REFLECTIONS2004 Creative Writing Contest Honorable Mention

Laceration Repair

What was his real name? Riggins . . . Rogers . . . Boggins? Triage Nurse called him the prick with the

thumb laceration. He resembled the two men who walked him into the ER and then left—thinning hair

combed flat, grease-stained jeans, and a pair of scratched goggles hanging from his neck. He made a

scene when Triage Nurse tried removing the bloody bandage. ‘‘Easy, will ya,’’ he said, yanking his hand

away.

‘‘I need to see it,’’ she said.

‘‘What for,’’ he asked. ‘‘You don’t believe me?’’

For three hours he waited. By the time I introduced myself his anger had stewed and the crude

bandage, layers and layers of blood-crusted gauze, had hardened and become even more difficult to

unravel. He wouldn’t lift his hand off the stretcher when asked.

‘‘It would make it easier for me,’’ I said.

‘‘The foreman made me come,’’ he said. ‘‘Everybody and his brother scared of being sued.’’ His eyes,

sloe black, set far into his sockets, wouldn’t look at me. ‘‘I took a piece out of my arm last year. Worse

than this, into muscle. It healed fine, and I didn’t need any doctor.’’ He rolled up his shirtsleeve, fingers

poking through shredded flannel. ‘‘Look here,’’ he said proudly. Halfway around his forearm a raised,

pink scar shaped like a quarter-moon smiled up at me.

‘‘You were lucky,’’ I said.

‘‘No,’’ he said, tapping his creased forehead with a partially amputated index finger. ‘‘I was smart.’’

I couldn’t peel away the blood-soaked bandage without tearing off the clot. I poured saline over the

bandage to soften it. It wasn’t necessary, but the pain would be severe without this simple step.

‘‘How did it happen?’’ I asked.

‘‘I don’t know.’’

He worked at a truck-manufacturing plant, eighteen-wheel dinosaurs that chewed up the inter-

state. The note from the onsite nurse said his sleeve got caught in a machine.

I asked him to describe the machine, what it was used for.

‘‘Why? You thinking of buying one?’’

‘‘It’s important to understand the mechanism of injury.’’

‘‘It’s big and sharp and loud.’’

The cut was deep, but not into bone. To evaluate whether nerves were cut, I asked him to move his

thumb through various positions, asked whether he could feel me when I touched different points.

‘‘Just fix the damn thing, will ya.’’

‘‘I don’t have to sit here and take this attitude from you,’’ I said, our eyes meeting over the gash in

his flesh, blood now pooling in his palm.

‘‘Yes you do,’’ he said. He didn’t say anything more, as if he knew I’d take a deep breath and bite my

lip because absorbing insults was part of my job. When I stood to leave his thatched eyebrows arched

with surprise.

‘‘Where are you going?’’

‘‘I’m not Dr. Doolittle,’’ I said, promising to return when he learned to act like a human being.

‘‘How long will that be?’’ he asked, checking the watch face on the underside of his hairy wrist.

Was he capable of a joke this dry, or was he serious? Such concrete thinking might be evidence of

someone with mental illness, or someone considered slow. Regardless, I sat down again and set about

fixing him. His thin body tensed as I angled the overhead lamp, snapped my hands into sterile gloves,

painted his thumb and palm with iodine solution. If we weren’t in the hospital, I could imagine him

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punching me for much less provocation than injecting a needle into his skin. ‘‘This is Lidocaine, like

Novocain at the dentist,’’ I said. ‘‘It may burn going in, but then you’ll feel nothing.’’

‘‘I know what it is,’’ he said.

‘‘Your entire thumb will be numb. You may feel me tugging on the sutures, but you shouldn’t feel

pain.’’

‘‘Do what you want to do and let me go.’’

‘‘I’d like to sew you up without local anesthesia,’’ I said.

‘‘Why don’t you?’’ he asked. ‘‘I am the prick with the cut thumb, right? That’s what the nurse called

me, right?’’

‘‘Yes, I’m afraid so.’’

Numbing his entire thumb was for my comfort. Now he’d have trouble making a fist. I didn’t tell him

that.

I focused on making certain the wound was absolutely clean. I noticed a wedding band, dull gold

covered with grease and mossy tarnish. I laid a sterile drape over the entire hand. A hole in the middle

exposed only the laceration.

‘‘Don’t touch this area above the drape. It’s sterile. I don’t want you to contaminate the wound now

that I’ve cleaned it.’’

He yawned. His face was reptilian, coarse and creviced. If he removed his skin, crumpled it into a

ball, and flattened it out again, it wouldn’t look this bad. After raising his right hand to cover his mouth,

he tugged on the sterile drape with his greased fingers.

‘‘What did I just tell you?’’

