Just spent nearly the entire night working on the most horrible hand injury I’ve ever seen. I brought some textbooks, planned to study conscientiously all night, got bored, said it too loudly, too many times, and of course got called by the ER. (Note: even more certainly than the taboo against saying “quiet night” is the rule against walking into the ER without having been called; it’s just asking for trouble, and you’ll always get what you ask for. I was going to look for some ivs to start, but instead I got this.)
It was messy, nasty, bloody, bits and pieces hanging out all over the place. I didn’t particularly enjoy that part of it, but with the patient and family looking so horrified, it’s not too hard to keep calm, act like you’ve seen it all before, and try to normalize it for them by showing that you, at least, are not disturbed. The really bad part was that the poor guy had just essentially lost his hand; not all of it, but it won’t be much good to him after this, and he knew it. He won’t be able to work, not as he’s used to, and he knew that, too. And what could I say to help with that?
To my surprise (after I’d gotten started, I remembered that back when I was doing plastics, I never managed to get a digital block to work), my digital block worked very well, right off the bat. (injecting local anesthetic in a few exact spots at the base of the finger to specifically numb the digital nerves that run on either side of the finger, rather than having to put anesthetic all around a large injury) I guess I’ve learned something about needles and anatomy since July. I think I did a good job for him, but it’s hard to feel satisfied, considering how un-useful any kind of a good suturing job is to him.
Right when I finished, and was starting to work an another hand consult in the ER, a nurse stat paged me from the floor: “There’s bright red blood pouring out of the patient!” She sounded so panicked I didn’t try to figure anything out over the phone, just asked her to hold pressure, and ran up there. There was no bright red blood, just a small pool of brownish fluid, and the patient sitting there shaking his head. “I feel just fine, it’s nothing, I told her that, I don’t know what y’all are so excited about.” After investigating a little, I agreed with him, and went back to the ER. I mean, the difference between bright red and dark brown is fairly clear, don’t you think? But at least I got good practice, running through in my head what I would need to do if it was real. And one should never complain about a patient not bleeding.
I was being cocky, daring the ER fates, by talking about being bored. I learned my lesson for the month: bored is good.