Tying Knots


I am learning a new skill. Sutures. Stitching. Sewing up skin. I have “mastered” two lines of nice little square knots. One knot over the thumb, the next with the finger going under. Make a circle, grab the tail, and pull. Easy. I’ve been tying knots in string my whole life. 

So, I really cannot back out and run away when a patient needs to have a laceration sewn up. I throw on my white coat and head down to the ER. Fidgeting the entire walk, wondering how I am going to get out of this one. I’m really not qualified to be sewing skin. I’m still learning knots on rubber! 

First, gather our supplies. Oh, shit! What size gloves do I wear? I am being coached the whole time we are getting everything. I feel pretty prepared. It’s going to be a simple interrupted suture. No big deal. One knot over the thumb, make a circle, grab the tail, and pull it through. Finger under, make a circle, grab the tail, and pull it through. Repeat. 

Okay. Why are my hands shaking so bad? Holy shit it got really hot in here. The bright light makes me feel like I am on display. Can everyone see how terrified I am? 

I try to avoid appearing incompetent as I writhe my way into sterile gloves. My mouth goes dry. I try desperately to look like I know what I am doing as I draw up the lidocaine. I assure you, I’ve been drawing up medication with syringes for years. Why do my hands look so Parkinsonian? Relax. Breathe. 

Injecting lidocaine into the site should not be this scary. My face is flushed and I am trying desperately to keep my cool and not let my voice and eyes give away my terror. 

It takes me 30 minutes to place 4 stitches. You would think I am sewing up the patient’s entire body. After all is said and done, my sharps disposed of, and the patient back in the upright position, I walk into the hallway and finally get a deep breath of air. 

The chief resident chuckles and says, “so, you’ll keep practicing.” I feel inept. Certainly not unusual for me. 

I go back to the call room and practice tying knots for the rest of the evening. Next time it will be easier.