Nursing Experience

Talk about a complete waste of a day. That was my day yesterday. I spent it all dealing with the Alberta Health Care Services nurse, the Foothills Medical Centre Emergency Ward, and various ambulance drivers and EMT's. As for myself, the only good part of the day came at the end, when Katherine made my favourite Won Ton Noodle Soup for me.

The day started normally, with my Home Care Aide coming to help me with my shower and exercises. We covered up the bandages on my left foot, and I came out of the shower nice and clean. After dressing, we went to my exercises, where I discovered that I had hurt more than just my left foot in the fall from my commode chair. Nonetheless, we complete our work just in time for the AHS Home Care Nurse to arrive.

The nurse was young, probably in her mid-20's or so. Clearly she was well education in her profession, but I suspect she needs a bit more real life experience. The first thing she did was unwrap my wound to inspect it. Then she washed it out, cleaning out the old blood, pushing gauze deep into the cut to clear it, producing more blood in the process. At this point she said to me "This cut is very deep. You need to go the the hospital and have it stitched."

I know my own body. I know a thing or two about damaging my body, how it recovers, what I need. I also know that putting stitches in a cut which is more than 4 hours old is a truly problematic issue, especially when the cut is narrow and deep. The only reason it was bleeding is because she was poking at it. I knew I didn't need, nor would I get, stitches from the hospital.

She was insistent. Being the easy going, compliant fellow that I am, after a few moments of discussion I said "You're the expert. What should I do?" She said "Call EMS. Have them take you to ER and get stitches." So I complied. I did just that, called 911, arranged transport, went to the ER.

I sat there for almost five hours. I was admitted quickly, and moved into the ER quickly. The wait was simply due to the absolute lack of urgency in my situation. They did take x-rays to rule out any broken bones; there were none. The nurse cleaned the wound so the doctor could get a good look at it. The doctor, after four and half hours, came in, looked at the wound, and said "Stitches won't help you much. They would improve healing time, and would make the scar look better, but who looks at the bottom of your feet? The real problem is that if we put in stitches, we are likely to enclose any bacteria that are in there, substantially increasing the possibility of infection. So we can go either way on this. The risk of infection is about the same if we stitch or not. What do you think?"

I replied in two short words. "No stitches." The conversation ended other than a few pleasantries. The nurse rebandaged my wound. I had had the common sense to bring my own wheelchair this trip, so the nurse arranged a wheelchair cab. I got home  at 7:00 PM. What had been a 30 minute effort to change a dressing had become a full day of wait to do nothing.

It's frustrating. Doctors and nurses with experience learn to listen to their patient, seeking to find what the patient knows about his or her condition, responding with minimal impact whenever possible. This is a lesson that young nurse needs to learn, to do the least amount possible for the most amount of gain. And don't send people for stitches if the wound is more than a day old. Just watch for infection, and keep it clean.