Do I sew, O Best Beloved? It is the one skill I am proudest of; my ability to align the edges of a skin wound with suture, to tie knots that lie neatly off to one side of a well-spaced series of stitches, and to do it without taking for-freaking-ever. "Sure," I answered. "I love to sew." His face brightened. "You can save my life. Go see the gentleman back in $room. He's all numbed up, just need to staple his leg and his side and stitch up his face."
Said young gentleman, according to his story, was sleeping on the couch when he heard his sister arguing with her boyfriend, and calling for help. When he investigated, full of protective instincts, the sister was being choked. This led to a dispute between the gentlemen involved which eventually became a fight involving knives. A quarter-inch further and he would've lost his eye.
Staff did the three stitches in his lower lid; I explained that I simply was not confident enough to inject lidocaine in that location. After that, he was all my patient. And pleasant enough to me once he discovered that "medical student" is not a paid position. "You have to smell my armpit, be here at seven in the morning, and put up with my s*it for free?" I smiled. I am good at smiling; I have a thousand of them. The most common smile, though, is the self-deprecatory one. "It's for my education."
The next patient's chief complaint was "jaw pain". I walked in; he was holding his sweatshirt to his face and mumbling. What happened? As if I couldn't guess the litany that ensued:
I was walking down the street, minding my own business, when these guys just jumped me. And I ran to the liquor store but they told me to get out. So I got to my car and drove home. Girlfriend breaks in. He wasn't goingto come here, but he was in so much pain... I nod, ask the next questions. Any-idea-who-it-was? Do-you-want-us-to-call-the-police? The answers, unsurprisingly, are "no clue" and "Naah, that's okay." If some unidentified persons assaulted me, O Best Beloved, you had better believe I would file a police report. When-did-it-happen? "Oh, around 2."
Physical exam: "Where does it hurt?" He points to his jaw. "Smile for me?" Checking...This gentleman's teeth were quite neatly aligned on the left; quite neatly aligned on the right. Good dental hygiene. Small laceration on the gums in the middle. Right teeth a quarter inch lower than left teeth. Whoops. I check for loose teeth, try not to flinch. "Are your teeth normally straight, sir?" The answer is affirmative, or as much as one can be with a gloved finger in one's mouth.
X-ray, Panorex and mandibular. The fracture line goes through the entire jaw and cocks off to a funny angle. Must've been a heck of a hit. Off to $hospital for orofacial surgery to repair.
Did I mention the charming girl, very sweet, whose pelvic exam was an exercise in finding the very smallest speculum we had and moving up until I could see, due to her extreme vaginismus? Your normal Graves speculum (that's the duckbill one, ladies) is about the width of my first two fingers together. It's not comfortable, but most women tolerate it - especially non-virgins, and it's usually safe to assume that someone with two kids is a non-virgin.
I couldn't get the stupid thing in more than a centimeter, her entire pelvic musculature contracted down on me. Went to the pediatric Pederson, a straight-bladed speculum about the width of my pinky finger. Couldn't see anything, the vaginal walls collapsed. Went to a pediatric Graves, a bit larger. Got a glimpse of her cervix, did my swabs, gave up on a bimanual (how does this woman have two kids?) and threw in the towel. Looked all right anyway. Frustrating, for both of us. I kept apologizing. She was in tears.
The little girl with the thumb laceration that my staff had to bind in a bedsheet and tape to the bed to suture (I passed). The little boy who came in with "foreign body, left thigh" and turned out to have stuck a Sea Sheller (red) into his leg, pointy end in. Numb and extract. "How did you get this, honey?" He just shook his head. "Magically jumped into your leg?" A nod. Four year old kids are wonderful at giving history.
Tuesday was my last shift. Monday I had the 18-year-old boy who presented with wrist pain. I walked in, looked at him and the way he was holding his arm, and said "So how'd you break your wrist?" His answer was classic. I slipped on the tiles. Beat. A guilty look. </i>No, wait. I was a dumba*s and I tried to jump off the stairs into the pool at a party, and I missed and slipped on the tiles.</i> And when-did-this-happen? About midnight. So, I ask, calmly, concealing my surprise, where-have-you-been-for-thirteen-hours? I was totally trashed, he says. I didn't want to make a fool of myself. I just woke up.
X-ray: Colles' fracture. This isn't his wrist, but it might as well be. Splint and send for orthopedic follow-up.
Finished my exam this morning; worst-case scenario passes it, and it's only 10% of the grade. Still need to go back to the house and pack up my stuff, figure out how to get it all in my car.
I am going home, O Best Beloved. Home for a month.