After reading a couple more articles in Shambhala Sun, I was notified that Mr. Williams was back from radiology. As I approached the room, I saw a young man pacing. He was talking to himself, at times attempting to muffle shouts as he alternated between wringing his hands and slapping his forehead with his fist. I scanned the room. No one else was with him. Nurse Lorraine was sitting in the nurses’ station writing up her notes. When she saw me, she said, “We got a live one, Doc. In and out, please. His wound is ready.”

I pulled up the X-ray on my screen and was happy to see it was normal: bones intact with good alignment, no foreign body and only minimal soft-tissue swelling in the palmar region, which was, presumably, where I’d see the laceration. With the hope that this would be a quick suture and discharge, I approached the patient’s room.

I tapped at the room’s entrance. “Hello, Mr. Williams.”

He looked up at me, blurting, “Hi, hi, hello, ma’am. Doctor. I mean, hello, Doctor, ma’am.” He glanced away and continued to pace.

Maintaining my position in the doorway, I said. “Mr. Williams, why don’t you have a seat on the stretcher here while we chat?” He was clean shaven with olive skin and large hazel eyes and other features that would have made him look like a native in most parts of the world. His straight brown hair was neatly cut, but disheveled at his forehead. A blood streak on his half-untucked oxford shirt was only barely perceptible against the dark background of the navy-blue cotton material.

He lowered his head. “Yes, ma’am.” He sat down, flopped his body back on the bed, and began repeatedly crossing and uncrossing his legs. I approached the right side of the stretcher, leaving both the door and the curtain to the room open. When interviewing patients, my practice is to provide them with whatever privacy I can, but in this case, I felt it more prudent to interview Mr. Williams in full view of the rest of the department. Doctors gain this instinct with practice. Sometimes we misread, but often we do not.

Mr. Williams’s chatter stopped, but he kept crossing and uncrossing his legs. Every once in a while, his entire body would jump as if he had been startled, and his eyes would dart back and forth as he squealed, “Shhhh!”

I interrupted his dialogue with himself. “Mr. Williams, I’m Dr. Harper. I don’t think I said that when I first came in. I hear you have a cut on your hand. Just so you know, I looked at your X-ray and it looks normal, which is good news. What happened?”

His movements stopped for a moment. “I cut my hand a little while ago. My friend cleaned it off for me. She brought me here,” he said, flinging his right hand toward my face.

“How did it happen?”

“I don’t know. I don’t know. I was out with my friend, and it happened. Fast. I don’t know. But she cleaned it.” He began to rock and rub the back of his hand. “She cleaned it. She cleaned it. She cleaned it and wrapped it up,” he replied as he jumped. “Oh!” he exclaimed, then covered his mouth with his left hand.

“Are you sure you don’t remember anything about how this happened? I just ask because most people remember at least something.”

He looked at me but said nothing. His eyes were glassy pools of erratic terror.

“Hmmm, well, do you recall if your injuries involved a knife or a gun?” Because these are potentially reportable injuries, I always made sure to ask this when the cause of injury was unclear.

“No. No. It was fast. I don’t know, I don’t know. We were out. No. My friend, she told me. She brought me here. She cleaned it.” He suddenly yelled, “Oh!” and then jerked his head to the side as his legs began to quiver. He ran his left hand over his head and down his neck before placing it on his chest and curling it into a fist, which he then raised to his mouth in what appeared to be horror. “No, no, it’s okay. It’s okay. It’s okay,” he muttered into his chest.

“Huh. Well, can you feel and move your fingers?”

“Yes,” he responded, holding his hand in front of his face, moving each finger in wide, slow, undulating movements, before plopping his hand back on the table palm up with a thud that made both of us jump.

“Mr. Williams, are you okay?”

His attention darted back to me. “Yes. I’m okay, I’m okay. I’m okay, I’m okay,” he said as he curled and uncurled his fingers into a fist, which he brushed over his mumbling lips.

“Mr. Williams, what’s going on?” I asked gently.

“They’re following me!” he exclaimed, covering his mouth again. He looked from side to side and then down at his chest as he began to whimper incomprehensibly.

