My pager goes off incessantly, and it's hard to predict whether it's the ER doc asking me to admit a sick child, a village health aide asking what to do about a man whose right index finger is almost completely severed after getting his hand caught in a flywheel, or the lab calling to report a sky-high INR value of 18. When I saw the page from OB this afternoon, I assumed that my 23-yr-old G7P2 being induced for cholestasis of pregnancy was on the verge of delivering...but it was actually one of the OB nurses who whispered sotte voce: "This is not urgent, but I cut my thumb and I was wondering if you would take a look at it." She had been washing dishes and accidentally shattered a mug, producing a curvilinear laceration that crossed the PIP joint of her left thumb. The bleeding had stopped after she applied pressure, and her range of motion was perfectly preserved. "Do you think I need stitches, or can I just keep it wrapped up in a bandage?"
Because of the awkward position of the laceration over a joint, I decided to give her a few stitches to hold the wound edges together during the healing process. One of the other OB nurses broke into the surgical wing and gleefully returned with 4-0 nylon suture, 1% lidocaine with epinephrine, Adson forceps, and the most beautiful, delicate needle driver I have ever seen. "It's a Webster," she told me. "It costs $300." It took all of my willpower not to surreptitiously sneak it into one of the myriad pockets on my scrubs. In the end, the injured nurse got 3 stitches and we all agreed she had to fabricate a far more swashbuckling explanation for the mechanism of her injury.
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