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The Art of Medicine

A slice of life

Maurer, Brian T. PA-C

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Journal of the American Academy of Physician Assistants: April 2018 - Volume 31 - Issue 4 - p 58
doi: 10.1097/01.JAA.0000531055.35373.08
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The value of experience is not in seeing much, but in seeing wisely.—Sir William Osler

“Can I see your first patient of the morning with you?” the new student asks. “It's a laceration, here to be glued.”

An interesting way to present a patient, I think to myself as I escort the student into the examination room.

I introduce myself and the student to the man sitting in the chair. Immediately to his right sits a lanky youth clothed in a dress shirt and tie. The man appears to be in his late 30s. Already the lines of life are etched in his face. The man is white; the boy is black; my student is Asian: a mix of cultures gathered together in this small space.

“What happened?” I ask the boy.

Silently, he holds out his left hand, palm up. I note the clean linear laceration across the hypothenar eminence. It appears as though the area has been coated with ointment. There is no suppuration of the wound.

“I was trying to slice an orange with a kitchen knife,” the boy says. “It slipped.”

“I see,” I say. “What did you do for the cut?”

“We had him put his hand under water from the tap to wash it out,” the man says. “He's been keeping it covered with some ointment and a bandage. I called the office yesterday to see if we could get him in, but they said there were no openings.”

I check the frown on my face. “Usually we try to see an injury the day it occurred,” I say.

“Actually, he cut himself 2 days ago,” the man says. “It didn't look that deep, so I didn't think he needed stitches. Then yesterday I remembered that sometimes cuts can be glued. That's when I called.”

Gently, I examine the wound. The moist edges separate easily but the cut is superficial. I ask the boy to flex and extend the fourth and fifth fingers at each joint: there is certainly no sign of tendon involvement.

“It looks okay at this point,” I say. “It's been over 48 hours since the injury. Usually, we like to close wounds within 6 to 8 hours; otherwise, they have a tendency to infect. I could try to glue the edges together but the glue won't stick to the greasy ointment. We'd have to scrub it out first, then hope for the best. Because it's superficial, I think your best bet would be to keep it clean and allow it to heal on its own.”

Gradually, the man nods his head. “If you think that's best,” he says. “Could we bother you for a new bandage? He's heading back to school from here. I've got to get to a funeral.”

The words stop me short. “A funeral? Who passed away?”

“Our next-door neighbor,” the man says.

“Had he been ill? How old was he?”

“Ninety-two,” the man says. “He hadn't been good for a while.”

“Were you close?”

The man nods his head. “He was the first to welcome us when we moved into the neighborhood 15 years ago. He and his wife were always good to us.” He looks at the boy. “Things were tough; they helped us out.”

“I'm sorry for your loss,” I say. “It's good that you can go.”

Again the man nods his head. I open a bandage and press it across the wound. “In a few days it will be healed,” I say; but not all wounds heal that easily, I think.

“Do you like to read?” I ask the man.

“I like to read, but usually I haven't got the time.”

“There's a book you might be interested in,” I say, pulling out an office notepad. I jot down the title and hand him the slip of paper.

A Man Called Ove,” the man reads.

“It's a modern novel,” I say. “There might be a movie coming out. It's not great literature, but it's a good story. Your 92-year-old neighbor reminded me of the main character.”

The man stands and offers me his hand. “Thank you,” he says. He ushers his son out.

The student looks over the boy's chart as I stand poised to write my note. “Would sutures have been better than glue?” she asks.

Copyright © 2018 American Academy of Physician Assistants