Hooked in the ER
by Joan B. Lehmann
In the Emergency Department where I work, the chief complaint section on the triage sheet changes with the seasons. With rockfish season, fish hook will start showing up again. Usually, this means a fishhook stuck in the finger or thumb of the would-be angler. Often the injury occurs even before the first cast. I even remember a patient who got hooked while cleaning out a church closet.
No body part is safe. Last year, I removed a hook from a mans earlobe. His little boy had gotten too excited with his new pole before they made it out of the driveway. As I injected Novocain into the back of his earlobe, I told him that getting his ear pierced in Ocean City would have probably cost $50. Getting it out was only going to cost him $100.
Once, a teenage boy presented with a case of hook. He turned his head 180 degrees to show me the rig. A silver leader, orange salmon eggs and yellow feathers hung from the middle of his scalp. I hated to remove it, for it contrasted nicely with his blue hair and made a fitting addition to his chains, tattoos and body piercings. I appreciated his allowing me to remove it, I told him, because if he had visited the mall with his scalp adornment, every teenager would want one.
One small boy had a fishhook stuck in his left upper eyelid. The location of the hook made me a little wary. The live wiggling worm on the hook made the nurses a little nauseous. Both boy and worm survived the operation.
Another small boy had snagged the fishhook into the seat of his fathers pants. Did you do this? I asked the boy. He smiled from ear to ear, Yeah, I caught a big one!
Modern medicine has invented a device specially designed for the job, the fish-hook extractor. Its a steel contraption with needle-nose pliers on one end to grip the hook. The handle is spring-loaded. Tighten the clamp, set the spring, push the button and presto, fishhook sprung. The sudden jerking motion and the loud snap serve as distractions as the hook is ripped out.
I am a native Marylander, but I was schooled in West Virginia. In Maryland, as soon as the hook barb meets flesh, it is a filthy, painful foreign body to be removed as soon as possible. In West Virginia, the fisher protects the hook at all costs.
Here, I routinely remove the bloody hook, hold it at the tip of my forceps and wave it under the patients nose. I watch him for it is usually him grimace and turn his head away from me (grossing out patients is one of the best parts of being a doctor) and listen to the metallic clink of the hook hitting the bottom of the sharps container.
But last spring, a woman came into the ER with a triple-hooked bass plug deeply embedded in her left thumb. Her husband hovered around her nervously. I injected Novocain into her thumb and opened the clamp on the fishhook extractor. She braced herself for the procedure. I was startled when I felt his hand grip my wrist.
Dont let nothin happen to that rig, Doc. Its my best plug!
It came clear to me. Are you two from West Virginia? I asked.
Yes maam. Elkins.
My theory was proved once again. I told them I would preserve his fishhook even if it meant sliding a small scalpel down the side of the barb, cutting her flesh to release it. Their heads nodded in unison. I removed the precious rig in toto without incident and with minimal blood loss. Then I started to wipe away a small piece of flesh from the hook with a piece of gauze.
Dont do that Doc. Fish hit better on blood!
Once again, their heads nodded in unison. It occurred to me that these two would be happy if I left the hook pre-baited with her hunk of thumb. Well catch a real bigun. Thanks, Doc! they might say.
I handed him the plug and he dropped it in a zip bag. The two scurried out the door to throw it back into the water before the sun went down.
Warm weather is when we get most of our fishing casualties, but they can occur any time of the year. The ER is open 24-7-365. Just do me a favor. Let me know up front if youre from West Virginia.
Dr. Lehmann works in the Fast Track at North Arundel Hospital. She graduated from Marshall University School of Medicine in Huntington, West Virginia. A Lothian native, she now lives in Pasadena.