Aseptic Technique

I was at my workbench in the hobbycraft shop when a fellow prisoner sidled up to me and asked in a low voice, “Doc, got a minute? ”

“Sure. What is it?”

“Mark cut himself. Could you take a look?

“Sure,” I said and followed him into the art room.

There, out of sight of the office, was Mark holding his left hand wrapped in a bloodied shop towel.

“What happened?’ I asked.

“Aw, Doc, I cut myself on the radial arm saw,” he said. “I can’t believe I was so damned stupid. I put my hand under the blade before it stopped.”

I carefully unwrapped the towel. There was a two-and-a-half inch gash running diagonally across the back of his hand just shy of the knuckles. I tested his fingers for extension. Whew. They worked fine.

“What do you think, Doc?” Mark asked.

“Well, luckily, it doesn’t look like you got any of the tendons. But, you need stitches.”

“Can you do it?” he pleaded. “I don’t want to go to the infirmary. You know, the bastards will give me a B write up for misuse of equipment or some other bullshit reason. I’ll get kicked out of hobbycraft for at least six months. And then they’ll charge me for the cost of stitching it up.”

It was true. The prison had instituted a policy of charging prisoners for the medical costs of self-inflicted injuries. To do so, they issued a disciplinary write-up first, then garnished the prisoner’s account. Losing the money was hard, but losing the distraction of hobbycraft was worse. It meant hours of boredom.

Now this was an ethical dilemma. If I did it, I’d be breaking prison rules and not practicing good medicine, but if I didn’t I’d be breaking the convict code and probably lose some valuable friends. The truth was I had frequently been asked to look at injuries, especially from fights. I once closed a guy’s scalp laceration by tying together tufts of his hair across the wound. It healed fine.

“I really shouldn’t. I can’t numb you up and I don’t have the right equipment.”

“Frank’s got some gloves and a needle and thread,” Mark said. Obviously the pressure was on. “Come on, Doc.”

I temporized.

“Come over to the sink and let’s wash it out real good.”

I put on the latex gloves and scrubbed the wound with soap and water ‘till it bled freely. Mark sucked in his breath and gritted his teeth. The edges were a bit jagged, but it would be a simple repair.

“Okay,” I announced, “I’ll do it, but it’s not going to be sterile technique and it’ll probably get infected. Do you know anybody in your unit who can get you some antibiotics?”

“I don’t know, Doc,” Mark said. “Like what?”

“Well, somebody must have some left over antibiotics. I’ll write down the names of a few that would work. But, you gotta try to get a couple of doses to reduce the risk of infection.”

I set to work with a straight needle and cotton thread under an artist’s light. Frank stood between us and the guards. Mark winced each time the needle went through, but made no sound.

When it was done, I smeared the wound with antibiotic ointment snuck from the shop first aid kit and covered it with a couple of bandaids. I gave Mark a note that said “cephalexin, ciprofloxacin, amoxicillin clavulanate.”

“Those are the names of some antibiotics. Ask around and see if you can find one of them and take it for a day or two.”

Three days later I saw Mark again.

“How’s the hand?”

“Not so good, Doc. It’s pretty sore.”

“Let me see.”

He peeled back the bandaids. The wound was red and swollen and pussy.

“Did you get any antibiotics?” I asked.

“Nah, Doc, I couldn’t find any.”

“Well, these stitches have to come out. They’re not doing you any good at this point and they’ll just make the infection worse.”

We went back into the art room. I used an X-ACTO blade to cut the threads. This time Mark groaned and fidgeted when I washed the wound.

“If this isn’t looking a lot better in twenty-four hours, you need to go to sick call and get some antibiotics.”

“Okay, Doc.”

I berated myself for having made the attempt without proper equipment. I fumed at the prison administration for linking access to medical care with the threat of punishment. I thought of physicians who practiced before Lister discovered sterile technique. What did they do with cuts like that? Cauterize them? No, probably just left them open to heal by themselves.

Mark finally went to sick call and got some antibiotics. It was long enough after the accident he could make up some innocent reason to avoid a write up. Besides, now he was being treated for an infection, not a laceration.