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.