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I was just getting ready to try for a few hours’ sleep when I got the call. I was working an overnight shift in psychiatry at the time. Apparently, a patient in psychiatric intensive care had fallen and hit his head.
He was well, and neurological observations were normal, but he had a large gash on his forehead. As he was aggressive and very difficult to manage, the nurses felt a trip to A&E would be problematic. Could I come and put in a few stitches?
A few weeks before, I would probably have said no. Then, my experience of suturing was limited to sewing up a spongy rectangle of fake skin in the skills lab, and a few home practice sessions involving mainly bananas but also the occasional orange. But in the interim, thanks to the thoughtfulness and generosity of a senior colleague, I had actually done it for real, once, on a live human being.
On the psychiatry ward, equipment and patient were helpfully assembled for me. I suddenly thought of steristips, but there were none available, and looking at the wound I wasn’t sure they would do the trick in any case. So I washed my hands, got consent, and started.
As I held the needle a few centimetres above his left eye, the patient started to squirm. Four nurses calmed him and held him still as best they could. Then he began to shout abuse. I imagine he was in pain and a bit alarmed at what was going on; he might even have been more scared than I was.
I blocked it out and focused on the task in hand. Fortunately, my fingers seemed to remember what to do. As time went on, however, the shouting got louder and more derogatory. ‘Get a blooming move on, do you even know what you’re doing?!’ and I can assure you he didn’t say ‘blooming’.
Time was of the essence. I felt it needed two more stitches ideally, but one more would have to do.
When I finally finished, the patient glared at me one last time and took himself off for a consolatory cigarette. The nurses at least were grateful.
For my part, I was extremely thankful to the senior who had taken the time, on a busy weekend shift, to supervise me suturing my first real patient. I’m sure she could have done it herself in half the time.
As I progress through my own training I hope I will find opportunities to be similarly supportive to those following behind me.
I heard nothing more about my psychiatric patient until a few weeks later when I was on call again, and had to see him about something else. He was much calmer this time, and as I chatted to him, I took the opportunity to examine the results of my handiwork. There was a small scar, but reasonably neat and healing well. Not bad considering.
When was the last time you felt out of your depth? Use the comments section below or tweet here and read other posts on the Secret Doctor Blog