A stitch in time

I actually have stitching to report on! Unfortunately, it is not the kind that involves fabric and floss. Nope, we're talking flesh and silk in this case, and not mine. Luke decided to follow in his uncle's footsteps and require his first (dare we hope only?) set of stitches at age two and a half.

Do not read if you are squeamish! Got it? There will be graphic descriptions and a macro photograph at the end of stitches and a still-bleeding wound (as in "you can see his fingerprint ridge detail" type of close-up photo). I'm not kidding!

I had just finished an Excel consultation with my now-former boss when the phone rang. I could tell from the number that it was the daycare center. Great, now what? He should not be running a fever, since he is being treated with antibiotics. It is possible he is throwing up or something. But I was not prepared for what she had to say.

It seems that Luke "cut" his finger. No one really knows exactly what happened. The problem is that whenever it was that he hurt himself, he didn't cry, so the teacher didn't know there was anything wrong. They were having some free play time, where they are allowed to play in the different play areas without being directed in certain activities. The teacher was roaming from group to group, checking on the kids. When she got to Luke's group, she noticed a sizable puddle of blood on the floor (not a drop or two), so she started checking kids to see who was hurt. He had blood all over his shirt (but not on his pants; how that happened, I have no idea), and his finger was still actively bleeding. They got out the first aid kit, cleaned it a bit, and tried to stop the bleeding. After 10 minutes, it was *still* actively bleeding, so they called me. Granted, the fact that he isn't clotting doesn't necessarily mean anything, especially if he inherited my clotting ability (which is virtually non-existent) along with my looks. "It is pretty deep, and it looks like the flesh is bulging out of it. I'm pretty sure it will need stitches." Lovely.

I call my boss, to explain the situation. She is a mother of three and a very firm believer in "family comes first," so all I had to say was that daycare had called and they think he needs stitches, and all she said "I'll be praying for you. Take care of him, and just give me and update when you get back or tomorrow. Now go!" and hung up on me! LOL Next call was to my mother. (Yes, I am a horrible wife. I called my mother before my husband.) I knew the injury was to the pad of his finger, but I didn't know if they could/would actually put stitches there, so I didn't want to sound like an idiot when I called the pediatrician's office. Mom (the registered nurse) said yes they could, so I called the pediatrician. Yes, I will call my husband, but I wanted to be able to tell him where we were going when I called! I didn't know if stitches were something they could do in the office, or if I just needed to take him on to the emergency room. Yes, depending on the injury, they did do stitches, so bring him in, they'll take a look, and decide where we need to be. It was now 10:50. We got a Noon appointment (they do not take walk-ins under any circumstances; if you walk in, you are given the next available appointment (whenever that may be), but they do reserve appointments each day for same day booking). Called DH on the way to daycare.

When I arrived, the assistant director met me to explain what they theorized had happened. All they could figure is that he caught his finger on a split in the wood of one of the book cases, and when he tried to pull his finger away, it ripped the skin. They bandaged it up and put him in the three-year-old room where they were watching a video (instead of the two-year-old room where everyone was still playing). As soon as he saw me, he wanted to be picked up, which was about the only sign he showed that something was wrong (he is normally very adamant about NOT being carried). We checked out his bandage, but it seemed secure, and he did not seem bothered by it, so I just left it, even though I really wanted to see the wound for myself. She did say she was surprised that it had not bled through the gauze yet. As we headed out to the car, he didn't want to get in to the car himself, or even to be put down. He wanted me to pick him up and put him in the car seat, again a sign that there was something wrong. Besides that, though, he seemed just fine.

It was 11:15. They were due to have lunch at daycare in 15 minutes, and being an idiot mom (hey, I was in a rush to get to my injured child!), I had left the diaper bag at home. It would only take 20 minutes or so to get to the doctor's office, so I knew I needed to kill a little time, and I definitely needed to get the boy a snack. Thankfully, his juice cup from this morning was still in the car (any juice he does not finish at breakfast, he gets to take with him to drink on the way), so we stopped at a gas station and grabbed him some juice and pretzels, while I had a Snickers and a Coke (I had not had anything at all to eat at this point).

