don't get to suture all that often, so it's not a procedure i feel fabulously confident about. but very second patient i saw had torn his chin open in a football game*, and the linear cut was just begging me to sew it back together.

and so i did. with a med student looking over my shoulder, asking me things.

med student: so why are you choosing simple interrupted closure?

me: [internal monologue: duh, because it's the only kind i really know how to do.] um, because it will approximate the edges of this linear wound well and be sturdy enough to stay in for the time needed.

heh. i know a lot about other aspects of pediatrics, but i am not the one you want to learn about suturing from. but oh well. i hope she wasn't too horrified by my technique.

actually, i kind of liked the student's attention: it gave me an excuse to do everything slowly and deliberately and talk through the procedure as i completed it! plus, i think it distracted my patient, in a good way. although the kid was uber-stoic (hooray for 12 year old macho-wannabe middle school football players!) and i think he was thrilled about getting stitches put on is face -- yes, for real. a battle scar, perhaps? maybe kind of like how in elementary school i was always jealous when someone broke their leg and got a cast and crutches.

my god, kids are weird. anyway, i wish i could post a picture of my handiwork, but

a) it might gross some people out, and
b) it might violate HIPAA (although i am sure this kid wouldn't have cared.)

just picture 8 or 9 pretty knots made up of 6-0 proline, holding together someone's chin. yay!

* this was one of 5 or 6 football related injuries that made it to the peds ED last night. it is official: no child of mine is ever playing that sport. sorry BUT NO.

the ER lifestyle
the hours we have during this rotation can be wacky, but on the whole are not bad. claire wrote yesterday that at her residency, all shifts are 12 hours. yuck! our ED rotation actually used to be worse than it is, but they added an extra month of it into our third year and in exchange made it kinder and gentler. i actually find it to be one of the most high-yield learning experiences, and i'm always happier with a better schedule, so i really liked this trade-off.

we have 12 hour shifts on the weekends, but the weekdays are all 8s. of course, there are also some painful days -- like today -- when we have clinic first, THEN a shift, making for a 13 hour day. still, though: it could be MUCH worse.

the hardest part is trying to keep to some sort of functional schedule to meet one's bodily needs, namely eating + sleeping (fine, and blogging too). in the past, i've never really gotten that far away from my 'normal' schedule, other than during the week of 11 pm - 7 am shifts. meaning: i still want breakfast-type foods in the AM, dinner-type foods in the PM, and i have a hard time sleeping in.

one caveat is that it's really hard to eat while you're actually on a shift -- things really move quickly, and you can't just stop amidst all of the action and eat a meal. i work around this by trying to eat as many of my meals as possible before and after shifts (after all, they're usually only 8 hours), and by bringing lots of snacks.

yesterday, with the whole day free, i decided to make dinner for me to enjoy early (and for josh to have later). this worked quite well! martha's beef and orange stir fry gave me are energy to burn on my shift, and i was able to make it through the rest of the night with some trail mix (and chocolate).

orange and beef stir fry, brown rice, and sautéed broccoli + baby bok choy

more naturally more
a little over a month ago, i wrote about the wonders of naturally more peanut butter. at my request, the company had been nice enough to send a sample of both the peanut and almond butter varieties, but it took me a while to break into that second jar.

this morning i took the plunge:

spread on a waffle with cinnamon-dusted apple. side note: i am proud of this shot! check out the blurry pumpkin in the background: artistic, no?

the almond variety was quite difficult to stir up, but once i did i was in for a treat. this stuff has the sweetness of barney butter, but with a much more pure and natural flavor. i liked it even more than the peanut variety (and that is saying something, since i'm typically a peanut fiend!). it had a slight grittiness to it, but not in a bad way, and melted beautifully into the waffles i spread it onto.

nutritional info:

and more importantly, the ingredients:

quite natural.

i will definitely be buying some of this when this jar runs out! thanks again, naturally more!



workout: 40 minutes stationary cycling (14 "miles"), weights
- 2 x 12 pushups
- 2 x 12 walking double lunges, 8 lbs each hand
- 2 x 12 bicep curls, 12 lbs each hand
- 2 x 11 tricep pushdowns, 15 lbs
- 2 x 10 lateral/forward raises, 6 lb weights
- 2 x 15 crunches
- 2 x 15 oblique crunches each side

doin' time: beef and orange stir-fry + sautéed brocolli and bok choy, as shown above.

reading: review on suture technique!


Susan said...Best Blogger Tips[Reply to comment]Best Blogger Templates

I *always* wanted to break my arm or something in elementary school...how fun that would have been! The closest I got was a broken finger that I needed to wear a splint for like two weeks. Not nearly as cool, and trust me, the story isn't any good either.

I'm thinking about reverting to some healthy but ridiculously quick snacks for "dinner" since I can never find time to do anything more than stuff my dinner down my throat at work. That's healthy, right?

inmytummy said...Best Blogger Tips[Reply to comment]Best Blogger Templates

That Naturally More Almond Butter rocks! The company sent me a jar too after I told them that I could only find the PB (which is also good, but I prefer the AB).

marathonmaiden said...Best Blogger Tips[Reply to comment]Best Blogger Templates

i had to do an er shift for one of my classes this semester and it seems like they are loooooooooong. you are lucky that it's (usually) 8 hour days for you! i definitely would think that it's hard to follow your body's schedule though. and i want to be a doctor?! haha

Chelsea said...Best Blogger Tips[Reply to comment]Best Blogger Templates

I can't even imagine giving someone stitches. My dad loves to tell the story of how I got stitches on the bridge of my nose, right between my eyes when I was 3. They didn't numb the area beforehand (I don't know if this is normal- maybe stitches don't hurt that much), but my dad was so proud that I was brave and didn't cry.

Claire said...Best Blogger Tips[Reply to comment]Best Blogger Templates

Wow...so glad you reviewed that! I haven't sutured since my surgery rotation, which was the FIRST one of my M3 year! Yikes! I think I should check it out before January. :-)

Anonymous said...Best Blogger Tips[Reply to comment]Best Blogger Templates

There are a slew of other reasons, one should never let a child play football. On a recent 60 minutes, they showed the irreversilble consequences of some of the head injuries that too many football players incur.

You get my vote for no football- but then you already knew that- Mom

Jess said...Best Blogger Tips[Reply to comment]Best Blogger Templates

I found Naturally More the other day and bought it on your recommendation. Haven't tried it yet, but super excited.

Just catching up on your blog, but nice long run and I love the running story.

atilla said...Best Blogger Tips[Reply to comment]Best Blogger Templates

speaking as an expert it sounds like you did a great job

Lu said...Best Blogger Tips[Reply to comment]Best Blogger Templates

I always wanted to do something to myself as a kid. I think it's like a rite of passage. I'm sure your sutures turned out wonderful. Dinner looked great.

Post a Comment