Turns out, the circular saw was the least of my problems ...
August 9, 2011 7:43 PM   Subscribe

I just put a 2 inch gash in my leg deep enough to expose fatty tissue. I can't afford to go to the ER. Will it be okay if I wait until morning?

I was using a wood chisel to remove trim from one of the doors on my chicken coop. I applied too much force and ended up opening up a 2 inch gash on my leg right above my knee. I could see fatty tissue but no muscles or veins. With a little help from my husband, I flushed out the cut with sterile saline, held the edges of the wound together while applying bandaids (tight, in an effort to keep the wound edges together), covered it with sterile gauze and loosely applied an ace bandage to immobilize the area.
I can't afford to go to the ER - the bill would put a serious dent in our finances - but I plan to go to the doctor in the morning. The one thing I am really worried about is the possibility of infection, seeing as I working in my chicken-infested backyard at the time. Tell me hivemind, do I have any compellingly urgent reason (worth spending $1, 000 +) to go to the ER now, or is it okay to wait? I know, YANMD.
posted by echolalia67 to Health & Fitness (48 answers total) 3 users marked this as a favorite
If you don't get medical help within 6 hours you won't be able to get stitches. You need stitches.
posted by bq at 7:45 PM on August 9, 2011 [7 favorites]

Is there an urgent care place near you? They're cheaper than the ER, and I think that stitches are one of the things they usually do.
posted by craichead at 7:46 PM on August 9, 2011 [4 favorites]

Can you go to an urgent care? It needs to get closed right away.
posted by la petite marie at 7:47 PM on August 9, 2011 [2 favorites]

According to this page:

How much time you have depends on a number of factors. If the wound has a high likelihood of contamination, then you have about six (6) hours to get stitches before the wound will become too contaminated to stitch. Some wounds are not generally stitched because of severe contamination, human or animal bites are good examples.

Wounds with less chance of contamination may be stitched as long as eight (8) hours after the injury. Depending on the wound, scarring can be minimized as long as 24 hours after the injury, but the longer you wait, the less likely that stitches will be possible.

posted by la petite marie at 7:50 PM on August 9, 2011 [1 favorite]

At least one of my kids has had staples or sutures put in at an urgent care. Depending on where you are, you may be getting past the open hours for urgent care, but it would be worth checking.
posted by not that girl at 7:51 PM on August 9, 2011

It's worth the payment plan. That wound needs to be closed, and can't be closed if left overnight. You don't want an infection, certainly. I've had MRSA twice and a gash like that would be prime breeding grounds for infection.
posted by xingcat at 7:51 PM on August 9, 2011 [3 favorites]

Response by poster: The urgent care closed at 5 PM & the injury happened at 5:30 PM; so no, there is no way I could get to an urgent care until the morning.
posted by echolalia67 at 7:51 PM on August 9, 2011

Sorry, but you need stitches and a tetanus shot for good measure. Find an urgent care clinic. Dot it now, then figure out how to pay them later. If you know how to play dumb, it really works!
posted by Gilbert at 7:51 PM on August 9, 2011

The compelling reason is that you don't want gangrene.
posted by dfriedman at 7:52 PM on August 9, 2011 [8 favorites]

Okay, warning - this is super sketchy: I've done it to myself as well as giving two other people stitches on pretty deep but otherwise very clean, easy and fast-healing cuts - give yourself stitches. It's a quick fix and will probably leave a scar and obviously, I AM NOT A DOCTOR, simply the daughter of a medical professional who deems herself headstrong enough to skip a few ER visits.
posted by banannafish at 7:52 PM on August 9, 2011 [2 favorites]

go to the ER and tell them you are indigent.
posted by facetious at 7:53 PM on August 9, 2011 [2 favorites]

I recommend seeing a doctor, as otherwise you cannot get stitches. At 2 inches long and quite deep, you want stiches. If, however, you really do not want to go to the ER, you should get butterfly bandages to hold the cut together.
posted by jeather at 7:53 PM on August 9, 2011

"Stitches do not decrease the risk of infection in a cut if properly cared for. Most cuts can generally be closed as long as 24 hours after the accident. Some cuts should be closed sooner, but it is very safe to wait at least 8 hours to have a cut closed." Source.