We arrived at the office at 11:50, and he was still clingy, insisting on sitting in my lap. I don't even think we waited 5 minutes before we were called back to a room. I explained what I knew of the situation and the daycare's explanation to the nurse, and she copied it all down in the chart. She looked at the bandage, and we noticed that blood was now showing on the gauze, a clear sign that it was still actively bleeding. She decided to leave the bandage on until the doctor came in. Well, actually, the nurse practitioner, which is fine. We like Leslie, and I think we've seen her more often than anyone else in the practice. Anyway, the nurse left us in the room with the fateful words of "Leslie will be right with you." It was high Noon. Leslie did not materialize until 45 minutes later!

Aside: This is a huge peeve of mine. WHY did you take us out of the waiting room, where there are plenty of toys and distractions for him while we wait, and stick us in a room with a single toy and two books, where we were then expected to wait for almost an hour?! They did that to us at the ENT in March, only there were NO toys in the room, and it was not child-proofed (seeing as it is not a pediatric practice), and I worked my butt off to keep him out of all the drawers and cabinets and away from all of the shiny sharp metal objects that were easily within his reach (at the ENT). Yes, I understand that you don't really know how long it will be before we are seen, but you do know that each medical professional takes a break between patients to make notes in the chart and things. Why not wait until then to take us back?! I've worked in a doctor's office, and I more or less understand why they do what they do, but when I am on the patient end (or the parent of the patient end), it is really annoying! GRRR /end rant

It was now over an hour past due for Luke's lunch and rapidly approaching his nap time. I feared an impending meltdown, but he did very well, and Leslie is really good with him. She took off the bandage, and I finally got my first look at the damage. As soon as the gauze was removed, the blood welled up in the wound. She dabbed at it with gauze (I can't tell you how much gauze we used!), trying to clean it up, but it kept oozing at a pretty steady rate. Still, we could see that the edges were very very raw, and the finger was quite swollen and puffy, more than just a slice, or even a rip, could account for. It ran from the very tip top of his finger (as in, you couldn't see the start of the wound if you held his palm facing you because it was on top of his finger) down the entire pad of his finger, almost half-way to his first knuckle; maybe 6-7 mm total. I couldn't help myself; I sucked in a huge breath and the word "wow" escaped my lips. I think this panicked Leslie into thinking I was about to faint (I wasn't, I just felt bad for him because it clearly had to hurt). I'm a nurse's daughter, I'm fine, though I did understand her concern, since even for nurses, it is different when it is your own kid (ask my mom). And admittedly, DH would have been a basketcase and may well have been in the floor by now. Had Luke been upset or acting like he was in pain, it would have been an entirely different matter! But since he was okay, I was okay.

She irrigated with water, which helped enough to get a good look at it while the water was running. She said it looked like there was an actual chunk of flesh missing, and there was some serious bruising at the base of the wound. After flushing with water, you could also see two small slits in the skin at the base of the wound. They looked like paper cuts placed in a very wide V shape (130 degrees or so, by my guess). Her theory on what happened is that it looks more like he pinched it in something, and when he yanked out his finger, it took a chunk with it. That would account for the cuts, the bruising, and the extra swelling. I am going to ask to see "the scene of the crime" when I drop him off at daycare tomorrow to see if we might can figure out exactly what happened. I'm not upset (well, I am, but just that my child is hurt; it is not directed at them specifically), but I would like to find the cause so that maybe we can prevent it from happening to someone else's kid.

Now, through all of this, Luke has not made a peep. Very stoic about the whole thing, in fact. At this point, with it still bleeding, she decided to have him soak it in some warm diluted betadine for a bit to thoroughly clean the wound and to help soften the edges (the wound was at least 2.5 hours old by this point, and though he was still bleeding, some clotting had taken effect). That he did not like, though all he did was immediately pull his hand out and whimper. The liquid was warm, like bathwater, but not hot. I wonder if just with the blood loss in the finger, it may have been cold, thus making the water feel hotter than it actually was. They cooled it a bit, and he did fine the second time around. I don't know if betadine has any affect on clotting, but after the soak, the bleeding did slow somewhat. She applied some pressure, which caused Luke to whimper again, but it did stop the bleeding long enough for her to get a good look at the edges. She said she wasn't sure if it could be stitched or not, so she would go find a doctor for a second opinion. In our many visits with her, it is the first time she has felt the need to call in a doctor. That scared me. (Admittedly, we mainly saw her for routine checks or ear infections, but still.)

