work

holy crap.

the children! the chiiiiiiiiildren! there's just... so... many of them!

i got whupped tonight. i knew it was going to be bad when i walked in and immediately the neurosurgeon was asking me a favor, and then the hematology clinic wanted a favor, and i hadn't even set down my black bag yet. i like carrying a black bag. it's my twist on old school.

anyway, the rooms filled and the calls just kept coming. we even overflowed into rooms that weren't mine. when they sent me a 5 year old kid with a facial laceration who was flipping mean and was going to need sedation, i had to call plastics to sew since i can't sedate and sew at the same time. they sent an intern who had way less expericience sewing than i do. he even peeled the two plies of the drape apart on purpose, not knowing he wasn't supposed to. and he broke the end of his running stitch so he had to start over. heh heh heh. whatever. it makes me laugh and feel superior. (snort of derision) ha! (i'm so bad-- but i can laugh because i was never that clueless as an intern. really.)

i don't know how many kids i saw. they just kept coming. babies most of them. fairly healthy babies. babies with nothing wrong. babies with colds. babies with runny poo. nothing majorly wrong with any of them. they all had to wait for what seemed like hours for me to get to them, only for me to walk in, coo at them, make them smile, and make them take a bottle, then say there's nothing i needed to do 'cause they were fine with minor illnesses and some were completely healthy, "call your doctor in the morning with an update your baby sure is a cutie yes you did the right thing by coming but next time think about what you feel like when you're sick and then you'll realize that when people feel sick they are cranky and sleep more and lose their appetite and maybe you don't need to come to the hospital just because your baby is cranky, sleepy, and not hungry now who does the little one look like, mommy or daddy?"

i felt kinda bad because everyone had to wait so long for me to do nothing-- and then the one girl who actually needed for me to do something had to wait the longest of all. fortunately she was awesome. ten years old and completely unafraid. unafraid through the wound cleaning, the shots, and the stitching. she watched me do it all. didn't feel it because she wasn't scared. and because i'm just that good, of course. (here you ought to roll your eyes because i'm being facetiously smug.) and man did she present to me a nearly perfect lac!

ahhh... the perfect lac. straight. clean. gaping, but with minimal tension. superficial, so no deeps are needed. on a brave patient who doesn't wiggle. preferably on a black patient because the demarcation between brown epidermis and white dermis is even easier to see, and i can really evert my edges by getting the tip of my needle to come out precisely at the junction. i always do two-bite closures for the sake of wound edge eversion. simple interrupteds; i never do running sutures. not in an active child. are you crazy?

i put eight little 5-0 ethilon stitches in her. that lac came together to a perfectly straight 2.5 cm line despite the initial wide gape and the 2 mm dog ear at one end of it. i mean, that sucker ended up being straight straight straight!

it's just really awesome when a lac comes together well. i guess the only thing that compares with getting a perfect lac and stitching it up beautifully is getting a horrifically complicated lac, like stellate and through all different layers so you have to do something kind of creative, with deeps and corner stitches and crap and maybe even a mattress or two, and ending up with a gorgeous repair. along langer's lines, ha! now that would be awesome.

wow. i forgot. i like doing lacs. you wouldn't know it for all my usual complaining. it's the wiggly kids and the mean kids that made me forget how much i like suturing in and of itself.

i felt bad at the end of it all, because i felt that i had let people down because of the long wait times. but my nurse was so encouraging-- "no. you are awesome," she said. "you were actually pretty fast. and i love that you spend plenty of time with your clinical assessment so we're not doing labs 'til kingdom come. you're better at figuring out what's going on and the patients do so much better for it." i was shocked to hear that. shocked. but pleased and encouraged of course. it made me feel really good. i think it's sad that i still need my ego stroked when it comes to my work.

ah well. i'm still young after all. when i'm old and truly salty maybe i really won't care what anyone thinks about my work. in the meantime i'll just keep doing my thing, whatever that is.