A young Vietnamese immigrant wandered into the inner city clinic where I trained as a student and subsequently worked for several years. Although he spoke little English, his chief complaint was obvious: an unsightly mass protruded from the right side of his face along the jaw line. He had been to a number of medical facilities for treatment, but no one wanted to excise the cluster of bumps just beneath the skin. In retrospect, the reason was obvious—he had no medical insurance.
I asked my supervising physician to have a look. He agreed with my assessment: a cluster of subcutaneous cysts. “You could do it,” he said. “Incise directly over the blebs. It should be fairly straightforward. You won’t be able to get them out without breaking them, but no matter. It should pull together nicely.”
In those days we performed minor surgery in the clinic. I scrubbed and prepped the area, positioned the drape, infiltrated the region with anesthetic and with a scalpel made the incision. Our nurse stood by, ready to assist, as I began the dissection.
When I was an adolescent over the course of three summers I worked on the staff of a local camp. One year I taught camp craft and pioneering. Under my supervision my young charges felled a number of tall tulip trees, lopped off the branches and laid them out according to plan. We spent several weeks that summer constructing a signal tower, using only braided rope for the lashings that bound the spars together.
As we labored one afternoon in the hot sun, the camp director wandered into the meadow to observe the progress. He stood with his hands on his hips, watching me demonstrate a standard lashing to the boys. Afterwards, he paid me a compliment: “You’ve got the hands of a surgeon,” he said. Carefully chosen or not, his words stuck in my head.
Several years later I learned how to close simple lacerations when I worked as a hospital corpsman aboard a high-endurance cutter. One night during a layover in Lisbon I was called to attend a sailor who had been stabbed during a fight that broke out in a bar. The man was drunk. They hauled him into sickbay and stretched him out on the table. I explored the shoulder wound (not as deep as it first appeared), irrigated and surgically closed it. The next day we put out to sea. Ten days later I extracted the sutures. The wound never suppurated; I counted both him and myself lucky.
Several of my classmates in PA school elected to pursue careers in general surgery. I opted for a track in general medicine instead. Even so, I found myself standing over this young Vietnamese man that afternoon, excising a mass that other clinicians more experienced than I had refused to touch.
I dissected the mass in toto and closed the wound, using vertical mattress sutures. The following week the young man returned to have the sutures removed. Only a hairline scar remained. I showed him the result in a hand mirror. I remember his smile—the only thing he had to offer in payment.
I still close minor lacerations on occasion in the office. These days I use Dermabond for the most part. It’s quick, easy and painless. They say that the results are every bit as good as surgical closure.
That may be the case. But I take some satisfaction in knowing that somewhere out there today, an older Vietnamese man remains grateful for the gift I was given in my youth: the hands of a surgeon.