Life as a medical student #19 My Shaking Hands: Suturing for the first time

The operating theatre with its bright lights, sharp steel and demanding scrub nurses is a land of mystery for most medical students. Having seen so many operations done (from far corner of the room, of course), I had never stitched up an actual person. Ironically, my first chance of sewing up an incision happened when I was at Tzu Chi Hospital in Taiwan. It was a reconstructive surgery after resection of retromolar trigone cancer. Doctor Kang and Doctor Weng had removed the anterolateral thigh (ALT) flap and was now beginning to re-connect blood vessels at the neck.

''Why don't you sew up the site on the leg where we harvested the flap?'' Doctor Weng said.

I was a bit startled, but I nodded. Looking down at the patient's leg, there was a 4-inch incision to sew up. It wasn't too deep. Probably just need a single layer of simple interrupted suture. Very quickly the nurse handed me a forceps, a needle-holder and a length of 3.0 nylon. I tried to make myself comfortable with the instruments like how I used to practice in classes, and concentrate on the incision in front of me. The first few stitches took me an eternity to put in - using the forceps my left hand grasped and everted the skin edge slightly, my right hand pronated and supinated to allow the needle to pierce the skin - I don't know why but that particular moment made my hands tremble a little. While taking a deep breath in, I imitated how the surgeons normally wrap the suture around the needle holder to form the loop, and then tie the knot. And finally cut the suture leaving a 5mm tail. That's my first knot! I looked up and exchanged glances with Doctor Weng. He seemed satisfied. With Doctor Weng continue guiding me, I began suturing with more confidence.

Slowly, but more and more smoothly.

Skin pads, banana skin, orange peels? Nothing beats suturing a live patient. I can now suture better. Really.