She comes back with Dr. Nunn, who just happens to be the same doctor we saw *last* week about the ear infection, so she checked out his ears while we were there (doing much better, BTW). Yes, she did think it could be stitched. Probably two stitches total. It needed a third at the top, but that is where the chunk was missing, so there was really no place to put it, but the other two stitches would help facilitate the healing of the top part. And they could do it in the office, IF they had all the stuff they needed. If not, we'd have to go to the ER. Oh, please no! We'll be waiting there for hours in a room with nothing to do and patients with higher priorities than us and staff who are not dedicated to the care of children. And it will be an additional $75 co-pay to boot (not including the $20 for the peds visit). And we still haven't eaten lunch! But fortune smiled on us, and they had the suture kit and the numbing agent, so we were all set.

Except that the numbing agent takes 15-30 minutes to work. People, it is after 1 PM. Neither of us have eaten, it has already been a very trying day, and it is approaching nap time. But it is either that, or they will have to use injectable local anesthesia, which will take several needle jabs. ::sigh:: Can you put the stuff on, and then us go eat and come back in 20 minutes? No, guess not. So they got him all taped up (you soak a cotton ball in the topical solution and tape it to the site so it remains in contact), and we waited. Thankfully, they brought us several more books and a couple of (working) electronic toys to try and keep him entertained. He was just getting to the "I'm so tired, I'm rubbing my eyes and pulling my ears" phase (and I know he was starving) when they came back and declared it was time.

We laid him down on the exam table (which he as never liked), with Dr. Nunn up by his head, a nurse at his torso, and me at the foot of the table. They took his hand and put it palm up by his head. The nurse used the hand closest to the table to hold his elbow, resting her elbow on his chest to keep him steady, and her other hand to hold his wrist. I laid over the end of the table on his legs and held his other hand. Everyone took a deep breath, and she started stitching. I was fine with the blood, but I don't think I could have watched her stitch him up. As it was, though, I couldn't see from my position even if I wanted to. Luke, however, watched her from start to finish, which almost unnerved her.

Since she knew I could not see, she was kind enough to narrate what she was doing so I would know how things were progressing. When she very first stuck the needle in, he did scrunch his face and stick out his lip and his eyes filled with tears, like he was about to start crying. They had focused on making sure the main pad of his finger was numb, so it may not have covered as well at the base of the gash and still been a little tender. But we all reassured him that he was doing really well and being such a big boy, and he took in one huge shuddering breath, and didn't make another sound. She got two good stitches in, and that was that; we go back Tuesday to have them taken out.

No one could believe how well he did, especially once they realized he's not even 3 yet. If you had told us everything that was going to happen to and be done to him today and tried to convince any of us that he wouldn't cry at all, we'd all have said you were nuts, but he did absolutely amazingly awesome. Everyone kept telling me he deserved a special treat, "maybe even a Happy Meal." You know he has to be doing something special when a *doctor* is recommending McDonald's for your child! LOL

By the time we left, it was 2 PM. Two and a half hours past lunch, and an hour past the start of nap. I made a beeline for the closest Wendy's (he doesn't care for McDonalds, actually) and got him 10 nuggets to go. He ate six in the car, and the other four after we got home while I was making the phone call rounds to my husband, my boss, and my mother (yes, in that order; see, hubby is first sometimes). He even brought the empty container over to me and said "want more." Nearly broke my heart, but I never in a million years thought 10 nuggets wouldn't be enough. I placated him with a bag of marshmallows and Star Wars. By 2:30, he was rubbing his eyes, so I put him down for a nap, and he slept for almost two hours. He was practically hysterical when he woke up. I think he slept hard and was very groggy, and I'm sure the numbing agent had worn off by then so his finger probably hurt like heck. We doped him up with some Advil, turned on Ice Age (his favorite movie, at least this week), and let him cuddle as much as he wanted.

And after all day of not making a peep about this thing, he pitched an absolute *fit* when I had to change his finger bandage before he went to bed. And as I suspected, DH swayed a bit when I got the bandage off and he took a good look. He turned pretty white, but he stayed upright. He's pretty upset about the whole thing now that he's seen the damage. "Mangled little nubbin" were his exact words, I believe. ::sigh:: I was, however, able to snap this quick photo of said mangled digit (using the spiffy macro setting on my camera) before applying the fresh bandage:



Way way way more exciting than I ever would have predicted today to be. Can I please just have a normal calm boring week? Please? You know the illness/health concern section of the monthly round up I have started doing? I would *really* like to have a month where I only had one word to type there: none! Is that so much to ask?

Currently feeling: so tired of doctors