Tuesday, June 26, 2007

96 Tears....or Stitches, or whatever

People are funny --- ya just gotta love 'em! I have to laugh every time I hear a variation of this question:

"How many stitches did they have to put in?"

Of course, the question is always directed at me --- you know, the guy who just carefully placed all of the sutures --- but somehow the question is always asked in regards to some nebulous "they." In any event, folks are always interested in knowing just exactly how many sutures were placed to close a patient's wound. Gee, how does one answer that question? Was it a subcuticular running suture? Interrupted single sutures? Horizontal mattress sutures? Vertical mattress sutures? Or, horror of horrors, skin staples?

And another thing -- what does this question imply? Is it simple curiosity, or are folks wanting to know if I made an ugly scar? Or maybe is there a subtle critique involved, that somehow I used too few or too many sutures. Sort of like the fabulous exchange between the Emperor and Mozart in Amadeus:
Emperor Joseph II: Your work is ingenious. It's quality work. And there are simply too many notes, that's all. Just cut a few and it will be perfect.
Mozart: Which few did you have in mind, Majesty?


What is almost never asked, of course, is what happened on the inside of said wound.


Surgery is in many ways like making chocolates --- the customer/patient wants the outside to look nice and pretty, but it's what is inside the chocolate that counts. Nothing is better than selecting a chocolate at random from a pretty box and tasting a little bit of heaven. But surely everyone has bitten into a chocolate confection, only to find it contained something that tastes like year old mold with a hint of orange? Well, unfortunately, surgery can occasionally be a lot like that. My job is to make sure that the "insides" of my "chocolates" are, if not necessarily tasty, then at least well made.

So, whenever I get asked about "how many stitches" were used, or "how big is the scar?," I have to act a bit like Carl Spackler --- "I have to laugh, because I've outsmarted even myself." The surgical "artwork" that I may accomplish on any given day may represent the finest display of the craft of surgery available, worthy of a Netter drawing.....but it can't be put on display like a scar. What surgeons do, and take great pride in, is more than skin deep, and if everything goes according to plan will never see the light of day!