They knew I was wide awake, having refused all but local anesthesia, but I like to think they forgot, what with my face all hidden under that paper tent. After all, at this outpatient orthopedic surgery ward declining the happy drugs was unheard of.
I had a simple problem, clearly imaged and photographed. It was something that matched the case history. You see, I was impatient about my eggplants in the garden. They bloomed and bloomed, but did not set fruit. I reached in to feel the closing bud and was stabbed by a sharp thorn. It hurt but only for a few seconds. Over the next few days it began to swell painfully. It was no surprise then to see the spine right in there below the joint. You can see it on this picture if you look carefully.
Teaching hospitals have been shown over and over again to be the best. But they mean the person actually holding the knife is not usually your prized surgeon, but a kid just learning the trade. I got to listen in on the teaching.
First, the surgeon admonished the kid to think before cutting. He should consider all the angles and avail himself of all the images they took of the problem. Think about exactly what they know. Stop and consider. Don’t be too impatient. Since it was my thumb they were about to savage, I was glad to hear this advice.
I had not refused the local anesthetic, of course, so I did not feel the cut itself. But it did not reveal a thorn, even though the image above shows one quite clearly. Stop, the surgeon told the resident. Don’t dig around in there any more. If what you did first does not solve the problem, don’t keep doing it. Instead, think of a new approach. How good this advice is, yet how hard it is to remember. How often does the old approach fail us. How hard it is to change. What wise words the surgeon had for the youngster.
They fairly quickly then convinced themselves that even though the image looks like a thorn, there was no thorn, just this thing called an epidermal inclusion cyst. The thorn had poked in some skin cells and they were multiplying happily right in my thumb.
It was cool and unusual enough that they asked around for a camera and then took a fairly gory looking one with the observing med student’s ipad (I’ll spare you). Then they stitched me up and sent me on my way.
So remember, plan carefully before acting and then don’t dig at a problem in the same old way if it isn’t working. Oh, and take pictures along the way.