"If a commission by an earthly king is considered an honor, how can a commission by a Heavenly King be considered a sacrifice?"
-David Livingstone

December 29, 2010

First Suturing Experience!:)

It's after 11 p.m. and I've already been soundly asleep for several hours (bedtime comes early here as generally I'm exhausted.) I wake-up with a start at the sound of a woman's voice calling, "Thra-moo! Thra-moo!" from the other side of my mosquito net. It quickly registers that this must be an emergency. They've never called me out in the night before. I recognize the little woman standing outside my room as one of my neighbors. She tells me that her husband has fallen and that he's hurt. I deduce that drinking must have been involved. I had suspected a drinking problem at this house before. My jumbled brain attempts to unscramble as I wander over to gaze with some confusion at my supplies. I'm not prepared with a jump kit. My bad. What to expect? Finally I settle on my trusty stethoscope, blood pressure cuff, 4x4's, and a few other miscelanious items. Emily (who just happens to be visiting me for a few days) and I scurry down the path after the spry little woman. We reach their little bamboo hut and climb up the rickety ladder. I find the man sprawled on his stomach next to the smoky fire. Several miscelanious people sit around the little room. They point out his bloodied hair which upon my further investigation appears to be a scalp laceration that looks like it will require suturing. He also complains of severe lower back pain. And, no, I was not mistaken in assuming the involvement of alcohol. The cramped quarters are much less than ideal, but my EMT conscience doesn't permit me to move him (spinal precautions...) I leave Emily with them and take off back up the hill to get the supplies we'll need. Yikes! What was it that told me to study out anasthesia and some of these kinds of techniques earlier! Back at the hut I spread out the goods and give Emily quick instuctions as to how to be my gofer. I quickly decide that sterile procedure was not invented for situations such as this one. Smoke from the fire blows my way and tears stream down my face from the irritation. I attempt to keep his unruly hair out of the candle that was placed at his head and cut away the hair around the cut as best as I can (I will have razors on hand next time!) and clean up the blood. The laceration is not much more than an inch or so in length, but it looks deep, and semi-jagged, and I can see what looks like some layers or something. Meanwhile, Emily gives me what I need and expertly helps decifer what people are saying ( a lifesaver, especially under the stress!) My man's not making this easy, thrashing his head around just when I think I've got things under control. I take my syringe of lidocaine in shaky hand and with a deep breath (and yelp in Emily's direction for prayers) we do this thing. It goes well accept for when he thrashes again and lidocaine spray splatters my face. To my elation the lidocaine does it's job and things are moving right along here! No sooner do I have his head draped with 4x4's (OK, so sometimes you do what you got to do...) and got on my sterile (YES!!) gloves on, than my patient thrashes about knocking off my "drapes" and sending my alcohol cleansed instruments into rather precarious positions. Just to give you an idea of what I'm working with here, the fire's on one side of the man and I'm leaning over him while squeezed into maybe a foot of working space with the wall crowding me on the other side. The chief of the village leans over from the other side shinging a light for me and, finally, at my frustrated insistance, he helps hold down the patient's head. OK! Here goes my maiden stitch on a real and live human scalp! I pull it through and have the horrifying realization that with the stress of the moment (and lack of practice) I have no clue how to tie this thing. One failed. By this time the anasthesia's definitely wearing off. I fill another syringe and start over. With another plea for prayer in Emily's direction, I try again and to my tremendous relief the tying technique comes back to me. Halfway through I comment (in English) to Emily that I don't believe I shall ever forget my first suturing experience and right at that moment the head beneath me nods. Somehow that got my funny bone.:) I'm praying through it that God will make up for the lack in sterilness as I'm doing my best, but have just about given up. All finished. They voice their heartfelt thanks and even attempted to shove a hundred baht bill (approx. $3) into my hands.
Right now it's 3:19 a.m. and I'm sitting here with my clothes reeking of smoke writing while I let the adrenaline wear off. This was a good experience. I'll know better what to expect for next time and be better prepared!

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