Stitches

Stitch

The chances are that you haven't had to go to hospital to be stitched up. I myself have only undergone this curious process twice, but it is an interesting experience, and one that I believe is worth describing in detail. As I write this, the ache from my two-inch cut is smarting only slightly ' it hurt a great deal more on the long walk home from St George's hospital as the local anaesthetic wore off and the pain set in. I still can't help myself, every couple of hours, from unravelling the bandages wrapped around my arm and staring at the neat-ish stitches wrought upon me by the efficient and emotionless South African nurse. Having been stitched before, I knew I had nothing to fear. The problem was that my right arm, the inside of my right arm, is a mass of scar tissue, criss-crossed with over one hundred fine white lines, the product of eight years of slashing and slicing. It also didn't help that I had waited for fourteen hours before going to the hospital, and had been shuttled from A&E to the walk-in clinic and back again, making my wound even older by the time I was finally seen. The edges of the cut, a small but deep cut, reaching down to the subcutaneous fat, had sealed themselves off, leaving a gaping, yellowing valley between the edges of the gash. It had bled like a bastard when I cut it last night. At the time, I didn't know if it was going to stop bleeding ' after spraying blood over the carpet, my phone, the case of my copy of On the Beach, I held it dripping, dripping, dripping, over the waste paper basket. I was almost worried. I think I suspected at the time that it would have to be sutured; investigating the wound the next morning, I knew it would have to be sorted. So I tramped down to St George's hospital in Tooting, hoping against hope that I would be back home in time for Neighbours. It was going to be a big day: Max was in the process of trying to have Steph sectioned. I had my own worries about being committed into the care of the mental health Torquemadas.

The triage nurse had asked me if I smoked, drank; if so, how much? About fifteen to twenty cigarettes a day, I replied. "And alcohol? "About twenty units, I said. "A week? she asked. "Um¦a day? I could tell that she was trying to remain composed, but I saw her give an involuntary grimace. I couldn't blame her ' many tramps drink more than that, but although I was dressed in pretty shabby clothes I don't look the type. My skin's still pretty good, and my hair's usually soft, shiny and lustrous. Just don't ask me to hold a pencil between thumb and forefinger: it'll oscillate like the needle of a San Andreas seismograph. She asked me if I was undergoing counselling for alcoholism and I wanted to cry: "No! But I want you to help me! Instead, I grinned sheepishly and shook my head. She slashed a couple of ticks into the boxes on the file in front of her and briskly bade me wait for the duty nurse. I was in love, albeit for only a few moments.

I'm not squeamish: if I need a vaccination, an injection, I'll watch the needle go in, if only to make sure that a good job is being done. I watched the needle delivering the anaesthetic with dispassion; I made a decent attempt to disguise the pain of the sharp poking into my raw flesh. After the nurse had injected me half a dozen times, and had gone off to obtain sutures, antiseptics and other surgical paraphernalia, I probed the area with my good hand and found it comfortably numb.

But sometimes it's worse when you can't feel any pain. The nurse savagely scrubbed the wound to get rid of the pus and coagulated blood ' I felt that alright. Once the cut was cleaned the blood flowed relentlessly, oozing up and dribbling in little channels over my arm. A suture is a foot-long piece of wire attached to a scimitar-shaped needle, and the process of stitching up a wound is remarkably simple. It is, in effect, a series of glorified granny knots. If, however, the area being stitched is already scarred, some small surgery is required. You can't stitch scar tissue to scar tissue, so the nurse had to cut off several strips of scarred flesh adjacent to the cut. Now, the funny thing about a local anaesthetic is that although it prevents the patient feeling pain, it does allow a certain sensation. For example, you can feel your flesh being fooled around with, albeit in a detached kind of way. A little like being on ketamine ' you're aware of your body, without any sense of it being yours. Not a terribly good explanation if you've had the good fortune never to have been in the depths of a ket binge. Let me put it this way ' I could feel the sharpness of the scalpel as it sliced, without the attendant pain. A part of my brain registered that this should be painful, and to that extent it was painful, but more from a sort of memory of pain rather than any immediate physical anguish. Very strange.

After that, the stitching was a doddle. The newly-cleaned edges of the wound are lifted up with tweezers (I doubt that's the medical term), and the curved needle thrust through the top of the first flap of skin and through the facing edge of the cut from underneath. The nurse then threads the suture almost all the way through, leaving only a quarter of an inch left hanging where the needle had gone in. She then wraps a quantity of wire from the long end of the thread several times around the tweezers with which she subsequently grips the short end of the thread and pulls, creating a knot. This process is repeated a couple of times until that part of the cut is sealed to her satisfaction.

It wasn't a huge cut, but it took seven stitches. Even up until the last stitch, the blood kept flowing. The actual stitching took a matter of minutes, and when it was done the South African nurse gave a curt nod and said "Goot. She had done a fairly good job: not as neat as the job performed on my calf four years previously, but good enough.

The nurse told me to clean myself up which, under the circumstances, was easier said than done. I lifted my arm off of the treatment table, and found that it was lying in a large and limpid pool of blood. It had got everywhere, absolutely everywhere, and I was worried for the nurse. Although the chances of my having AIDS are pretty slim, if she was exposed to this much blood on a daily basis then she was running a pretty hefty risk of infection. Still, I suppose she knew what she was doing. But worse than the fresh liquid blood leaked liberally over the treatment table was the semi-coagulated blood that hung from my forearm, like crimson, half-set jelly. As I gingerly washed it all off into the sink, and watched the blood mix with the water to form a brownish stain splashing all over the porcelain, I wondered if anyone was going to scrub the sink down with alcohol. Who was the last person to use this sink anyway? Had it been some AIDS or MRSA-ridden hobo who'd taken a sly swig straight from the tap? It didn't bear thinking about.

"Come beck in a week to hev those stitches out, said the nurse. I thanked her, apologised for wasting her time, thanked her again and left. You never, in my experience, need to bother going back to hospital to have stitches out. It's not a complicated procedure ' a nurse simply snips them one by one and pulls them out. Part of the whole self-harm ritual is the self-medication afterwards; if you can't stitch yourself up, you can at least remove the sutures. Stationery scissors will cut the wire, and then you have the delicious tickling feeling of pulling the stitches out. It's an almost orgasmic sensation as you feel the foreign objects, buried for days under skin and scab, sliding out of your body. And bollocks to waiting a week: I took them out a few days after they'd gone in. It's now just over a week since I took them out, and the puncture marks of the stitches are beginning to fade, but they're still noticeable. Maybe I did take them out a little early ' the two ends of the scar are nice and neat, with only a thin line of scab, but the middle section (the areas of stitches three to five) is a little wider. It'll heal though.

What I haven't conveyed in my account so far is the feeling that hospitalisation produces in me. Sitting in the waiting room is fairly nerve-racking, partly because you don't know how serious the wound is, and partly because you don't know what will be the reaction of the nursing staff. But once you are in the nurses care you feel¦.well, taken care of. I felt hugged by a wave of relief that someone was taking care of me. It's hard to describe. I imagine it must be similar to the feeling experienced by those with Munchausen's syndrome. Once you're in the hospital and being treated you no longer feel so alone. You feel as if something is being done to help you. It's almost as if the awesome responsibility of guarding and protecting your pain is somehow lifted. But as I walked out of the hospital and up Garratt Lane I felt just as lonely as I had before I cut.