Sapphire Eyes ~ 10 Chapter Challenge

Sutures ~ Deb

"Hastings," I call out, and the frantic mother from earlier grabs Kaden's shoulder and walks him across the waiting room up to me. "I'm Dr. Horton, and this is my high school volunteer," I say, gesturing with my chart to Mirna, where she is standing by the counter wearing a doctor coat that is two sizes too big for her. Mirna winks at Kaden, and he cracks a little grin. "She wants to go to medical school, so I'm letting her observe me at work. Come on back," I say, and I lead the way down a hallway into trauma three. "Have a seat."

Kaden slumps over to the checkup table while I grab what I need for the suture and set everything on the prep tray close to the checkup table. I try to act completely engaged in my work, but I steal glances at Kaden to see him gazing at Mirna, and I glance at Mirna to see her blushing at Kaden. He smirks at her and she tries not to smile. They are so obvious, but somehow Kaden's mother seems oblivious.

"Alright, I'm going to use this needle to numb your chin," I say as I pick up the syringe, stick it in the vial of lidocaine and draw out 100 mL. "It'll be three small pricks, and then you won't feel a thing."

I carefully position the needle and inject a third of the dose on each side of his chin, to the right of the laceration, the left, and below it. He cringes with each prick of the needle, even though I'm trying to be gentle. He gasps with the last injection.

"Nice job. Now we wait." In the silence, Kaden shifts closer to his mother and grabs her hand, which seems like a very childish thing for a teenager to do. It's rather precious. His mother actually frowns at him, and I'm left wondering what her problem is. This kid was obviously in an accident and is no doubt feeling vulnerable from the injury, and I cannot help but ask about it. "That's a deep cut. How'd it happen?"

"He had a seizure in the bathroom," she explains

"Mom!" Kaden hisses in embarrassment. He glances at Mirna. She raises her eyebrows at him and then looks away.

I cannot help but frown. "That's a shame. How about we do a blood draw and check your AED levels," I suggest.

"That won't be necessary," his mother says.

I'm used to this sort of response from patients who deal with daily seizures. They don't see how AED levels can tell them much when the seizures happen every day. But it's useful data for us. "A serum level can help rule out causes for the seizure, such as non-compliance, and can help determine if changes need to be made to doses or medications."

"Daily seizures are typical for Kaden," his mother explains. "Besides, we have an epileptologist to take care of all that."

She has no idea I'm going to be seeing Kaden next week. I decide not to bring it up, and instead I lower my voice to whisper to his mother. "I know you may feel like you know your son, but—"

She cuts me off. "You're right. I know my son, and we don't need any tests done. Just take care of the stitches."

Well, that's unfortunate, but hopefully there will be other opportunities to get blood draws after seizures. I hate hinting that patients may be in noncompliance with their med regimens, but with teenagers especially, it's actually common. They want to feel in control of their lives, and with refractory epilepsy, the only way to feel in control is with choices like skipping meds when adults tell them to take them, just to be rebellious. It's unfortunate but possible that this kid may be doing just that and causing his seizures to worsen.

I study the laceration to distract myself from the awkward moment. It is only about three centimeters long, and half a centimeter deep for the most part. It will make a curved row of sutures though, which will be rather ugly. Since it's on his face, I'm going to use simple interrupted sutures so he won't have seriously bad scarring, though it's possible he'll still get a scar.

"Are you numb yet?" I ask, to break the awkward silence.

He nibbles on his lower lip and nods. I pick up my taper needle and gingerly begin the sutures, creating a slight eversion as I make my way around the laceration. I take adequate accurate bites of cutaneous tissue and apply moderate tension to the sutures, throwing back and forth twice before moving on to the next.

Kaden's eyes start to tear up as I continue to work my way around the curved laceration. By the fifth suture, tears are streaming down his face. I feel simply horrible, but there's nothing to be done but soldier on and get it over with sooner. His mother squeezes his hand and holds his shoulder. Kaden glances at Mirna and goes red in the face from embarrassment.

"Last one," I say as I thread the needle through his skin one last time. "Ten stitches," I say as I expertly tie a braided suture knot and snip the vicryl. He wipes his face and sniffs rather pitifully. I pull out an alcohol swab to clean the laceration.  I busy myself with cleanup, gather the chart, and usher them toward the door.

"Will he have a scar?" his mother asks as he slides off the table. He clearly mouths the words thank you to Mirna, which is very thoughtful of him. She seems completely pleased with herself for getting him through that god-awful line in the waiting room. I'm honestly glad I could be here to make their wait shorter.

"It's possible," I say. "We'll know in three to five days when you come back to remove the stitches."

Mirna shrugs discreetly and then with her hand down by her waist, she waves goodbye to Kaden and they head for the door.

"Okay, thank you." His mother takes him by the shoulder and walks him down the hallway toward the Emergency Room desk. They're gone just like that.

I mirror Kaden's mother and put my arm around Mirna's shoulder. But like the typical teenager that she is, she shrugs me off. "Thanks for helping him," she says though, and I'm surprised at her manners.

"It's no problem Mirna. Really, I'm happy to help."

"He looks like Jimmy, doesn't he?" she says in this sad, quiet voice.

"I did notice that. But only a little." I let the silence sink in as I contemplate how long it's been since the accident. Not nearly long enough to dull the pain. I blink the tears away and lead Mirna out to the car to head home.