November 6, 2018
I did my first suturing today.
I thought that would be a great accomplishment, commemorated by pictures and probably a self-congratulatory facebook post. After all, isn’t that the coolest thing you get to do if you’re a “bush nurse”? Especially if you’re actually just an EMT…not even a real nurse. How many EMTs get to say, “I stitched a person’s body part back together”?
In my first two weeks here, I had been the second set of hands for quite a few suture jobs. I thought that was just how things go here. Every other day or so, you stitch people back together (and there was that one night with four jobs from the same fight…). So a couple weekends in, I sat down with a suture kit and a skirt I had shredded while climbing out of a river. Perfect opportunity to learn the stitch, which wasn’t as hard as I had thought.
Then, right on cue, the fountain of suture jobs dried up. The end. Lots of tuberculosis and broken bones followed, but no more suturing. Apparently, maladies come in waves, and the suture wave was over. Oh well. Good for everybody here – good job not chopping body parts open!
Last week, I told Manandi that the next time she saw a suture job, I’d like her to talk me through the process. She smiled and nodded, “Sure!”
The next day, Wednesday, a woman walked up to the porch, carrying a little boy – her nephew. She told the story with shaking hands and frightened eyes.
“His mother went to the bush and left her kids with me. I was clearing some bush in my garden…I cut a pineapple and gave it to them, then went back to work. Somehow, he fell and rolled to where I was cutting.”
His right hand was shaking too, and he was crying. His name was Sedrik, and his right pointer finger was gone just below the middle knuckle.
Before going further with this story, I have to stop and praise the Lord for His protection of this little boy (who became my buddy). I don’t want to imagine how bad that injury could have been. I’ve seen women cutting grass with machetes here. They don’t mess around: they work hard. Sedrik could have lost much more than a finger.
My heart hurt for Sedrik and his auntie. They were both traumatized.
Manandi sent her back to the garden to find the missing finger. “We’ll see if we can sew it back on.”
A couple hours later, auntie returned. We cleaned the finger, gave Sedrik some knockout meds, and turned the exam room into an operating room. Manandi fished out the extender tendon from the stump. While she was working on clamping the one in the detached finger, I tried unsuccessfully to find the flexor tendon.
“It’s okay. We need to get it sewn – it’s already been off so long.” Shaking her head, Manandi made the call to go ahead and put it together without reattaching both tendons. In retrospect, I think she knew that Sedrik’s chance of keeping his finger was very small; in which case, it really wouldn’t matter that both tendons weren’t repaired.
I held the finger in place, and Manandi sutured all the way around. I was afraid she was gonna ask me to suture. After all, I’d just told her I wanted to. But this was different. I sat beside this little boy, literally holding his hand together, thinking of my nieces and nephews – both my brother’s children, and the crowd of kids at my church whom I love like family.
Reni, my four-year-old niece, makes my heart sing when she holds my hand. My pastor’s kids love playing dodgeball and nerf wars and guitar with me. My best buddy Isobel draws me pictures. Gentry runs into my classroom every morning to give me a hug on her way to her kindergarten classroom. Liam loves pillow fights at my house (even though he nearly lost an eye during one…). Ben became a proficient guitarist through a couple years of lessons. Max gives me high fives and big grins every week. Red-headed Emerson holds his hands out asking for candy. Baby Ellison just grips my finger and drools on my arm.
If something happens to one of those kids, they can go to an actual hospital with an actual operating room and an actual surgeon. Sedrik? We were all he had. And in spite of our best efforts, he probably would still lose his finger. You’re awesome, and you’ve got this, Manandi. Holding the parts of this hand together is really as much as I want to do right now.
Sarah, Sedrik’s mom, arrived after we were done. He was still knocked out. (Ketamine is weird – the patient’s eyes stay open, even thought he’s totally gone.) Sarah climbed up onto the table, picked up her boy, and cradled him. I thought of my sister-in-law, and my friends Sheila and Peachee and Amber and Amanda and Cheri, and how much they want their kids to be okay. This momma is exactly the same. Yet, even if his finger lives, it will never work right.
Lena had told me that Sarah was a good friend, so I loved her more already. For the next five days, we saw Sedrik daily. He needed strong oral antibiotics and shots, because the risk of severe infection was so high. Each day, I got to play silly games with him and his baby brother, Seth. He started smiling, eventually, and Sarah started calling me his “nani” – big sister. Go ahead and melt the rest of my heart, why don’t you…
We prayed. And gave shots. And checked color and capillary refill and suture line. And prayed. And sent pictures to Lena for input. And prayed.
Today, the tip of his little finger was dry and shriveled, the rest soft and dark. It had to come off again, or gangrene could eat up the rest of his finger (or worse). Sarah wanted to wait until the end of the day, when the other patients had left (it’s hard to do anything serious in the clinic without an audience).