I would totally wait. This is a cut. It is not an emergency, and if you need stitches for closure, tomorrow will be fine.
posted by DarlingBri at 7:54 PM on August 9, 2011 [1 favorite]

You CAN skip stitches, assuming the bleeding has stopped, but you're gonna have a seriously wack scar. I drunkenly sliced my thigh (accidentally, obviously) one night before a flight and didn't get stitches. The scar is pretty epic.

I am not a doctor. You might also get a nasty infection and die of blood poisoning for all I know, but I am still alive. Just more Road-Warriory.
posted by mckenney at 7:55 PM on August 9, 2011 [1 favorite]

I have a fourteen-year-old scar from very nearly the same injury as you have, a chisel slip which went unstitched. It didn't get infected, but it was not as big as yours and it didn't involve chicken feathers.

Please be safe.
posted by Countess Elena at 7:57 PM on August 9, 2011

(PS: I didn't mean to be curt and am assuming you have successfully staunched the blood. I would be totally comfortable waiting, obviously, but a) I am not a doctor, and b) you should do what you feel most comfortable doing.)
posted by DarlingBri at 7:58 PM on August 9, 2011

Response by poster: My husband lost his job about 2 months ago, so we don't have extra cash - we really can't afford to lose more than 1/2 of our monthly budget. Can it be treated in the morning? I don't really care about scarring, I'm more concerned about an infection.
posted by echolalia67 at 7:58 PM on August 9, 2011

When I was nine I busted my shin open in gym class. Large gash, and deep (not so much fatty tissue on the shin, but it chipped the bone--something I didn't find out until after it had healed). My mom (who was a teacher at the school) decided I didn't need to go to the ER, so we held it together with some butterfly stitches until it healed up--which took freaking forever. Months later it was still giving me problems.

However, it did eventually heal. Save for a large scar and a divot where some shin bone should be I'm no worse for the wear.

I would wait until tomorrow. IANAD, this is your call.
posted by phunniemee at 7:59 PM on August 9, 2011

Yeah you sound like you've cleaned it really well. I'd wait. Plus it doesn't sound like you have much of a choice.
posted by mckenney at 8:01 PM on August 9, 2011

The ER will see you and you can work out a payment plan and give them a little bit at a time, as you can. So long as you're making good faith efforts to pay it off, it's unlikely they'll send you to collections -- wait until after the fact, then negotiate to pay them $20.00 a month until the end of time, or something. That will be infinitely less expensive than the bills you will have if you develop a serious infection.
posted by Devils Rancher at 8:05 PM on August 9, 2011 [9 favorites]

Just a data point: I had a leg wound that I thought was more minor that it turned out to be. When I went to the doc after 24 hours, I had to have it cauterized. I have a scar, which I actually don't care about much.
posted by BlahLaLa at 8:06 PM on August 9, 2011

Seconding Devils Rancher. Go to the ER. When you get the bill, immediately call up the business office and get on a payment plan that you can afford. They will work with you, it's what they do. Explain your situation and everything will be fine.
posted by SquidLips at 8:19 PM on August 9, 2011 [2 favorites]

I just two weeks ago had the skin on my leg broken by a batted softball. (Long story, but I was pitching.) I ignored it for two days. I then found out it was infected about a week after it happened. No problem. I got some anti-biotics which did not do the trick. Went back to doctor and he gave me stronger ones. Infection all gone. If I were you, and this is not medical advice, I would put bandaids of a butterfly bandaid on it as tight as possible, cover it (as you did) and go first thing in the morning.

Also, call your doctor now. See who is on call. They might tell you to come to the office and they will meet you there if you tell them your situation.
posted by AugustWest at 8:25 PM on August 9, 2011

Your profile indicates that you are in San Francisco. Do you qualify for HealthySF? I think sometimes ER visits to SF General can be sort of covered under that retroactively. I know the process is complicated, though, and you might have to fight for it.
posted by needs more cowbell at 8:25 PM on August 9, 2011

If this gets infected or complicated because you delay going, you're looking at a hell of a lot more in expenses than stitches at the ER. How lucky do you feel?
posted by availablelight at 8:29 PM on August 9, 2011

(Specifically, my friend had her ER bill go away in that manner a few months ago. But it took a while.)
posted by needs more cowbell at 8:35 PM on August 9, 2011

Meh. Mom's an ER nurse and she never let me go to the ER for similar injuries. Just stopped the bleeding until I could go to the regular doctor the next morning to get stitched up. IANAD, YMMV, strangers on the internet disclaimer, etc. Oh, and my mom says to make sure you shower before going into the doctor's office tomorrow, because when I went in the next day all dirty from the rough-and-tumble that got me cut, she was always embarrassed, which came out to me as pissed.
posted by u2604ab at 8:36 PM on August 9, 2011

Your profile indicates you are in San Francisco. There are many urgent care facilities in the area, some of which are 24 hours.

