January 19th, 2004

Spay or Neuter

How not to place a suture.

It's early in the morning, O Best Beloved. It's early in the morning and I'm sitting in a medical building; I can't even escape it on my days off. Taking Dad to the office to get himself scoped, and he has to be there at 0600. So, being the newly anal-retentive medical student I am, I got him at 0530 and we got here early - about 0545. So we're sitting here while Dad frets about whether or not he's here on the right day, as he didn't get his expected confirmatory call and he was half-out still when he got the scope the last time.

I don't mind getting up early any more, as long as I can get to bed the night before. And last night I was asleep by 2100, secondary to a headache and general exhaustion. And, as the registration person shows up, it turns out that the scope is scheduled for next Monday, as Dad feared. So she's in the back, to see what she can do - nobody wants to make him go through another two-day bowel prep.

And the verdict: They had a 6 AM no-show so he's already back there at 0645; it's strange to be the family member waiting out front for the scope to be done instead of the student scrubbing up to help hold the biopsy cups. Trying to read my Blueprints but I really need to be writing things down; maybe I could outline the chapters on here. Angel's computer is nice, once you get used to it - Shelob, we call her - and she's tiny and light and has a wonderfully long battery life. Her screen is what I'm used to in the glare-reducing department, but Tinuviel has no problems with glare that I've noticed yet. Maybe because I don't look at the screen all that much.

I have a few stories from yesterday to tell, despite having only been there for rounds. And rounds, O Best Beloved, were a nightmare. We got called by the nurses to go see about Mr. C, who had spent the whole night vomiting. Vomiting, they told us. They didn't tell us that his abdominal wound where we did the aorto-bifemoral bypass had been pouring fluid. BW took one look at him, pulled the dressing off, and said "Give me a Q-tip". And the Q-tip sunk a good 4" into his wound. The fascia dehisced, also known as the sutures pulled out and we have to take him back to the OR to close it again. Thanks for letting us know that his wound was gushing, BW mutters. He should've been in the OR six hours ago. So we tried to hurry rounds so that BW could get there as quickly as possible, and were stymied up on the floors when the JP drain in our gunshot patient (he shot himself, O Best Beloved, in the side, on accident. It went through his diaphragm, his stomach, his liver,and his other diaphragm. What a ridiculous accident.) wouldn't come out. SB looks at me. "You want to stitch this back in?" Sure, but how? Well, go get some small silk suture and some lido and come find me. I'm going to write notes.

