Last night at County ER, USA, I had the dubious honor of sewing up a 5cm self-inflicted arm laceration on a young, angry, drunk, suicidal, borderline-personality-disorder guy.
It was a fairly superficial cut, as far as these things go. He had multiple other healed cuts on his arms which implied this was not his first time cutting, and since my exam revealed an isolated skin laceration, the first thing to do was irrigate the wound and stitch it up. Straightforward, yes?
Of course not. At County ER we put most of our drunk patients (and all of our drunk, suicidal patients) in 2-point restraints, simply because as they begin to sober up they often decide it's time to leave... and more than a few have still been very drunk while sneaking out the back door. One patient years ago was run over by an incoming ambulance as he made his escape; ergo, restraints until you can make sober decisions.
As my patient started getting it through his thick skull that he was restrained, he began thrashing around. Violently. While I had all my needles out repairing his skin laceration. Did I mention he was hepatitis C and HIV+? Of course he was. Why wouldn't he be?
A particularly hard kick sent my lidocaine syringe arcing through the air, missing my thigh by inches. My suture slipped through my fingers; it's a miracle the needle didn't impale me as I lost my grip on the thread. He stared directly at me with his beady, spiteful eyes, "It's a good fucking thing I'm restrained, because I'd fucking kill you right now. Right fucking now."
Four nurses rushed over to help me restrain him and lock down his arms and legs, assuring him that it was a felony to assault a healthcare worker. I quickly put some gauze on his cut and bandaged him up.
I assume that the 7 stitches I managed to place will hold his cut together just fine. I'm just glad I could be of service to such a fine, upstanding young gentleman.