Is it likely that the wound will be fine in the morning? Maybe. Is it likely that you don't want any part of the possibility of infection that could set in? Absolutely. That's the really dangerous part, giving unfriendly organisms an extra 12 hours to multiply in what could be a pretty anaerobic environment.

It's risk-factor analysis. But I'd be hopping in a car or riding a bus or finding a cab to take me to a 24 hour Urgent Care somewhere in the city.
posted by griffey at 8:47 PM on August 9, 2011 [2 favorites]

Your leg is worth more than $1000. Were I in your shoes, I'd look into finding an open urgent care facility or ER.
posted by Blazecock Pileon at 8:53 PM on August 9, 2011

Response by poster: Fuck.

Thank you for all of the information - I now know how serious this is and the risk I'm taking by not getting it treated now. I hear you, "go now" people; you're absolutely right but I haven't much choice (due to the financial situation) but to wait until the morning and hope for the best. The Urgent Care opens at 8 AM ... I will be there at 7:30 AM. Thanks again and wish me luck.
posted by echolalia67 at 8:57 PM on August 9, 2011

Good luck! I really think you'll be fine. You'll have a really uncomfortable night, and maybe get a stern lecture from the doctor you see tomorrow morning, but that'll probably be the worst of it. People all over the world sustain worse injuries every day with lesser access to medical care and live to tell the tale. We make some great antibiotics these days--it's gonna be ok.

I hope everything goes as well as possible. Keep us updated!
posted by phunniemee at 9:05 PM on August 9, 2011

It might not cost as much as you fear. One of my kids had a recent trip to the ER and the amount billed to our insurance was around $500.

He didn't need stitches, and I don't know how much they add.
posted by The corpse in the library at 9:10 PM on August 9, 2011

Best answer: You really aren't listening though that ERs will work with you on making payments, many will take even five dollars a month for years if that is what it takes. Or they will have an indigent care program that will cover at least part of it.

I spent a lot of almost two years in and out of the hospital due to infection. If you had cut yourself in a cleaner environment it would be less worry, but, in a yard full of chickens? That is asking for infection to set in. While we may have great antibiotics, we also have numerous strains of bacteria that are resistant to most antibiotics. Believe me you want to avoid the heavy hitter antibiotics, as they can have serious side effects, and one dose of those antibiotics often costs more than an ER visit.

Added to that is if it is a serious infection that needs those antibiotics, you will often end up in the hospital while you are on them.

I hope it works out ok, but, I really am worried about you putting this off.
posted by SuzySmith at 9:13 PM on August 9, 2011 [4 favorites]

Response by poster: Okay, I'm going now. Sorry, this is kind of a scary thing for me.
posted by echolalia67 at 9:27 PM on August 9, 2011 [5 favorites]

Look into healthy SF as suggested upthread. I'm really sorry you had to make this choice. I didn't pay bills this month in order to fill my prescriptions and I totally feel you on this.

Let us know how it goes, ok?
posted by guster4lovers at 9:31 PM on August 9, 2011

I see that you've cleaned the wound; have you put any topical antibiotics on it? I'd suggest Betadine (alcohol takes 30 minutes to kill anything), then polysporin or something better.

Oh, you're going to the ER -- sorry, and good luck.
posted by amtho at 9:36 PM on August 9, 2011

I have purple parallel scars on one calf that look like I got clawed by an animal, but they're actually where a bike petal gouged my leg tearing triangular furrows through the skin. They didn't seem quite as deep as I later realized they were. We washed them and put antibiotic stuff on them and kept them clean and bandaged. For weeks. Then I had scabs there for half a year or so after that. It took a long time to heal but other than that everything was fine.

