I’ll give you a taste of what it’s like to be a physician and try to interpret what people tell you on the phone. And why it’s always good to look at the patient. People often get mad when doctors won’t treat them without seeing them – this post may give you some idea why physicians always want to see the patient.
And why I don’t answer specific medical questions in the comments section.
A little after midnight last night I get a call from Scott, our #3 child, who tells me that he has fallen at an ice rink and cut his head. I ask him where, and he told me that the cut was right along his brow ridge. He hadn’t been knocked unconscious, and he wasn’t having any neurological symptoms he said. Only a lot of bleeding. I asked him to describe the cut.
Many people fall and cut the area right above their brow ridge. It’s a fairly common injury and usually requires stitches. What happens is that the weight of the falling head compresses the skin between the ground (or ice) and the bone of the brow ridge resulting in a kind of a burst injury in which the skin ‘bursts’ open. There is a lot of bleeding and a full thickness injury of the skin that requires some kind of closure.
When I spoke with Scott last night I asked him all the appropriate questions about the condition of his cut. I knew exactly what kind of cut this could be and queried him closely. I came away from the conversation believing him to have a slight cut a little over a half inch long that wasn’t really gaping. The gaping was the critical issue because burst injuries gape. Since it wasn’t gaping, I wasn’t worried. He said he would come by today and let me look at it.
When he showed up (below) and I pulled the bandage off, he began bleeding profusely from a large gaping wound. The wound itself was pretty gross and bleeding like a stuck pig, so I didn’t include a photo of it.
Back when we had a clinic this would have been a no-brainer. We take him to the clinic and sew him up. But we have no clinic now…and no real doctor tools. We scrounged around and found one piece of 4-0 Prolene suture in a sterile pack (I would have preferred 6-0, but beggars can’t be choosers), but nothing else other than the gauze and other first aid stuff all doctors ought to have around. We also happened to have some lidocaine (local anesthetic) and a syringe. We dug out a pair of needle-nosed pliers, a pair of tweezers and a set of MD’s cuticle scissors and we were ready to go.
We sterilized the pliers, tweezers and scissors by boiling them, got Scott up on the kitchen island, got his cut lit up with my reading light, and fixed him up frontier style. In the photo at the top of this post I’m injecting him with the local anesthetic. I anesthetized him pretty well because MD was conducting a meeting in the other room, and we wanted to keep the screams to a minimum. Below I’m suturing his cut using the needle-nosed pliers and drugstore tweezers.
Below is the finished product.
And here is Scott looking none the worse for wear.
I would never have done this in such primitive fashion were the cut any place else, but the skin on the face and scalp is so vascular that you virtually never have to worry about infection.
The take home message is not to get irritated at your doctor if he/she asks to see you before recommending a specific treatment.
Had Scott not come to the house today, he would have continued to bleed, and would have probably healed up alright, though with a bigger scar than he will now sport. Or he could have gotten infected despite the profuse vascularity if the wound had stayed open.
I’m glad he came by.
I never watch medical dramas on TV but I enjoyed ‘ER Dad’ ! Nice to see medicine in practice 🙂 Hope Scott heals quickly.
bw’s
Anne
You probably enjoyed it more than Scott did. But he was a trooper.
Cheers–
MRE
Wow, very cool! Thank you for sharing that.
It was a philosopher/physician named Hippocrates of Cos (over 2300 years ago) who first began examining sick men carefully without theorizing. Prior to him medicine was full of speculation and superstition–non-scientific. Yet interestingly enough a lot of modern treatments are based on that dark era such as physical therapy (the savage medicine man would at times pound the bad spirit out of the ill man’s body).
Hippocrates was the first to apply the principle of science: the questioning, the careful examination–without diagnosis there can be no sound treatment. This is probably why Hippocrates is referred to as the father of medicine.
I am reading a hand-me-down book from my dad he gave me when I told him I may be interested in becoming a physician a couple of years ago (2nd career). The book is called “The Doctor in History” by Howard W. Haggard. The copy my father gave me is his own copy printed in 1962, in Argentina. I finally started reading it over the holidays.
Thanks again for the post and to Scott for being such a sport and letting you share it. Is this your son that captured you making a Cafe Americano?
Warm Regards,
Alex (Dallas, TX)
Hi Alex–
No, the son who filmed the Americano episode is Dan, the #2 son – he’s in Scotland right now.
Cheers–
MRE
That was a great post. It’s amazing what you can do with a kitchen island.
Nice job on the stitches, and you probably saved Scott a few hundred bucks.
At least a few hundred bucks. I gave him the deal at cost.
Cheers–
MRE
You obviously haven’t lost your skills as a surgeon; resourceful too. Nice, clean sutures. Good work doctor.
