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All stitched up

‘Forever a scar and it’ll be my fault’

01-1 intro

Having hundreds of medical interns running around the hospital is nice, but before they start stitching up real patients, they need to practice. But how?

Every six weeks, a new group of interns takes a stitching course at the UMCG’s skills centre. It’s taught by two experienced surgeons. Over the course of two days, they mess around with sutures, tweezers, needle holders, and… pig’s feet.

But many students take it even further than that. Before they can feel secure enough to use a needle and thread in the operating theatre, they practice their sutures on the strangest things, from stress balls to bananas.

 

By Lucia Grijpink / Photo’s by Reyer Boxem
02-1

Pig’s feet

Madeleine ter Kuile – Master 1
Martini Hospital, Groningen

02-2

‘Forever a scar and it’ll be my fault’

Madeleine ter Kuile is practising her stitches on a pig’s foot during the stitching course at the UMCG’s clinical training centre. ‘I was only told that pig’s feet were involved right before I started, so that was a bit of a shock’, she says. ‘They made a few nice cuts in the feet for us to suture. What mainly struck me was the ‘nice’ smell. As though bacon had been left out on the kitchen counter for too long.’

Stitching reminds her of sewing with a needle and thread, ‘except I feel super clumsy because you also have a needle holder and tweezers and you have to hold them a specific way’.

Madeleine has already stitched up two real people. The first time was during an operation to remove a varicose vein. A surgeon was performing the operation, and in addition to Madeleine, a resident was present as will. This meant all the fun jobs automatically fell to him. But when the resident was busy and the surgeon started the sutures, Madeleine saw her chance. Perhaps she could do a few stitches?

‘It was remarkably similar to the pig’s foot’, she says. ‘There was just more subcutaneous tissue. In the pig’s foot, you hit bone much more quickly.’ But there was also a major difference. ‘Knowing that it’s a person changes everything. I was like, if I fuck this up they’ll forever have a scar. And it’ll be my fault.’

3-1

Banana

Rick Overwijk – Master 2
De Tjongerschans Heerenveen

3-2

‘Medicine is life’

Rick Overwijk is a second-year intern. When he was due for his surgical internship in Assen, he decided to start practising his stitches. ‘I didn’t want to look like a moron.’

Online, he found an article for interns comparing various practice objects. The chicken breast was a clear winner. But because Rick doesn’t eat meat, he went for the runner-up: a banana. ‘It works really well, because it has a peel with the banana itself below, which is similar to subcutaneous fat.’

He performed his first real suture on a patient’s hand, where a growth had been removed. ‘Afterwards, my supervisor said he couldn’t have done it better himself’, he beams.

He even practised using the needle holder and suture on his girlfriend’s torn skirt. ‘Medicine is life’, he laughs.

Rick wants to keep performing small operations. ‘I think I’d like to become a general practitioner, but one who performs small surgical procedures. My own GP sends anyone with the smallest of cuts to a specialist. But I really like working with my hands.’

He put three different kinds of stitches in his banana. ‘But now there’s banana mush all over my needle holder.’

4-1

Chicken breast

Maarten Huismans – Master 2
Deventer Hospital

4-2

A fridge full of chicken breasts

Before Maarten Huismans was allowed to do his own suturing at the plastic surgery department in Deventer, he had to pass the chicken breast test. The intern had to bring in a chicken breast, make an incision, and prove to the plastic surgeons that he was capable of nicely stitching up the meat.

Maarten had little experience up until that point. During a previous internship at the surgical department in Delfzijl he hadn’t picked up enough knowledge. ‘I’d been waiting for them to ask me to suture. But that didn’t work at all. You have to step up and ask them.’

At home, his fridge was full of chicken breasts, and he hung string from the wall in his bathroom, to practise his knots. His friends gave him a suture kit for his birthday.

‘I love practising’, he smiles, while making an incision in the chicken breast with a large kitchen knife. ‘The chicken breast works well because there’s very little resistance. It’s all too easy to pull a little too hard and make the edges stand up, or pull the thread completely through.’

It took Maarten only two breasts to pass the test.  One to practise on, and one to use in the hospital. After just one evening of slogging away, he decided to give it a go. And he passed.

5-1

Orange

Marlies Buitendijk – Intern

Emergency room, Emmen

5-2

‘I had to suture the entire abdomenen’

Marlies Buitendijk has just finished her junior doctor surgical internship at the Martini Hospital, which means she has graduated. She didn’t learn how to do stitches until her second year of internship at Enschede.

