Tuesday, August 27, 2013

Sunday Stitches

It had been such a pleasant weekend.  I rode my trusty steed, Chubby (see A Horse of My Own), in the woods near my home on Saturday morning, reveling in the beauty of late summer foliage, the dense tree canopy offering cool shade as we trotted beside a gurgling stream, serenaded by mockingbirds and startled occasionally by deer.  Later I hosted dear friends for dinner (see Late Summer Supper), the weather so delightful that we dined on my patio to a symphony of katydids and crickets.

On Sunday, I busied myself with yard work and household projects, adding a second, larger cistern to my self-watering drip-irrigation system in order to accommodate an increase in water consumption following my installation of a more powerful pump to feed the additional flower boxes I put in two months ago (see The Garden Issue).  The day had been productive and pleasant. I looked forward to rewarding myself with a dip in my swimming pool before fixing dinner.

Late in the afternoon as I began to clean up, I anticipated the enjoyment of a late summer cocktail of pureed strawberries, thyme-infused simple syrup and vodka with my sometime companion, Jesse, after which I would prepare a simple Sunday night pizza of fresh spinach, tomatoes and basil pesto from my garden, baked on chewy Naan flatbread, accompanied by a blueberry-cucumber salad and a batch of my mother’s timeless cheddar soufflé.  I had even whipped up a fun dessert ahead of time by swirling pureed blackberries with Agave-sweetened yogurt to make homemade popsicles, which awaited mealtime’s end in my freezer.

The evil-doer lurked in my garden shed,
laying in wait to sabotage my
good intentions
I was putting away the last of the garden tools I had gotten out during the day. I had gone into my garden shed to store a hose remnant, a vestige of the cistern project, when it happened. As I stretched over a large steel hand truck to hang the hose on a nail, I lost my balance and fell forward, striking my shin against the dolly’s heavy metal lip.  I knew before I looked down at my leg that I had gashed it deeply enough to need stitches.

Many of you know that I suffer from “the heartbreak of psoriasis”, an auto-immune disease which, thank goodness, no longer carries the social stigma that it did back when those sappy television commercials aired in my youth.  I am fortunate that my case is not severe, but over the years I have nevertheless tried everything from ultraviolet light treatments to Methotrexate (a potent – and potentially deadly -- component of a chemotherapy cocktail requiring monthly blood work and periodic liver biopsies) to self-injecting syringes filled with Enbrel, a tumor necrosis factor (TNF) blocker which caused my white blood cell count to plummet to precarious levels, before settling on the medication that works best for me: a topical ointment made by Leo, a pharmaceutical company based in Dublin, Ireland. 

I'd just received a leg
full of sutures when
this picture was taken
near my cousin's house
in Pen Argyl,
Pennsylvania, in 2011
Although the cause of psoriasis is still not well-understood, it is known that those who suffer from the disease have immune cells in their skin which are triggered into hyperactivity by an abundance of protein in one’s system, replicating themselves six times faster than normal skin cells do.  This overproduction of epidermis causes patches of extra skin to build up and flake off, primarily on the bony parts of the body, like elbows and shins, along the spine and on the scalp, although psoriasis can occur anywhere.  Taclonex, my treatment of choice, is a powerful corticosteroid salve which acts to thin the skin on which it is applied, thereby reducing the buildup of excess skin cells, called plaques.  Over the years, Taclonex and similar ointments have thinned the skin on my shins and forearms so that it tears like a fragile sheet of paper.  A bump against the edge of my dishwasher one July resulted in 17 stitches to my lower leg.  A fall two years ago at my cousin, Danny's, home in Pen Argyl, Pennsylvania, which would have caused hardly a bruise on another person, resulted in several stitches to my leg on Labor Day weekend.  And years of using psoriasis medicine on my scalp has meant that the bristles of my hairbrush will cause pinpoint bleeding if I so much as tug the brush through my hair a bit too forcefully.

The supplemental cistern, right, is not
as attractive as the original, but it
doubles my water storage capacity
I own a pair of youth-soccer shin guards, and you would think that by now I would be savvy enough to put them on before a day of gardening or industrial-strength yard work, knowing as I do how work-a-day bumps and scrapes one typically collects while executing weekend chores can result in hours at the emergency room for me.  But I seldom remember to wear my lower leg protection, especially on a hot summer day.  And so the inevitable occurred late Sunday afternoon.

Still dressed in my gardening gear,
I peruse a Macy's sale flier as I
await Dr. Summers-Stephen and
her sutures
I am fortunate to have a Patient First walk-in medical center right in my little corner of northwest Baltimore County, and am even more fortunate that it was staffed Sunday evening by the personable and extremely competent Lawanda Summers-Stephen, M.D.  Dr. Summers and I engaged in lively banter as she gently applied needle and monofilament to my two-inch long gash.  It is an unfortunate side effect of my super-thin skin that sutures simply tear through my flesh, causing a physician to have to make gigantic, blanket-style stitches in order to pull the edges of my wounds together.  Consequently, on a laceration which would have resulted in ten or more small sutures to healthy tissue, Dr. Summer-Stephen could only apply four large ones to mine, binding the rest of the gaping wound with steri-strips as best she could, and covering the whole thing with a biocclusive transparent dressing, newfangled bandage modeled after the human blister, which uses no adhesive (a dangerous thing on my delicate dermis), but rather the body’s heat to generate sticking power.

It was after 8:00 p.m. when I got home, still determined to put a homemade dinner on the table and finish the weekend in style.  I shelved the blueberry-cucumber salad and my mother’s labor-intensive cheese soufflé for another day, and instead tossed a simple green salad and baked the pizza.  Although the Novocain had long since worn off, I was not in much pain as I sipped a glass of red wine and enjoyed my dinner, so I’m not sure what caused me to glance down at my leg, elevated as it was on an adjacent chair. To my surprise, bleeding from the wound had not stopped, but instead seemed ready to burst forth from the sealed bandage and cascade down my leg.  Since it was now after 10:00 p.m., my local urgent care facility had closed for the day. This time, Jesse drove me to the nearest hospital emergency room, as I wondered what on earth was causing such an exodus of hemoglobin.

Awaiting discharge papers at
Northwest Hospital Center, well after
The riotously funny certified physician’s assistant on duty at Northwest Hospital Center when I arrived, Richard Blanchard, laughed at the burgeoning bandage on my leg and threatened to poke it with his pen, thereby releasing the pent-up plasma.  Fortunately, the attending nurses talked him out of it, contending that they had already seen enough blood and gore for one day’s work in a busy Baltimore county emergency room.  Mr. Blanchard carefully removed the previous dressing and applied a new, high-pressure bandage fashioned from a standard Telfa pad and lots and lots of gauze wrapped tightly around my leg.

Home once again, I fell into an uneasy sleep, but not before wrapping my leg in Saran wrap so as to keep from bleeding all over my sheets in the night should the latest dressing fail to stem the tide.  Fortunately, the new bandage held fast, and by 4:00 a.m. the discomfort in my leg subsided enough to allow me to relax a bit.

It was just another day for me, alas.  My arms and legs are thick with the scars of living a well-enjoyed life. As my girlfriends threatened in the following days to encase me in bubble-wrap so as to keep me from further injury, I find that my occasional trips to the emergency room seem a fair trade-off for the satisfaction of a happy, active, adventure-filled life.  Remembering to don my shin guards before future forays might not be a bad idea, though. 

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