The Pondering Grapefruit
a blog of moments and musings
I am starting a new series of writings of the cases I see in the emergency department. I want to portray snapshots of the stories I witness. In my job as a medical scribe, I document the patient's chart, but in a very concise manner that aims to be as objective as possible. To counteract that, these snapshots capture the emotional landscape of patient care that is left out in the medical charts. I've done extensive research into HIPAA and have adjusted names and details to protect patient privacy. Here goes with the first one.
There's word of a woman who came in with a cut between her toes. She had somehow fallen, broken at least one toe, and gained a deep gash the base of another toe. The doctor is complaining because it's apparently really hard to stitch up anything that lies between the toes. It comes time to see the patient. We enter the door to find a tiny old woman with her daughter at bedside. The patient reminds me of a muffin. She has a round face and round features, and I think that she would have a very sunny smile if she were not quivering in fear and pain from her broken toe. They are foreign--the nurses notes say they speak Farsi. I can hear her daughter whispering condolences to her mother as she trembles in pain.
"Is it really bad?" Asks the daughter.
"I'll need to check it first," says the doctor. He does, and it is really bad. The cut is deep, and right along the crease of the middle toe. The sheets beneath the foot are already stained with blood that had been dripping down her foot. I look around her bed and notice that there are blood stains on the bed near her head and shoulders. I wonder how it got there if the blood was from her feet. In the corner of the room, I see a crumpled towel stained with pink, yellow, and red. Blood, iodine, and more blood. Laceration repairs are normally the simplest cases, but this one feels unexpectedly heavy.
First we need to numb of the foot. Everything is already set up. I can tell that the doctor is flustered because he slightly frowning, and no techs or nurses were around to help. He fulls the toes apart and injects copious amounts of Lidocaine into five different areas around the cut. The patient whimpers, her foot shakes, and her lips quiver even more than before. She starts crying and pulls the blankets above her head, but they slip down to her neck. Her daughter wipes her tears with some gauze left behind on the counter by a previous nurse.
Once she is numbed, the doctor opens up the stitches. It's 5-0 Prolene, pretty thick, and I think it's because we're working with feet. I can tell he's still flustered. "Can you check to see if a tech is out there?" I run out, and there is none.
"Negative," I tell him. We try that again, and on the third time he asks for a nurse to come in. I find one outside, and she wonders why he needs her. It soon becomes clear that he needs someone to someone to simply hold the toes apart as he's stitching. Now that we are all here, the repairs begin. I see now why it's hard to work between toes. They get in the way. I think of the times I had to scrub thick calluses from between toes when I worked as a nail technician.
The patient's skin is thick on her feet. Her crying has stopped, but she's still uttering soft moans. She says the pain is not from the cut, from from her broken toe being pulled to the side, but there is nothing we can inject to make that feel better. There's a 1 inch trail of blood running from the cut down to her foot. In the corner of the room, a used glove falls from the overfilled trashcan onto the floor, next to the pink and red and yellow towel, and another unused glove.
He places about 7 stitches and quadruple knots the last one. We are done. At this point the daughter is fanning her mother with a urine pan. I think they are very humble. That's something that my parents would have done, creatively accessing their environment, and not asking for assistance. But maybe I am romanticizing the immigrant life. The last knot has been tied, and the doctor stands up. I can tell he is flustered, because he hits his head on the overhead light and then bumps into the computer on his way to throw away his sterile gloves. The bed sheets are damp from all the saline used to wash the wound. A certain heaviness has lifted, and it feels like the sudden stillness after a thunderstorm.
I close the door behind us. The next nurse who comes in will clean up the rest. In a couple hours, this room will be empty and clean, the trashcan liner replaced, and the beds sanitized clean, as if no one had ever cried on this bed before.
on this bed before.
About this Blog
I have no idea how to describe what my writing is about. I just write. I post when I can, which can be weekly or monthly depending on where the universe is taking me. As for the Grapefruit, my Vietnamese nickname, Buoi, means grapefruit.