Staples and Stoicism

I was on the train back to Beer Sheva, answering practice test questions on my laptop, when I remembered the look on David’s* face and my stomach lurched. I was on my way back from volunteering at a free clinic, where I’d been helping one of the nurses. David was the first patient to come in, and the crown of his head was wrapped with bandages.
The nurse read over his letter from the hospital, which said that he needed his stitches removed today. So this, she told me, is something that the nurses do, and it is a quiet day here, so we’ll just do it here in the triage room. She asked me if I’d ever removed stitches and staples, and when I said that I hadn’t she suggested I come and learn. We went with David and his friend into the adjacent nursing station, and the nurse gathered her tools: bandages, chlorhexidine, and a gadget for removing medical staples that was not unlike the one used in offices to remove regular staples.
She removed the bandages from his head. Underneath, his close-cropped hair was matted with scabs, dried blood, and crusts. Stitches and staples snaked around the top and right side of his head, still abraded and swollen with bruises. She showed me how to remove a staple, and then handed me the tool.
“Try it,” she suggested.
I put on gloves; they were too big and flopped over the ends of my fingers. I placed one hand lightly on the unscathed side of his head, to tilt it to the right angle but also hoping to be reassuring, before getting to work.
It wasn’t hard: slide the bottom teeth under the staple, squeeze it, and out comes the staple, bent into an “M” shape. I started with the staples in areas that had healed cleanly and these first dozen or so came out easily; then I turned to the ones in the abraded and scabbed areas. It was often hard to get the tool under the staple because of scabs adhering to the staples. I tried wetting the scabs with more chlorhexidine to soften them. And then there was inserting the tool against tender areas. David sat there stoic, but when I struggled to insert the gadget in the messier areas I heard his sharp intakes of breath and I could feel his body tense. A few of the staples seemed to have rotated and I had to work them around to be right-side up before I could pull them out. Blood started to trickle down his temple and I patted at it with more gauze and chlorhexidine. It occurred that the worst thing I could do was hesitate once I had both of the teeth under the staple; the kindest thing was to work fast and smooth and get it right on the first try.
When I was done with the staples, and they were piled neatly on the counter, I double-checked that there were none left in his head, and then shook his hand. “Kol hakavod,” I told him. “You have a lot of strength.” He laughed, and motioned that he wanted the staples. His friend found a bag, I scooped up the staples, and he smiled and tucked it away in his pocket. I went to find the nurse to learn what to do about the stitches.
The nurse showed me how to take the pinchers, grab the end of the suture, pull it taut and cut it with a scalpel blade right below the knot, and then pull the suture through and out. I took the tools, and started with the next suture, but I struggled to find the knot beneath the scabs. I moved to another set of stitches with less scabs, and the first few came out more easily, and then it was on to the harder ones. The sutures I was pulling out were often covered in scabs and ooze, and occasionally, fresh blood.
Finally David stopped me, and motioned to me to wash the wounds again with chlorhexidine before continuing. As I started to do so, his friend explained that he was never going to say that he couldn’t take the pain, but that he needed a break. I washed the wounds twice over, taking my time, trying to moisten and soften the scabs while giving him as much time as I could. Then I picked up my tools again.
At one point I realized that left hand was trembling as I worked, and that I had been at all of this for almost an hour. I switched the scalpel to my steadier right hand, and worked at grasping the blue plastic sutures with the pincher in my left hand. The last ones that I did were so encrusted in scabs that finding the ends meant digging through the scabs and reopening them. Every move led to a sharp intake of breath from David.
When I finished removing the sutures and they were piled up spider-like, dabbed with scabs and pus, I offered David my hand again and told him he had a lot of strength. We agreed to throw out the sutures, since they were disgusting, leaving just the staples as a souvenir. The nurse instructed me to bath his head in polidine, and taking more gauze, I slowly traced over and over the maze of torn and healing skin on his scalp, hoping that it would be enough to prevent infection from setting in.
Later, on the train, after helping out in the pharmacy with other students, finding medicines for patients, after listening to the stories from another pretty amazing nurse and catholic nun, after learning from her how to draw pus out of a wound with hydrogen peroxide, after walking back to the bus with a patient and a volunteer translator heading for the same way, and practicing my Arabic with the translator, an Eritrean man a year or two younger than me who was practicing his English, finally I was on the train, and trying to get a bit of actual schoolwork done, when I remembered David and his stoicism and his pain.
How I had had to pull the sutures against injured skin, and hold it taut while trying to find the place to cut. How painful this had been, repeated again and again, twenty times, thirty times. How a patient shouldn’t have to suffer through that. There must be a better way that this is done, maybe lidocaine spray or something. I hadn’t tried to look for it, maybe there had been something like that in the poorly organized pharmacy, that could have eased the pain, if I’d thought of looking.
I had never removed sutures and staples before, and it is a hard thing for a patient to be student’s “first”. It is a hard thing to depend on free rather than professional/institutional health care.
I felt sick about his pain, and sick that I hadn’t tried to do more.

*Names and identifying details are made up to protect privacy, the rest is as true as true can be.

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