‘I was assisting with a whipple surgery. The patient had a large incision across their entire abdomen. When the surgery was finished, they suddenly asked: “Do you know how to suture?”‘ Unsure, she answered: ‘I guess…’

‘So then I had to intradermally suture the entire abdomen. I was sweating buckets because it was only my second time doing stitches, but the nurse helped me out.’ The nurse stood across from Marlies and helped her through it.

Marlies decided right there and then that she needed more practice. She first tried a plastic piece of fake skin, but this was much too tough. So she went looking for something that felt a bit more like real skin. Oranges turned out to be a great alternative. ‘You have to be even more careful with an orange, because you pull the thread through before you know it.’

A roommate from Enschede was also practising, but he chose a very unorthodox object. ‘He wanted to study cardiothoracic surgery, so he got a pig’s heart from the butcher. He completely dissected it and stitched it back together again. It was really interesting, but I would’ve preferred it he hadn’t done it in our kitchen.’

06-stressbal

Stressbal

Manolis Kyrloglou – Master 1
Martini Hospital

06-2

‘It’s a good idea to keep practising. On anything’

Manolis Kyrloglou, from Greece, did his first internship with the plastic surgery department at the Martini Hospital. There, it is very important that sutures are aesthetically pleasing. And that means practice, practice, practice.

Manolis was in his room when he noticed a broken stress ball. He had no idea how the ball got torn up, but he thought it might be cool to try and stitch it up. It turned out to be quite challenging. ‘It kept rolling away, so I had to hold on to it firmly. It was also really difficult to get the needle in. It’s different with skin: there’s a bit of resistance going in, but nothing after that.’

He was allowed to suture several times during his internship. Often he was just stitching up small holes from liposuction, but the highlight of his suturing career was when he was allowed to help with a scar revision surgery in the abdominal wall. ‘The abdomen was cut open and closed again. They didn’t let me do the whole thing, but I stitched up approximately five centimetres.’

Manolis isn’t sure if the stress ball actually helped him. ‘But I do think it’s a good idea to keep practising. On anything.’ Sadly, he had borrowed the needle holder he used to suture the stress ball from the plastic surgery department. So he had to hand that back in.

mobile versie

Suturing a real person takes guts. Medical interns have to do it during their three-year master’s programme. So what’s the best way to prepare?
By Lucia Grijpink / Photo’s by Reyer Boxem

Having hundreds of medical interns running around the hospital is nice, but before they start stitching up real patients, they need to practice. But how?

Every six weeks, a new group of interns takes a stitching course at the UMCG’s skills centre. It’s taught by two experienced surgeons. Over the course of two days, they mess around with sutures, tweezers, needle holders, and… pig’s feet.

But many students take it even further than that. Before they can feel secure enough to use a needle and thread in the operating theatre, they practice their sutures on the strangest things, from stress balls to bananas.

Pig’s feet

Madeleine ter Kuile – Master 1
Martini Hospital, Groningen

 

Madeleine ter Kuile is practising her stitches on a pig’s foot during the stitching course at the UMCG’s clinical training centre. ‘I was only told that pig’s feet were involved right before I started, so that was a bit of a shock’, she says. ‘They made a few nice cuts in the feet for us to suture. What mainly struck me was the ‘nice’ smell. As though bacon had been left out on the kitchen counter for too long.’

Stitching reminds her of sewing with a needle and thread, ‘except I feel super clumsy because you also have a needle holder and tweezers and you have to hold them a specific way’.

Madeleine has already stitched up two real people. The first time was during an operation to remove a varicose vein. A surgeon was performing the operation, and in addition to Madeleine, a resident was present as will. This meant all the fun jobs automatically fell to him. But when the resident was busy and the surgeon started the sutures, Madeleine saw her chance. Perhaps she could do a few stitches?

‘It was remarkably similar to the pig’s foot’, she says. ‘There was just more subcutaneous tissue. In the pig’s foot, you hit bone much more quickly.’ But there was also a major difference. ‘Knowing that it’s a person changes everything. I was like, if I fuck this up they’ll forever have a scar. And it’ll be my fault.’

Banana

Rick Overwijk – Master 2
De Tjongerschans Heerenveen

 

Rick Overwijk is a second-year intern. When he was due for his surgical internship in Assen, he decided to start practising his stitches. ‘I didn’t want to look like a moron.’