There is a nurse up on the floors, O Best Beloved, who we all try to avoid. She's tiny and cute and sweet and tries to help and she wants to be useful, but she's balked by two things: (1) She's Chinese (I'm pretty sure she is Chinese, not some other Asian ethnicity; I do pretty well at telling from name, face, and accent), and has a practically incomprehensibly thick accent and the associated language difficulties (amasashi, you know what I mean), so when she gets a call from the radiologist saying there's a new lucency in the film and could we order another take to make sure it's just a bad film, she calls up BW at 11:30 at night in a panic - "Patien' ha' lung canca'! He gon' die! You shoot X-ray!" - and won't calm down enough to be understood. It also means that you can't understand what she's saying about her patients, and she rarely gets it right anyway. That leads me to point (2): She sucks. She's been there for quite some time, and still she's slow, she doesn't know where anything is, she's easily distracted, and you have to tell her things like five times before she understands what you mean and what you want, no matter how slowly or clearly you explain it. This makes efficient patient care very difficult. In fact, it makes patient care very difficult. Especially over the phone.
This is relevant because when I went to get my suturing supplies, the only nurse I could find on the floor was the little Chinese nurse. "Ca'Iiiihep'ou?" Please imagine this incredibly thick Chinese accent in which no word has a definite ending and all the vowels sound like a schwa. I don't think I can type it and have you be able to read what she was saying. I will attempt, though, as it was a nightmare ballet of blinking to understand at all. "Yes," I say, reluctantly. "I need some lido, some 3-0 silk, and a suture kit." Her response - Lidoooca', silk? "3-0 silk suture, lidocaine, and a suture kit, yes." I get'ou lidooo, one minu' And she meanders off. I follow. She does, indeed, get me lidocaine - but not with epinephrine, which she should've asked about and I should've remembered to ask for. Anysin'el'? "Yes. 3-0 silk suture. I didn't see any in the clean utility room." The clean utility room, of course, being where we keep all the supplies that we don't need under lock and key. She heads back to the clean utility room anyway, which is fair, and begins at one end, pulling the packages out of their boxes,looking at them, and then putting them back. Even the packages which could not possibly be suture, such as NG tubes and chest tube trays.
She reaches into the surgical towel packs, roughly 100 times the size of a suture pack, and hands me one. You nee'zis! No. No, I do not need sterile towels to put a single stitch in a boy's abdomen. But I take them, rather than try to explain to her, and slip them back into the bin later. At the end of the clean utility room, after something approaching ten minutes of looking at every single package, during which time I am getting internally quite agitated and ready to club this woman with a Kocher, should I find one, she turns to look at me. No sree-zero sushu', she says. I go ask somebodeeee. No, please, I think to myself. Let me go ask somebody else.
We meander down the hallway to the nurses' station, where the missing other nurse (half the nurses at Wishard are missing, the other half are overworked) has resurfaced. We ha'sree-zero sushu'? I canna fin', starts in the Chinese nurse. The other nurse blinks rapidly. "What?" "I'm looking for 3-0" (pronounced three-oh) "silk suture, and a suture kit," I interject, speaking right over the Chinese nurse's emphatic "Sushu! Sushu! We ha' sushu?" "Oh," she says. If it's not in the clean utility room, then you'll have to call CSR." She gives us the number. Chinese nurse heads for the clean utility room. "We looked there," I say. "Call CSR," the other nurse says, louder. "Thanks!" I call over my shoulder as I move to intercept the Chinese nurse.
She dials CSR and hands me (thankfully) the phone. I explain that I need 3-0 silk. CSR says "Don't you have any on the floor?" No, that's why I'm calling you. After some discussion, they say they'll put it on the dumbwaiter. Chinese nurse is hovering. "On dumwawa? I go ge'." I follow, and good thing, because she gets distracted twice on the way and I have to steer her back on track. "Dumbwaiter." "Ohhhhya', dumwawa." She calls the dumbwaiter and opens the door for me when she gets there, sorts through all the stuff looking for the suture, doesn't close the door when the call buzzer goes off. "Maybe that's CSR wanting their dumbwaiter back," I suggest. Mebbe, she agrees, and after I repeat myself three more times, she closes the door and allows CSR to summon the dumbwaiter.
It returns with suture. Chinese nurse looks at me. "You nee'anysing el'?" No, I tell her. No, I'm fine. And I wait until she's well out of sight before flagging the first person I see and asking them for CSR's number. Sit down and call them myself. "I need a suture pack as well." We don't have any suture packs. "Oh. Can I have a needle driver?" We don't have any needle drivers. We have needle holders... "Right, put one on the dumbwaiter for me?" I glance over at the nurse next to me (where were all these nurses when I needed one?), who's obviously heard the conversation. "I forgot," I began. "You're at ****," she finishes.
So I go to the dumbwaiter and I get my needle driver holder, and I go back to clean supply and I grab a suture removal kit (contains one forceps and one scissors) and I take all of my equipment (suture, needle driver holder, suture removal kit, lidocaine, needle) to my resident, who says "Where have you been?" And I say "I had to get help from the Chinese nurse." And he says "Oh." and after he finished writing his note we went to stitch the JP drain back in.

It went well, except I didn't numb a big enough area, so my patient was crying and I felt terribly cruel. Wrote notes, went home - all the way home to Fort Wayne, where I have spent a relaxing post-Dad's colonoscopy day making a Mexican brunch casserole (v. good) and eating some of it. Now I think I'm going to go clean out the garage so as to make room for a pantry cabinet.
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