Wednesday, May 12, 2010

Scouting Surgery

Square Knot

Little did my grandmother know what she was doing when she placed needle and thread in my hands, saying, "Some day you'll be glad you know what to do with these." She thought she was enabling me to take care of myself as an adult, by showing me how to repair torn clothing and darn socks. What she really did was get me ready for this morning's clinic on suturing techniques.

Now, it's true that stitching together two halves of an open wound or surgical incision isn't quite the same thing as hemming a pair of pants or applying decorative buck-stitching to saddle parts in my father's shop, but at least the concept is familiar. And, fortunately, you don't have to run a tiny piece of nylon monofilament through an even tinier needle's eye first, or patients would bleed to death before we even got started. Can't you see it? Some poor guy's lying on a gurney, crying, "Doc, you gotta help me!"

"Yes, yes, I know. Just be 'patient' -- pardon the pun -- it will be a few more minutes while I get this thing threaded," replies the doctor, squinting and poking with gloved fingers at a target s/he needs a magnifying glass to find. No, sutures come ready-made with nice, curved needles that pierce the skin easily -- including yours, if you're not careful.

The trick involves learning to place them while clamping the needle with a pair of forceps in one hand and holding the skin with tweezers in the other. It's like standing in the batter's box with a bat in each hand, trying to hit the ball with both as it passes over the plate. Ambidexterity would be helpful at a time like this and the truth is, when coordination was passed out, my left hand was out to lunch. Obviously, I need practice -- a lot of practice.

Knot-tying is easier and I have Boy Scouts to thank for that. The technique is slightly different, but a square knot is a square knot, whether it's connected to a bridge constructed of rope or securing a suture in place. They don't give out merit badges for the best surgical knots, but after banging my head against the wall through three years of basic science, it will be fun playing "Scoutmaster," once again. Don't tell my surgical preceptors I said this -- they'll probably expect me to start a fire by rubbing two sticks together and that's just too much like work.

(Creative Commons image of Square Knot sculpture by jcarwash31 via Flickr)
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