Sunday, February 2, 2014



After three years of residency and nine years of private practice in Internal Medicine I found myself working in a busy city hospital emergency room.  As some of you may know, Internal Medicine is generally a rather clean and bloodless endeavor.  Oh there may be an occasional encounter with melena or hemoptysis  (much nicer words for bloody stools and bloody sputum), but for the most part, Internists are spared the grosser aspects of the practice of medicine.  Because my internship was back in the middle ages, I had the privilege of what was then called a rotating internship, meaning I rotated through all the major services – medicine, surgery, ob-gyn, pediatrics, and the emergency room.  Thus, some 15 years later, I felt reasonably comfortable in my new role as an Emergency Room physician.

It was only a matter of days before my comfort level was severely tested.  The EMTs routinely called the ER ahead of their arrival to allow us to make proper arrangements for the particular problem we would be seeing.  On this day they called in to say they had a man who got his “hand caught in a chain saw”.  He was pale and sweating, but an IV was running and his BP was stable.  The information was relayed to me and the rest of the staff.  While I was doing my very best to appear calm and nonchalant, the nurses were busy getting the room ready for our patient.  (This is a good time to point out that the people who really run the emergency rooms are the nurses and support staff.  Without them the physicians would be rendered lost and helpless.)

The ambulance arrived and the patient was wheeled into the treatment room; waiting with me were the nurse and the first year resident, and the 2 EMTs.  Much to my distress, the patient’s hand was wrapped in a bulky towel soaked through with blood, and in a calm, quiet voice that belied my true emotional state, I muttered something like – “well let’s take a look and see what we’ve got here...” Assuming my “been there, done this” look I began gingerly unwrapping the towel, fearful of what I was going to find.  A hand is no match for a chain saw.

My pulse quickened, as the towel was slowly unwrapped until only a single layer remained, stuck to the hand with clotted blood.  Without being asked the nurse knew to pour sterile saline over the matted mess, loosening the bloods hold on the towel.  Holding my breath I unwrapped the final layer…and could not believe what I saw.  A damn BLOODY GLOVE!   Now I had to remove this f…… glove, and I was sure that one or more fingers would come off with the glove.   Smiling at the patient and the small crowd of staff that had quietly joined us to satisfy morbid curiosities, and with my pulse now at least 140, I muttered something totally inane and carefully removed the glove, prepared for the worse.  Finger by finger, the glove came off.  And there they were, all 5 firmly attached fingers, each covered with multiple superficial lacerations.  And I mean superficial.  I don’t know which was greater, my relief or my anger for having to endure all of this for those simple lacerations.

I managed the whole affair calmly, never betraying my dread of what I might find.  But I can’t help wondering, what would I have done if one or more fingers had come off with that glove?

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