Emergency: Hand Laceration!

During my internship, my fellow interns and I were assigned a different service each month. It was part of a family practice residency, so we rotated through most of the basic things we would be expected to deal with. A few months of pediatrics, a few months of OB/GYN, a few months of internal medicine, etc. Four months out of the year, we were house docs, just staying in house (in the hospital) and taking care of whatever needed a doctor, or to be more accurate, a doctor’s signature. Mostly, this was just keeping things on an even keel. The patients were stable for the most part, with orders written already. We were there in case something came up; complaints of constipation, keeping blood sugars in check, talking with family member who wanted info if the attending wasn’t around, stuff like that.

Two of these months were the day shift, coming in at 6AM for morning report and working until 6PM. Two of those months were night shift, coming in at 6PM and leaving, usually, after morning report, around 7AM. The nights were quiet for the most part, but whoever was on was the only doctor in the hospital. That’s not entirely true; there was an ER doc on overnight, too, but, except for the most life threatening of emergencies, he was never seen. And while the hospital was not large, it consisted of a standard medical/post-surgical floor, an ER, a rehab unit (occupational/physical therapy rehab, not drug rehab), a geropsych lockdown unit and a 5 bed ICU. I loved working nights. I’m a night person, so I never slept when I was working nights and I made sure everything ran smoothly.

I would come in at 6PM and meet with whoever was on day shift and get the report. How many patients were in each unit, what needed to be done, what problems should be anticipated; that sort of thing. Then, and this is the important part, I would meet with the nurses on each unit. They are the boots on the ground and could usually tell me more about the patients than the doctors’ notes. If things were quiet, I’d go back to the residents’ break room and get some food in me. There was cable TV and internet, so I could occupy myself quite well, but I knew that an emergency could arise at any second. So I would round every 3-4 hours, visiting each unit, talking to the nurses, preemptively taking care of whatever I could. For the vast majority of the time, things worked great. Every now and again, however, I would get something story worthy.

One such night was going swimmingly. Quiet Med/Surg floor, empty ICU, empty rehab unit. I was happily surveying our empty ER when I saw two men standing at the admitting desk. Both swayed ever so slightly, one of whom was holding his arm up, a crimson towel wrapped around his right hand. I was slow to realize that the towel had originally been white. Once back in the ER, I learned that the gentleman in question had just recently been fired. He had been a cook at a local bar and, after getting his walking papers, decided a day of drinking would be in order. Evidently, he had drunk enough, with his companion, that it had seemed like a good idea to go back to the fine establishment he had been fired from, to continue his inebriation. Upon encountering the manager that had fired him, my patient had decided that it would be better to put his fist through a plate glass window, rather than his former manager’s face, leading to him now sitting before me.

Unwrapping the bloody towel, I found his hand to be a gory mess, oozing red, with a single, pulsing jet of arterial spray providing dramatic effect to the whole scene. I rewrapped the hand and excused myself, swiftly walking to find the ER doc. Explaining to him that I felt that this man needed more than what I could provide, that he needed an orthopedic hand surgeon, he groggily followed me to inspect the damage. He was nonplussed. Pointing to the spouting arterial, he said, “Tie that off first, then repair that tendon, and that one, and then sew him up. He can follow up with a specialist later.” With that, he wearily went back to bed.

Resigned to the task at hand, I set up my sterile field, gloved up and injected his hand with anesthetic. Luckily, both of the men were so inebriated that I don’t think either of them were feeling much of anything. It took me roughly 90 minutes to put his hand back together. After it was done, I was convinced that I had mutilated and crippled this man. I urged him to follow up with some doctor (any doctor, for the love of God!), fearing infection, fearing disability, and sent him on his way. It was one of the more trying experiences in my life and it remains vivid in my mind and I’m not sure I would be telling anyone any of this, if this were the ending I had. As they say in the infomercials, however, but, wait, there’s more.

Years later, after I had left medicine, I was working out at some gym (I don’t remember which one I was with at the time) and I heard someone say, “Excuse me.” I didn’t recognize the man, but he asked if I was a doctor. After a few more questions, we had determined that I was, indeed, the man that had sewed his hand up. I openly expressed how convinced I had been that I had ruined his hand. He showed me the appendage in question and there wasn’t a single scar upon it. His take on the night, though fuzzy, was very different. He felt very well cared for and said his hand healed better than he expected it would. I don’t live in a world of black and white, but his words allowed me to chalk this experience up to a win. The whole reason for me to go into medicine was to feel like I was helping people, and his thanks to me is an experience I will always cherish.