Sedrik played on the steps while I treated patients all day. He played peek-a-boo at my table, ran behind me and poked my side, and mimicked my silly faces. Little Seth, clad in his birthday suit, just laughed on his mom’s lap. These boys are too much…
By the time the last patients were done, Sedrik had fallen asleep on the porch. I picked him up and sat next to Sarah. He was half-sleeping, half-whimpering. Poor little guy. This has already been so much pain for him.
Time to start. Emma gave him the Ketamine shot, I handed him a pack of Maggi noodles, and then he was out and we got him on the exam table for the second time.
I unwrapped his finger, removed the splint, and wiped his hand down with saline. A piece of saline-soaked gauze helped to soften the crusty parts. I felt a little nauseated as I snipped the sutures that held the dead finger to the living stump and then removed them with tweezers.
Manandi came in just in time to pull the dead part off. I glanced up at Sarah, standing beside me, silent tears streaming down her cheeks as she caressed her boy’s head. I knew this was hard for Manandi too; Sarah wasn’t only a patient, she is a relative of Manandi’s.
We cleaned and cleaned. Such risk of infection still…
Manandi snipped away hardened pieces of dead flesh. Marie kept up communication with Lena, sending pictures and questions and relaying her responses. Manandi kept saying, “Mi no save (I don’t know),” as she cleaned and cut.
“Do you want a scalpel?” Marie offered.
“We have to cut away enough flesh to fold skin over the bone and suture it to the other side.”
“It’s really tough…this is all muscle here.”
Sarah pressed in on my left, inhaling sharply every time Manandi leaned in with the scalpel. Does she understand why we have to cut? I tried to explain what we were doing, but it was still painful to watch.
Finally, Manandi set the scalpel down. The skin still wouldn’t reach the other side. Too much flesh in the way. “Do you want to try?”
Um, no, not really. But I guess I will anyway. I signaled with my head, and Marie understood my unspoken request.
“Here’s a chair, Sarah, you can sit down. Here’s some gauze; can you wipe his mouth?” Thank you, friend, for giving her something to do so we can just cut what needs to be cut and get this finished.
After some further surgery, the skin would finally cover the bone. I held it in place, and Manandi began suturing. We are almost done…
“Once I’m finished with these, you can do the rest.” I didn’t think I understood her right, but when she handed me the needle, I realized I had. And just like I’d practiced, I stitched the rest together. Manandi was a great teacher and help. I still need to practice more. My fingers felt awkward and clumsy.
Then it was done. We cleaned the suture line thoroughly, tossed the needles and scalpel into the sharps container, then wrapped up the bloody gauze and gloves in the chuk and tossed it. Marie carried the instruments into the other room and scrubbed them down. The end.
Sarah held Sedrik while I secured his arm in a sling. We chatted a bit. Kind-hearted Emma brought over some cucumbers from the house; she was concerned for our friends since they’d been here all day without eating. We waited until Sedrik was responsive, and then they headed home.
So…my first time to suture, and I really don’t care if anyone got a picture. It was just sad. We weren’t just stitching together something to heal, we were closing up a wound that meant a kid lost his finger. Yeah, we did our best. We tried to save it. But it didn’t work.
And there’s still the danger of further infection, and we’re still praying that he doesn’t lose any more of his hand. That’s part of why I think I feel the need to write about this now, before it gets worse (if it gets worse).
It’s almost time for sleep now. But one thing about suturing is the smell of iodine and blood that lingers in your nostrils. As I sit here at the desk, having taken a shower, changed, and eaten dinner, I still smell it.
And then there’s the picture that stays in your mind. A bloody stump, the bone exposed. Sedrik’s eyes open, glazed over, drool trickling from the corner of his mouth. Sarah’s tears.
And there’s the feeling too – holding a little hand in my gloved ones, regularly dabbing the blood away with gauze to keep my grasp from slipping. The warmth of mom’s body pressed against my side. Manandi’s head brushing mine. But mostly just his little hand.
I don’t feel self-congratulatory. I mostly just feel sad.
Maybe the next suture job will be different.
January 12th PS – This story needed a delay to share for a couple reasons. For one, people generally like to know the actual ending of the story. While I needed to write this before knowing the end for my own sanity, I guess I figured other people would expect to know how it ended.
Also, Sedrik was the first patient I got so attached to. This one is more personal, because Sedrik stole my heart. It’s hard to write a story and be so emotionally invested in it.
So the end…
Praise the Lord, the “it could get worse” was never realized. After another month or so of antibiotics (tablets and shots), Sedrik was discharged with a healed stump of a finger. I saw him last week, watching volleyball with an auntie. He’s a little stinker, so he just frowned at me. But the next day when Sarah came to clinic, she told me his secret. He was happy to see me – he told her so when he went home.
I sure do like that kid.
