Little 4 year old daryl came into the ED, dressed in his superhero underwear with blood covering the right side of his face. It looked bad. The nurse said it looked bad. She couldn’t even get close enough to clean it up.
The nurse suggested I’d need to use conscious sedation, but when I walked into the room, little crying Daryl was chowing down a twix bar. I asked Mom not to feed him anymore.
Everytime I’d make some progress with a sterile gauze soaked in sterile saline (loosening the clot and making it bleed a little), mom would dab away with her grubby purse-rescued facial tissue at the new blood.
After discussing risks and benefits of sedation versus brute force to sew the single lac that needed attention (there were 3 others that didn’t), mom and dad asked Daryl what he wanted to do. Does anyone else see the absurdity in this? Can a four year old conceptualize those options?
In reality, I had no interest in sedating a kid for a 1 cm lac with clean edges that needed only 1 suture…but I needed to give the parents enough reasons to not choose sedation. When I mentioned that we routinely prepare oxygen and airway equipment for all sedations, mom almost passed out. Daryl was eating the other half of the Twix bar.
I finally told the parents what I recommended, because they were clearly too distraught to weigh the options. Bed sheet. Papoose. Three nurses. One doctor. One stich. No anesthetic.
Dad was the squeamish one that left the room. Mom stood in a corner. It took all of 1 minute from start to finish. Mom thanked me profusely for doing it so quickly.
I hope Daryl doesn’t grow up with nightmares about me.