Archive | 5:57 am

the papoose

2 May

Only in the world of pediatrics would there be a most adorable word for what is essentially a child-sized, makeshift straight jacket.  John first told me about it when he rotated at Children’s during residency and I was horrified.

“Why don’t they just sedate the kid?”

“Well, that’s an awful lot of risk for 4-5 stitches on the face that the kid is numb to anyway.  We do give them topical lidocaine.”

One of the many reasons I swore I would never go into pediatrics: the horror of the horrified child, bound and trapped, and the poor parent probably shuddering in a corner.

But then I sort of surprised myself last week.  A toddler came in with a vertical laceration on her forehead caused by a typical toddler-toddler collision.  She was happy and doodling, not in pain and without signs of brain injury.  The cut was clean and sharp, and the two sides easily fit together.  But, due in part to its vertical nature, tension kept the two ends apart such that, left not sutured, it would make for a not-so-glamorous scar in the middle of this kid’s face.

I was given the task of sewing this little lady back up with what had to be the thinnest, hair-like dissolvable thread imaginable (though probably not even close–I’m not sure I want to know the fragility of the sutures they use of fetuses).  On the first attempt it became clear that this toddler, though calm and cool when we were only examining her, would not maintain her composure when we were physically restricting the movement of her head and going at her forehead with a needle.  She also somehow developed ultra-human strength that far surpassed what was possible from her 25- to 30-pound frame.

I saw the attending mouth to the nurse, “The papoose?”  And in what felt like seconds, our patient was rolled up like a little burrito and screaming her head off.

As I was trying to maneuver this hair-like thread through the layers of skin, my face was fairly close to her’s, my ears inches from her mouth, which kept emitting deafening cries.  Two sutures in, it occurred to me that this would be an appropriate time for me, the mom who cowered and cried uncontrollably during her daughter’s two-month vaccines, to pass out.  But I didn’t.  After a few more stitches, we were done, and our sweet patient was wrapped up in her mother’s arms, completely tear-free.  Not gonna lie, a little proud that I didn’t vomit, faint, or run from the room screaming myself, but perhaps I’m setting the bar a bit low…