Suturing: On Healing Patients

I pump the bed up, adjust the looming overhead lights on her face, and prepare to suture. A fine-needle syringe of lidocaine, plenty of gauze pads, betadine, and many threads and needle holders wait at the bedside. Her upper lip has been ripped by glass in two places, each ragged laceration coursing from the bottom pink all the way up to the indentation of her nasolabial folds. She is swallowing the blood which slowly oozes into her mouth.

I slip into stiff, sterile gloves and sigh. I let the beeping monitors and carrying voices fade into the space around me. I listen to the silence in my mind. This is my one chance today to make something beautiful.

I adjust the needle on the needle holder at a slight angle, straighten a 6-0 thread by running it through my fingers like silk. And then I begin. The first stitches are the least impressive but the most important. These are the deepest stitches: the ones lurking in the mucosa, far beneath the surface, which will remain unseen but will make all the difference. This is where alignment of a three-dimensional image becomes essential; tears are rarely symmetric, and my fingers coach the needle to compensate accordingly. I thread it through, look at the shape I have created, un-thread, and re-thread again. The angle and depth of these stitches are critical. Each fine movement is precise.

As I venture into the orbicularis oris muscle fibers, I begin to finesse my closure, gently tugging the edges towards one another. The success of the last layer, the subcutaneous tissue beneath the epidermis, depends on the first stitch: the one I place at the superior vermilion border. This stitch must be aligned perfectly in order for her smooth lip line to be maintained. I redo this stitch three times, until I am satisfied. And then all of the other stitches fall into place, with minimal tension, one after the other, a train of blue simple interrupted stitches. The skin mildly everts, as if welcoming a new beginning.

This is one of the simple, healing moments in medicine: taking torn edges of lips – which kiss, talk, weep, and scream – and letting them encounter one another again. Burying deep within them a knot that anchors their wavering surface permanently, lacing them into a thin, healing line – straight but full of angles, tears, and tissue destruction just beneath the surface. A sutured smile – beautiful but flawed.

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