‘‘Sorry,’’ he said, actually looking remorseful.

I began suturing without the usual comments. I didn’t ask whether the needle hurt. I didn’t de-

scribe how I was probing the cut in search of buried flecks of metal, grease, or flannel threads. I didn’t

want to talk with him, which was unfortunate. Repairing the laceration would take time. Sitting down

to sew can be a pleasant break, an opportunity to have a conversation, not as doctor and patient, but as

normal people might do if they found themselves sitting together, waiting. Tension grew without words

to fill the time.

I thought of his wife. Who would marry such a man? I imagined her as slight, prematurely graying,

soft spoken. A proud, quiet drunk who never slurred her words, nor did she stumble. At worst she

rattled the coffee cup in its saucer and spilled a few drops. He probably hit her, but not nearly as much

as he used to.

Their grown children probably lived within a few hours’ drive. They straddled the limits of distance

and proximity, living as far away as possible while remaining near enough to visit and check on their

mother.

With each knotted stitch, the wound edges together but barely touching, I believed I was closer to

figuring him out. By the time I finished, I no longer disliked him as much.

I collected the suture instruments; he examined his thumb. ‘‘How many stitches?’’ he asked.

‘‘Thirteen.’’ I held his hand, wiped off the blood, applied a clean dressing. ‘‘No work for two days.’’

‘‘I’m going back to work now.’’ He pulled out a folded paper from his shirt pocket. ‘‘Fill this out. I

can’t go back to work without a doctor’s OK.’’ He pointed to a few lines on the form, the boxes I needed to

check, and where I should sign.

‘‘You’re right-handed. You have a deep cut into your right hand. If you use it the stitches could tear

open, the wound might get infected.’’

‘‘That shouldn’t happen if you did a good job, right?’’

I didn’t have time to respond before he took the scissors off the suture tray, eased himself out of his

flannel shirt, and tried cutting the sleeve above the elbow, above where the fabric was shredded.

‘‘Give me those scissors,’’ I said.

His hand, bulkily wrapped with gauze, barely allowed his fingers to operate a simple pair of scis-

sors. A potbelly bulged through his white T-shirt, tinted gray. He winced, jaw clenched tight, trying to

slice through fabric that would only fold and catch between two blades.

He pushed the scissors and the shirt into my hands. ‘‘You do it.’’

JGIM 557Reflections

I tossed the scissors onto the suture tray. ‘‘You can’t even use a pair of scissors, how are you sup-

posed to work on an assembly line.’’

‘‘I need to work,’’ he said. ‘‘Cut the sleeves.’’

‘‘Why?’’

‘‘My wife will give me hell if she finds out I got hurt again.’’

‘‘The bandage and the gash won’t tip her off?’’

He studied his hand. ‘‘I can make up a thousand stories for this.’’

With a tape rule I measured from the shoulder and cut the flannel until he had short sleeves of

comparable length.

He worked his way back into the flannel shirt. ‘‘You missed your true calling, Doc. You should’ve

been a tailor.’’

He examined the bandage on his hand. ‘‘I hope it heals as good as this other one,’’ he said, the ugly

scar on his forearm mocking me. ‘‘Everyone is so scared of being sued these days.’’ He grinned, studied

my ID badge, smiled at me with tarry teeth. ‘‘I’ll take good care of it, Doc. Don’t you worry.’’

‘‘I worry,’’ I said.

He pointed to the form. ‘‘Then sign it, and we can both get back to work.’’

I slashed the boxes, scribbled my signature.

‘‘Thanks,’’ he said, without looking at me.

JAY BARUCH, MD

Cranston, RI

—FROM FINAL JUDGE CORTNEY DAVIS—

‘‘Laceration Repair’’ is fast moving with great dialogue and wonderful language that picks the reader up

and plunks him or her right down in the ER next to a doctor who must stitch up a surly patient’s hand.

The nurse calls the patient ‘‘the prick with the thumb laceration,’’ and what a patient he is—one of those

who wants to call the shots and criticize everything that’s done. The doctor tells him he doesn’t have to

‘‘sit here and take this attitude’’ and, in a snappy back-and-forth exchange both doctor and patient stake

out their territory. Something else happens too. Observing his patient, the doctor imagines his life, cre-

ating a wife, a family, a way of being—and by doing so comes to know and tolerate his patient. By the

story’s end, the doctor is almost tenderly cutting the patient’s sleeves to the same lengths so he can go

back to work. Prickly to the end, the patient studies the doctor’s name badge, tells the doc not to worry. ‘‘I

worry,’’ the doctor replies.

This story exposes in a few pages the complexities and subtle undulations of emotion in a feels-

exactly-true interaction between physician and patient.

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