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).
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:
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.
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!