Online, he found an article for interns comparing various practice objects. The chicken breast was a clear winner. But because Rick doesn’t eat meat, he went for the runner-up: a banana. ‘It works really well, because it has a peel with the banana itself below, which is similar to subcutaneous fat.’

He performed his first real suture on a patient’s hand, where a growth had been removed. ‘Afterwards, my supervisor said he couldn’t have done it better himself’, he beams.

He even practised using the needle holder and suture on his girlfriend’s torn skirt. ‘Medicine is life’, he laughs.

Rick wants to keep performing small operations. ‘I think I’d like to become a general practitioner, but one who performs small surgical procedures. My own GP sends anyone with the smallest of cuts to a specialist. But I really like working with my hands.’

He put three different kinds of stitches in his banana. ‘But now there’s banana mush all over my needle holder.’

Chicken breast

Maarten Huismans – Master 2
Deventer Hospital

 

Before Maarten Huismans was allowed to do his own suturing at the plastic surgery department in Deventer, he had to pass the chicken breast test. The intern had to bring in a chicken breast, make an incision, and prove to the plastic surgeons that he was capable of nicely stitching up the meat.

Maarten had little experience up until that point. During a previous internship at the surgical department in Delfzijl he hadn’t picked up enough knowledge. ‘I’d been waiting for them to ask me to suture. But that didn’t work at all. You have to step up and ask them.’

At home, his fridge was full of chicken breasts, and he hung string from the wall in his bathroom, to practise his knots. His friends gave him a suture kit for his birthday.

‘I love practising’, he smiles, while making an incision in the chicken breast with a large kitchen knife. ‘The chicken breast works well because there’s very little resistance. It’s all too easy to pull a little too hard and make the edges stand up, or pull the thread completely through.’

It took Maarten only two breasts to pass the test.  One to practise on, and one to use in the hospital. After just one evening of slogging away, he decided to give it a go. And he passed.

Orange

Marlies Buitendijk – intern
Emergency Room, Emmen

 

Marlies Buitendijk has just finished her junior doctor surgical internship at the Martini Hospital, which means she has graduated. She didn’t learn how to do stitches until her second year of internship at Enschede.

‘I was assisting with a whipple surgery. The patient had a large incision across their entire abdomen. When the surgery was finished, they suddenly asked: “Do you know how to suture?”‘ Unsure, she answered: ‘I guess…’

‘So then I had to intradermally suture the entire abdomen. I was sweating buckets because it was only my second time doing stitches, but the nurse helped me out.’ The nurse stood across from Marlies and helped her through it.

Marlies decided right there and then that she needed more practice. She first tried a plastic piece of fake skin, but this was much too tough. So she went looking for something that felt a bit more like real skin. Oranges turned out to be a great alternative. ‘You have to be even more careful with an orange, because you pull the thread through before you know it.’

A roommate from Enschede was also practising, but he chose a very unorthodox object. ‘He wanted to study cardiothoracic surgery, so he got a pig’s heart from the butcher. He completely dissected it and stitched it back together again. It was really interesting, but I would’ve preferred it he hadn’t done it in our kitchen.’

Stressbal

Manolis Kyrloglou – Master 1
Martini Hospital

 

Manolis Kyrloglou, from Greece, did his first internship with the plastic surgery department at the Martini Hospital. There, it is very important that sutures are aesthetically pleasing. And that means practice, practice, practice.

Manolis was in his room when he noticed a broken stress ball. He had no idea how the ball got torn up, but he thought it might be cool to try and stitch it up. It turned out to be quite challenging. ‘It kept rolling away, so I had to hold on to it firmly. It was also really difficult to get the needle in. It’s different with skin: there’s a bit of resistance going in, but nothing after that.’

He was allowed to suture several times during his internship. Often he was just stitching up small holes from liposuction, but the highlight of his suturing career was when he was allowed to help with a scar revision surgery in the abdominal wall. ‘The abdomen was cut open and closed again. They didn’t let me do the whole thing, but I stitched up approximately five centimetres.’

Manolis isn’t sure if the stress ball actually helped him. ‘But I do think it’s a good idea to keep practising. On anything.’ Sadly, he had borrowed the needle holder he used to suture the stress ball from the plastic surgery department. So he had to hand that back in.

Nederlands

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