Caution: sharp objects ahead

by Lorien E. Menhennett

When you call it a "butterfly needle," it sounds so innocent and cute ...

When you call it a “butterfly needle,” it sounds so innocent and cute …

One step closer.

That’s what I tell myself with each new medical school milestone. This week, there were two big ones. Both involved sharp objects. But with the exception of some minor bruising, everyone came out just fine in the end.

Monday, I took my first stab at drawing blood (that pun was so intended). I’ve done delicate surgical procedures on mice, including injecting medication into the inferior vena cava. But survival was not a goal of those procedures. Phlebotomy is obviously much different. This first time, we medical students practiced on each other. With some guidance, my classmate stuck me on her first try. I had a little more trouble. Three pokes later, I managed to see the coveted red flash of blood. I patted myself on the back until I saw my friend the next day. When asked, she showed me her arm — a purple bruise where I’d poked.

I’ll get better. It takes practice, just like everything else.

Suture kit

With suturing, you use metal tools to hold the needle and the skin.

Though it was technically my first time with this too, Tuesday’s activity — suturing — actually felt less foreign in some ways. I learned basic sewing when I was in elementary school. I feel comfortable with the general act of guiding a needle and thread. With sewing though, you use your hands to hold the fabric and the needle. With suturing, you use metal tools to hold the skin and the needle. That took a little adjusting.

Another adjustment: it took me a moment (and a comment from a surgery resident on my crazy stitches) to realize that while sewing and suturing share many features and movements, the basic suture technique I was practicing differed from sewing in one very important way. With sewing, you create contiguous stitches to keep the fabric together. You tie a knot and cut the thread only when you’re done, or when you’ve run out of thread. With the basic suturing technique I practiced Tuesday (called the “simple interrupted suture”), you create distinct stitches that are separate from each other. Stitch, knot, cut. Repeat.

This makes sense. Fabric needs that continuity to stay together. With skin, you’re holding things tight temporarily, just until the skin gets its act together and heals itself. Then you don’t need the stitches anymore. The simple interrupted sutures are actually a lot like straight pins in sewing. When you hem a dress, you pin it up first to keep everything straight and tidy. Then you run it through the sewing machine. Once you have that strong hem sewn, you remove the pins. Likewise with the simple interrupted suture I learned: you put temporary, individual sutures in until the skin is healed. Then you pull out the sutures, just like you did with the pins of your dress hem.

It makes sense to me now, but my practice foam block (full of contiguous sutures) must have looked like a complete train wreck to that surgery resident. Well, now I know. And more importantly, I understand.

Knowing, understanding, practicing: this means I’m headed in the right direction. Even if I did leave a little bruise.