Agraphia Medical Tragicomedy

20Jan/10Off

30 minutes

Many of my stories happen at 4:30 in the morning.  Why?  Because that's when I'm forced to make the choice: my sleep, or my patient?

This was a particularly nice 16 year old who lost control of his car on black ice, careening into a tree at high speed and breaking most of his ribs.  The crash caused his windshield to instantly shatter, giving him a few scattered cuts across his face  and one huge slice through his lip.

Ribs will heal on their own, but the lacerations to his face need sewing.  Now, I'm no plastic surgeon, but I am an ER doc and I sew up a lot of wounds. Importantly, the vermillion border - the demarcation between the lip and the face - is one of the most cosmetically important areas of the face. Even a millimeter of disunion is instantaneously recognizable by the human eye.

And so, 24 hours into my trauma call I was faced with a choice.  Let one of my less experienced colleagues fix his lip in a few hours, or take the time to do it now, myself?  My body was screaming from a difficult call night; 15 or so trauma codes in the last 12 hours, sleep deprived for a month, contorting my back to examine patients in c-spine collars all night long.  I felt the overwhelming, primal need to crawl into a corner and sleep.

I suppose, in the end, it was a false choice.  I went into this profession for a reason - to help people.  Knowing full well that these 30 minutes of my time would directly impact every interaction he has with people for the rest of his life... well, that's time well spent.  The repair went wonderfully.  He'll have a barely noticeable whitish scar through his lip.

What I've gotten used to in medicine is this:  most patients will never realize how important my small time in their life really was.  A missed diagnosis here, a well-repaired laceration there, a timely intervention when needed.  I think it's a large part of why I went into emergency medicine - I want to be there for the important stuff.

When he gets out of the hospital, I'll tell him.  "Your lip looks great, man.  I'm glad you're doing better."  He'll probably never know why I was more concerned about his lip than his ribs.

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