Tuesday, March 31, 2009

Plastic Surgery and Netter

While I was in the labor ward finishing a repair of a vaginal laceration, I got called from the ER about a patient they wanted me to see. So, I finished what I was doing and headed for the ER. I found a lady who had been in a car accident who suffered some bad lacerations to her face. A nursing student had initially tried to sew up her lac, but he wisely called and asked for help.
She had a laceration that involved the base of her nose and part of her upper lip. The base of her nose was off of her face and the area between the 2 nostrils was separated. I put my finger into this lac at the base of her nose and I was amazed at how far it went. Thankfully I didn't hit brain or go through her palate so I decided to start sewing. The nursing student stayed to help me hold things open and to blot her eye as water would go in. During the procedure she often had to sit up and spit out a bunch of blood that she had accumulated in her throat, but we kept going. Early on as I was trying to figure out how to put this together she says, "Doctor, please don't leave a scar." I had to try not to laugh. She had no understanding of what her nose/face looked like when she came in, and now she wants me to try and not leave a scar. Plastic surgery wasn't part of my residency training, but I was doing the best I could, but I knew a scar was inevitable. I told her I was going to do by best, but I thought she would have a scar.
It was late by the time I got done, so she stayed overnight on the ward. I had attempted to draw a picture in her scalebook to try and show where the lacs were for anyone who might be interested later. As I was drawing it, I was thinking, I am not an artist, I shouldn't be doing this, but I drew it anyway. The next morning Jim comes and finds me on the ward asking about her. He shows me my drawing and informed me that Frank Netter has nothing to worry about. (Netter is the illustrator of a number of anatomy textbooks). I went to see her on the ward and was surprised at how well she looked. I don't think any plastic surgery programs are going to come knocking on my door, but I was thankful to be able to help her look a lot better than when she came in.