Polite Dissent

Batman: Gotham Knights #53
A. J. Lieberman, writer
Al Barrionuevo, penciler

In this issue, Hush joins Dr. Mid-Nite as one of the few physicians portrayed in comics who are actually shown practicing medicine.

Hush travels to Star City, where he rescues Prometheus from a battle with Green Arrow. Green Arrow had shot Prometheus 3 times: once in each shoulder and once in the thigh.

In a hotel room, Hush initially has Prometheus icing his shoulder, and then encases his whole body in bags of ice. An IV is placed and running some sort of fluid. Hush removes the arrows and sews up the incisions. He injects Prometheus with morphine to kill the pain.

First, Hush has good suturing skills. He gives an excellent demonstration of vertical mattress sutures.

Sutures come in two main varieties: running and interrupted. In a running suture, a knot is tied at one end of the incision, enough stitches are placed to close the wound, and then a second knot is placed at the far end. Running sutures are fast and not as irritating to the body as interrupted sutures (there are fewer knots). Therefore they are good when speed is an issue, or internally when fewer knots are better. On the other hand, running sutures aren’t as forgiving, and one break will re-open the entire wound.

In interrupted sutures, each stitch is tied and knotted separately. Interrupted sutures are easier to line up and give better cosmetic results. They are slower to tie, but sturdier because one stitch can break without affecting the others.

Hush is using a special type of interrupted suture known as a vertical mattress suture. These are good for closing gaping wounds without putting undue pressure on the incision (note that the knots are not over the incision). They can leave a bigger scar sometimes and can be a pain to take out, but are a good choice in this instance.

I’m unsure what the purpose the ice is serving. There is anecdotal evidence that lowering a patient’s temperature slows bleeding, but if it is lowered too much the bleeding worsens. The temperature must be tightly controlled, not like it is here. More importantly, individuals who have lost a great deal of blood are at increased risk for hypothermia, so icing Prometheus is not a good call.

Finally, it would be a lot easier on Hush if he’d just inject the morphine in the IV already there, rather than trying to inject the vein.