physician heal thyself *

Six hours into my second day back at work, while on call over Labor Day weekend, this happened.

I thought twice about posting this picture right up at the top, above the fold, but in the end, figured--you know this is a medical-ish blog, right?  It's just a little blood, right?  YOU CAN HANDLE IT.  (You can tell me if I should have thought three times about it instead.)

Anyway, I won't get into too many of the details of how the injury happened--mostly because in the past two weeks I've told this story at work about fifty skrizillion times and am bored of repeating myself--but let's just say that it was obtained while doing a procedure on the general medicine floor, and happened due to a combination of 1.) suboptimal conditions, 2.) poor equipment design, and 3.) poor judgement (my own) in persisting to use said equipment despite #2 in the setting of #1.  Be careful with your sharps, everyone.  They are...sharp.

Anyway, after finishing the procedure (I luckily had a second set of sterile gloves in my pocket that I was able to put on to finish off the task--a task on a patient that was not at a point where I could walk away) and though the glove was all flabby like a water balloon of blood by the end of the procedure, had a nice tight cuff that contained all my lifeblood quite nicely.  Then I irrigated my wound, finished the procedure note, and made haste down to the emergency room, where they took very good care of me.

I was instructed to get my stitches out in ten days, but the problem with wound care on your hand when you work in a hospital is twofold.  One, you have to keep your wound pretty covered up at all times--I basically had it laminated with a combination of Steri-strips, Tegaderms, and various configurations of bandages for the entire ten-day course the stitches were in.  Secondly, as I think I have mentioned before, I was my hands a lot during the course of an average work day, and no matter how occlusive I tried to make the dressing or how "waterproof" the various products used purported to be, my wound spent the better part of the ten days marinating in a brine of Band-aid water.  I tried to take the dressings off when I got home to let the laceration breathe, but the tails and knots of the stitches kept getting snagged on various things (clothing, towels, the kids' faces) so I ended up keeping the bandages on most of the time I was home too--another place where, between food prep and giving baths and changing dipaers--I had to wash my hands almost as often as I did at work.

So when my stitches came out this past Wednesday, the wound looked...rough.  First of all, it didn't really look like it had healed at all.  It was still gapping significantly, I could still see adipose through the edges of the wound, and the surrounding flesh and skin looked all ragged and macerated.  Joe offered to close it for me again, in layers this time with subcuticular stitches, but after mooshing it around and considering, I decided that I would just take off all my bandages whenever I wasn't in the hospital and let the whole thing dry out and close by secondary intention.  I was going to take a picture of the wound at this point, but be thankful I didn't, it looked even more gory on Wednesday than it did when I got the injury in the first place.  But anyway, it looks like Project Dessicate and Granulate is working, because now, three days after my stitches were removed, my hand looks much, much better than it did a few days ago.

(You'll just have to trust me on that last point.)

*          *          *

So, I'm back at work!  And it is...OK.  Actually, it's kind of hard to say how it's been and how it's going to be, since we haven't really officially pressure-tested the system yet.  Joe's mom, upon hearing how stressed we were about juggling everything, swooped into town the Tuesday after Labor Day and has been helping out with us at home for the past two weeks--getting dinner on the table, helping Cal with his homework when I'm working late, holding the baby so that Joe or I can go to the bathroom, entertaining-slash-distracting Mack, and any of about a billion different things that tip the balance of our mornings and evenings from smooth to totally unmanageable.  The kids have been delighted to have grandma in town, and it's made the transition overall much smoother.

Unfortunately, she has to go home tomorrow.  So after that, it's sink or swim.  Well, sink, swim or bob, I guess.

Overall, the difficulty with finding our new balance point now that I'm back at work is not so much getting everything done, but deciding if how we're choosing to allocate our time really is the best. Essentially a quality versus quantity argument. Well, let me revise that--it's not quality versus quantity so much as the concern that, with our current setup (three kids, Joe and I both working fairly extensive hours) that we may have neither. Part of the quantity element might be improved in a few months after my call schedule settles out--like I mentioned before, I have a pretty bad schedule for the rest of the year, I assume in part due to the leveling algorithm imposed by the computer system that my practice uses to assign our work assignments. And presumably, the quality of our time might improve when things settle down too--once the newness of the transition wears off, once the kids are more settled into their routines, once the baby gets a little older, etcetera etcetera. Maybe.

In the end, it's all doable, but we'll have to evaluate in another couple of months if the quality of the doing is really the best for everyone. Because I can't help but think--and this is judgement on no one but ourselves--that it feels awfully irresponsible to choose to have three kids and not choose to find some way to spend a little more time with them all.

* * *

You'll have to indulge me this last bit, but Cal's been just exploding with creativity since school started, and just recently, the stuff he's been writing is getting (in my utterly biased opinion) kind of good. He's been saying for a year or so now that he wants to be an author when he grows up, and while until now I've sort of considered it one of those classic Kid Aspirations (teacher, astronaut or similar--interesting to note, however, that Cal has absolutely no interest in becoming a doctor) this is the first time that I've thought there may actually be something to his plan. This (page one of his latest story) has a evocative "Hunger Games" or "Lord of the Rings"-esque feel to it, doesn't it?

(Cal hasn't watched "Lord of the Rings," by the way.  When I suggested that he might enjoy it, Joe shot me down saying that it was far too scary for a seven year-old.  I don't remember it being particularly terrifying, but what the hell do I know, I slept through the first two movies and didn't even watch the third.  What do you think?  Is it "Star Wars" level scary, or "Willow" level scary?  What is a scary kids movie, anyway?  Everyone talks about how magical "E.T." was, but that fucking thing terrified me as a child and still to this day.  That neck!  Those fingers!  THOSE WATERY TREMULOUS EYES.)

Anyhoo.  Everyone here's surviving.  Even doing well at times.  Hope you all are too.

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* I am fairly certain that I have used this title for another post before, but I've been keeping this blog for almost twelve years now so I'm fine with some creative reuse if you are.