“Who is following you?”

“They are. You can ask my sister. She called. I can call her. But she bothers me. But we can call her. I don’t know.”

The evaluation was becoming more complicated. My priority now had to be to address the laceration quickly so we could move on to the more pressing concerns.

“Now, Mr. Williams, the cuts on your hand are a little deep, so I recommend I put in some stitches to close them up.”

“Okay, Doctor.”

“Have you had stitches before?”

He shook his head.

As I set up the instruments on the bedside table, I explained the procedure. He lay back on the stretcher like a rod. It was anyone’s guess what he heard between me and the voices in his head. “Now, Mr. Williams, we will begin. Again, the numbing medicine will burn at first, and then your hand will feel numb. It’s very important that you stay very, very still. You can say whatever you want, just don’t move, okay?”

“Okay.”

“Ready?”

His left hand was balled up into a fist. He chewed on his thumb as he mumbled, “Yes,” and then squeezed his eyes shut tight.

“You’ll feel a pinch now.” He lay there stiffly as I pierced his palm several times to deposit the anesthesia. “All done with that part.” He sighed and glanced down at the V-shaped cut at the fleshy part of his palm, near the base of his thumb, which now oozed a red mixture of blood and lidocaine. Testing the area to make sure it was properly anesthetized, I inquired if he felt any pain. He indicated that he did not. As I placed the lidocaine and needle aside, he gasped again and then looked away. I loaded the suture on my needle driver before looking up to inform him that I was about to begin. But before I could, his entire body jumped. The instruments slid to the side of the tray, and the bottle of lidocaine toppled to its side and then clanked against the raised edge of the table.

He looked to the far corner of the room and yelled, “Stop it!” to whatever ghosts were there.

“Mr. Williams, are you with me?” I asked in a manner that sounded far calmer than I actually felt. I took deep breaths to still my palpitations, to cool the warmth rising in my chest. I looked through the open door to see Lorraine staring at me wide-eyed over her computer.

Mr. Williams looked back toward me. His body was still tense, and each limb was rigid on the bed, as if secured by suction cups. But his face softened, and his eyes were pleading. “Yes, yes, Doctor.”

“Mr. Williams, do you still want to proceed?”

“Yes. Okay. Yes, yes.”

“You just have to stay really still—perfectly still. If you move, I can’t put in the sutures.”

There are times when we take an uncompromising stance with patients, when we tell them to either cooperate or leave. But sometimes a softer approach is necessary. This patient seemed too fragile: I knew I would have to nurture him through the process like a doting aunt.

A third of the way through the procedure, he suddenly drew up his legs and before I could ask him to stop, he said, “It’s okay, it’s okay. You’re okay. She’s okay. We are safe here. It’s okay.”

I held my instruments in the air as the suture dangled between us. I waited for the outburst to pass. I waited to complete the world’s fastest sutures. I thought about just stopping, even contemplated zipping through a simple continuous running suture (a type of stitch where the sutures aren’t separated. You simply place throw after throw, then tie the suture material off at the end so that the tissue is connected by one long piece of suture material. The benefit of this stitch is that it prioritizes speed. The downfall is that if it breaks anywhere along the material, the entire closure comes apart), but finally reminded myself that this was his hand and I should do the sutures for the most effective wound healing, so that he would have the best chance of retaining its function. But the key was still to finish fast.

He shifted his gaze to the needle driver and forceps and then to the black nylon thread pulled taut. He then looked over to the scissors and other sharp instruments to my right. His eyes parked there, and I lowered my hands to rest my instruments on the tray. I laid the suture down so it wouldn’t injure him and left the untied suture in place of the most recent stitch. I felt myself drawing my tray of sharps closer to me. He exhaled and appeared to settle again, reminding himself aloud that he was okay, I was okay, and he was safe. Within moments, I completed the fastest sutures I had ever thrown.

“All done!” I announced as I collected the instruments. I undraped his hand and asked him to wait where he was, so the nurse could clean and dress the stitched-up wound.