But you know what? I really wish I had seen somebody about it early on.
posted by wobh at 9:53 PM on August 9, 2011

alcohol takes 30 minutes to kill anything

Is that true? I always thought alcohol was a good way to sterilize small injuries. (Not that it would necessarily work on a deep wound like this.) Why do nurses swab your arm with alcohol for just a moment before giving injections etc, if alcohol takes 30 min to kill bacteria?
posted by LobsterMitten at 10:06 PM on August 9, 2011

Hope this isn't too off-topic --

This doesn't seem like the super-likely case for it, but I read that tetanus can thrive in anaerobic locations like chicken coop bedding. (It's not caused by rusty nails; it's just that the rusty puncture wound makes a particularly comfy spot for it to grow.) I can't find the article now, but I know I read an article from an authoritative source (probably one of the farm lists or news sites) that mentioned this, and I made me and mr. librarino both get tetanus shots right away. When I told the doctor we were farming, with chickens and goats and stuff, she said it was "medically relevant" and made sure to write it down in my chart. So it might be a good plan in general for you to have a tetanus shot up to date, if it isn't already.

Good luck with the financial aspect. I've been putting off doctor bills so that I can cover other bills, and I have a full-time job with reasonably good insurance. I know it sucks.
posted by librarina at 10:08 PM on August 9, 2011

Best answer: I have to tell you that you are getting a few remarkably bad pieces of advice from some people: I am an ex-military medic

#1: do NOT gove yourself stiches
#2 DO go to an ER. Do it NOW. Do NOT wait until the morning.

You can work out payments later - if you've cut down all layers of skin as you describe then you are at high risk of infection - a variety of infections. You are risking your leg. Literally. Go now.
posted by Poet_Lariat at 11:34 PM on August 9, 2011 [8 favorites]

Response by poster: Back from the ER - 8 stitches. Nurses said that the wound looked pretty clean, should be no problems. Going to bed.
posted by echolalia67 at 11:52 PM on August 9, 2011 [21 favorites]

Thanks for the update. Hope you got some decent painkillers and you can rest.
posted by kinetic at 4:21 AM on August 10, 2011

echolalia67, if you need any help or advice about negotiating a payment plan with the ER, please feel free to MeMail me for tips. We have private health insurance and we do negotiations ALL THE TIME with various specialists.
posted by cooker girl at 6:57 AM on August 10, 2011 [2 favorites]

Glad you went to the ER and got it treated - you'll be much happier with the cosmetic result. For those who find themselves in a similar situation in the future, it is not really imperative to close a wound of this nature. McKenney is right - you will have quite a scar if the wound is left to heal by secondary intention, but the skin is meant to heal from the bottom up without needing closure (human skin has been around a lot longer than sutures). Sutures are used mainly to bring the skin edges together so that the scar tissue that forms between those edges is minimal. And scars can always be revised weeks, months, or years in the future when money isn't quite as tight.

(I am a doctor. I am not your doctor. If you are ever concerned enough to ask if you should seek medical attention, the party line answer is almost always "yes.")
posted by robstercraw at 8:06 AM on August 10, 2011 [1 favorite]

Response by poster: Hope you got some decent painkillers and you can rest.

Nope, they told me to take 600 mgs of ibuprofen. Thing is, the cut really didn't hurt much at any time. I've had much more pain from skinned knees or even superficial cuts while shaving my legs. That's probably part of why I was resistant to going to the ER - if it didn't hurt, it couldn't be all that bad, right? Wrong.

Thank you all for the gentle nagging to go to the ER - I wasn't really thinking clearly and could have ended up with a really nasty infection.
posted by echolalia67 at 8:59 AM on August 10, 2011 [5 favorites]

I am very happy you went ahead and got the care you needed.

Last time I was forced to go to the ER I was a part time worker and a full time student, so I had very little money. I was able to provide my pay stubs as proof of income and get the bill itself reduced by some significant percentage, then put on a payment plan. They will absolutely work with you, so don't fret.
posted by Famous at 1:19 PM on August 10, 2011

Just chiming in to say that I had a similar situation, I didn't go to the doctor, and I ended up with a nasty infection and the nasty side effects of hardcore antibiotics. I missed work and felt like a fool for being so laid up after a small injury. You made the right choice.
posted by samthemander at 6:32 PM on August 10, 2011

I am so glad you got checked out and are doing well! I worried about you all night last night, as I hate the thought of anyone having to deal with a nasty infection especially solely because of money.
posted by SuzySmith at 10:11 PM on August 10, 2011 [1 favorite]

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