W
I just want to say that I have found Vitamin E oil to be very helpful in reducing scarring, and bleeding/brusing. But, you must know that… 😉 Hope he heals fast..
I’ll get the sutures out in a few days, which will help with the scarring. And I will have him use vitamin E – it’s an old standby of mine.
Cheers–
MRE
That reminds me of my childhood. My dad was a physician and I seemed to need quite a lot of head stitches. The ones that I remember most were the ‘shovel incident’ and the ‘shovel incident’. I never got the cool white head bandage though.
Scott got the “cool white head bandage” only because we didn’t have any tape at hand.
Cheers–
MRE
Great stitching. I have some clothes that need altering – are you available???
Seriously, I don’t envy doctors who get calls wanting telephone diagnoses, or who are asked to diagnose via a blog or website. I’m not sure I’d trust a diagnosis from a doctor who didn’t see me in person. Stick to your guns, doc, and ignore the requests for free medical advice. Let them go see their family doctor.
Hi Nita–
Thanks for the understanding. It’s not that I hate to give ‘free’ medical advice – afterall, the advice I give almost daily on this blog is free – it’s that I don’t want to give erroneous medical advice based on not having adequate information.
Cheers–
MRE
“I anesthetized him pretty well because MD was conducting a meeting in the other room, and we wanted to keep the screams to a minimum.” Haha, so funny, although I don’t know whether that was intentional 😀 I hope he gets well soon!
And your son is really handsome, how old is he? That scar will only make him look more interesting 😉
Greetings from Germany,
Simone
Hi Simone–
Scott is 30. He can pass off this scar (which, if I did my job right, won’t be that noticeable) as the result of a saber duel I suppose.
Cheers–
MRE
Needle nose pliers? You mean you don’t have any kellys? I clipped, um acquired my first set as a freshman in nursing school. After 30 yrs I have a few. LOL
Glad to hear your son will be ok. He does NOT look happy! Who’s taking the pictures? If you’re stitching and MD’s in a meeting?
Nope, no kellys, no needle holders, and not even a hemostat. The worst part was having to use tweezers instead of pickups. MD ran in from time to time to monitor the progress and took photos while she was there. I took the photos of the finished job.
MRE
Ig lives another day!! Happended upon your website looking up Dan the Man. Hope all is well. 3 sons of my own now, but no doctoring skills. Tell MD hi.
Indeed he does. Good to hear from you, Señor Rojo. I kind of keep up with you guys through Ted. I miss the parent’s weekends at W&L. Say Hi to Julie and Wally for me and to Katherine and the Rojos pequeños.
Cheers–
Ha, I also laughed at the thought of MD conducting a meeting in the next room while you were stitching up your son in the kitchen. At what point did you decide that it would make for a great blog post? Did he mind you taking the pictures very much?
Hmm… Well, that explains why my sister was so good at splitting her scalp open on a number of occasions when she fell off of whatever she was climbing. Luckily, we lived right by the medical clinic and I still have the image in my head of my mom on the phone reporting that my sister was on the way and my dad hurrying across the street with her in his arms as the white-clad nurse swung the side door of the clinic open.
He didn’t mind the photos. He’s a regular reader and a frequent commenter on this blog, so he was glad to be a part of it (or so he told me).
Cheers–
MRE
Can you use unwaxed dental floss if you don’t have any sutures? LOL, j/k…. you go 🙂
I’m not sure I would try it.
Cheers–
MRE
Such resourcefulness would be very valuable out here in the remote wilds of Alaska. If you want to return to practice I can give you some references. One doctor friend of mine even amputated his own frozen toes, tho to be sure his wife, also a doctor, tells it differently. No doubt the disagreement was due to the dual administration of anesthetic: topical and single malt. Which did Scott receive?
M
Scott’s not much for the single malt, so we went with the local.
Cheers–
MRE
Love this story. Wish I could have been there ( seriously ). I would have made a great assitant. Be honest, didn’t you have fun doing this? I really should have ventured further into medicine. I am certified as a medical assistant but never tried to go for any other advanced degree. A couple of years ago my husband suffered a deep gash just above the elbow. When the doctor came to see him in ER, they were short of help. I offered to assist the doc with my husband’s care and I had a blast.
I used to keep “stuff” in my car just in case a woman went into labor at the park or in the grocery store ;-). I know it sounds silly but I was ready for an emergency delivery. You have a cute son BTW.
Happy New Year,
Mary T.
Hi Mary–
I did actually kind of enjoy it. I wish I had had better equipment, however. MD and I have decided to go ahead and put an entire suture kit together so we’ll have it should the occasion arise again, which, of course, means that the occasion will never arrive.
Cheers–
MRE