Cutting edge

The introductions had been made and I had finished taking the history from this nervous 5-year-old and his mother, neither of whom I had met before. I was about to begin my exam when I noticed that the window on the head of my ophthalmoscope was loose. A simple tightening of the little screw should do the trick. I reached into my pocket, pulled out my 2½-inch penknife, and began to open it. The patient screamed and clung to his mother with a death grip.

It turns out that just as I was entering the exam room, the mother and son were finishing a discussion about doctors and knives. Somehow, the preschooler had heard about doctors doing amputations. I suspect an older brother or playmate had planted the seed of fear in the fertile soil of this young man’s imagination. The mother had reassured him that this new doctor didn’t do amputations and certainly didn’t have a knife. It took a few minutes of intense reassurance and a promise from me to leave the knife in the sink before I was able to gently pry the patient from his mother so that I could examine him.

I have carried a small single-blade penknife in my right front pants pocket for most of my adult life. Although I was only a Boy Scout for a couple of years, clearly those were formative years, and I have always tried to "be prepared." Letters must be opened, apples quartered, impenetrable blister packs penetrated, and loose screws tightened. Armed with a penknife, I am like MacGyver: ready for the next challenge to survive.

For those of us who have been habitual knife carriers, the Transportation Security Administration regulations in the wake of 9/11 have left us feeling naked and vulnerable when we travel. Some disarmed travelers have even taken the rash step of checking their carry-ons to avoid the insecurity of traveling knifeless. But I have learned to cope with my vulnerability and even believe the TSA is making a mistake with their recent plan to remove small penknives from their no-fly list.

I still carry a penknife when I’m at home and in the office and often use it to rescue myself and coworkers from minor catastrophes. But when the metal must meet the patient and sterility is important, my weaponry expands to include a No. 10 blade for shaving warts and a No. 11 blade for lancing large boils. I prefer to use these blades without their handles. While this does slightly increase the risk to my own skin, it has the advantage of making the weapon much less menacing to the patient.

However, my favorite sharp instrument is a lancet. You know, the ones that are usually encased in blue or white plastic and have a twist-off cap of matching color. They are the ultimate in stealth weaponry. They appear to be just innocuous little pieces of plastic. Even with the cap removed, the blade is difficult to see. One doesn’t have to be much of a magician to keep the business end of this little tool from the inquisitive eyes of nervous patients.

Actually, when it comes to sharps, all patients are nervous.

But lancets are excellent tools for incising small blisters. They are particularly effective for teasing out splinters. Although they were designed to puncture, lancets actually have a surprisingly useful cutting edge. Unfortunately, the development of mechanical spring-loaded lancets has made these little wonder tools difficult to find. I have hoarded all the ones I can put my hands on. We old Boy Scouts always want to be prepared.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].

The introductions had been made and I had finished taking the history from this nervous 5-year-old and his mother, neither of whom I had met before. I was about to begin my exam when I noticed that the window on the head of my ophthalmoscope was loose. A simple tightening of the little screw should do the trick. I reached into my pocket, pulled out my 2½-inch penknife, and began to open it. The patient screamed and clung to his mother with a death grip.

It turns out that just as I was entering the exam room, the mother and son were finishing a discussion about doctors and knives. Somehow, the preschooler had heard about doctors doing amputations. I suspect an older brother or playmate had planted the seed of fear in the fertile soil of this young man’s imagination. The mother had reassured him that this new doctor didn’t do amputations and certainly didn’t have a knife. It took a few minutes of intense reassurance and a promise from me to leave the knife in the sink before I was able to gently pry the patient from his mother so that I could examine him.

I have carried a small single-blade penknife in my right front pants pocket for most of my adult life. Although I was only a Boy Scout for a couple of years, clearly those were formative years, and I have always tried to "be prepared." Letters must be opened, apples quartered, impenetrable blister packs penetrated, and loose screws tightened. Armed with a penknife, I am like MacGyver: ready for the next challenge to survive.

For those of us who have been habitual knife carriers, the Transportation Security Administration regulations in the wake of 9/11 have left us feeling naked and vulnerable when we travel. Some disarmed travelers have even taken the rash step of checking their carry-ons to avoid the insecurity of traveling knifeless. But I have learned to cope with my vulnerability and even believe the TSA is making a mistake with their recent plan to remove small penknives from their no-fly list.

I still carry a penknife when I’m at home and in the office and often use it to rescue myself and coworkers from minor catastrophes. But when the metal must meet the patient and sterility is important, my weaponry expands to include a No. 10 blade for shaving warts and a No. 11 blade for lancing large boils. I prefer to use these blades without their handles. While this does slightly increase the risk to my own skin, it has the advantage of making the weapon much less menacing to the patient.

However, my favorite sharp instrument is a lancet. You know, the ones that are usually encased in blue or white plastic and have a twist-off cap of matching color. They are the ultimate in stealth weaponry. They appear to be just innocuous little pieces of plastic. Even with the cap removed, the blade is difficult to see. One doesn’t have to be much of a magician to keep the business end of this little tool from the inquisitive eyes of nervous patients.

Actually, when it comes to sharps, all patients are nervous.

But lancets are excellent tools for incising small blisters. They are particularly effective for teasing out splinters. Although they were designed to puncture, lancets actually have a surprisingly useful cutting edge. Unfortunately, the development of mechanical spring-loaded lancets has made these little wonder tools difficult to find. I have hoarded all the ones I can put my hands on. We old Boy Scouts always want to be prepared.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].

The introductions had been made and I had finished taking the history from this nervous 5-year-old and his mother, neither of whom I had met before. I was about to begin my exam when I noticed that the window on the head of my ophthalmoscope was loose. A simple tightening of the little screw should do the trick. I reached into my pocket, pulled out my 2½-inch penknife, and began to open it. The patient screamed and clung to his mother with a death grip.

It turns out that just as I was entering the exam room, the mother and son were finishing a discussion about doctors and knives. Somehow, the preschooler had heard about doctors doing amputations. I suspect an older brother or playmate had planted the seed of fear in the fertile soil of this young man’s imagination. The mother had reassured him that this new doctor didn’t do amputations and certainly didn’t have a knife. It took a few minutes of intense reassurance and a promise from me to leave the knife in the sink before I was able to gently pry the patient from his mother so that I could examine him.

I have carried a small single-blade penknife in my right front pants pocket for most of my adult life. Although I was only a Boy Scout for a couple of years, clearly those were formative years, and I have always tried to "be prepared." Letters must be opened, apples quartered, impenetrable blister packs penetrated, and loose screws tightened. Armed with a penknife, I am like MacGyver: ready for the next challenge to survive.

For those of us who have been habitual knife carriers, the Transportation Security Administration regulations in the wake of 9/11 have left us feeling naked and vulnerable when we travel. Some disarmed travelers have even taken the rash step of checking their carry-ons to avoid the insecurity of traveling knifeless. But I have learned to cope with my vulnerability and even believe the TSA is making a mistake with their recent plan to remove small penknives from their no-fly list.

I still carry a penknife when I’m at home and in the office and often use it to rescue myself and coworkers from minor catastrophes. But when the metal must meet the patient and sterility is important, my weaponry expands to include a No. 10 blade for shaving warts and a No. 11 blade for lancing large boils. I prefer to use these blades without their handles. While this does slightly increase the risk to my own skin, it has the advantage of making the weapon much less menacing to the patient.

However, my favorite sharp instrument is a lancet. You know, the ones that are usually encased in blue or white plastic and have a twist-off cap of matching color. They are the ultimate in stealth weaponry. They appear to be just innocuous little pieces of plastic. Even with the cap removed, the blade is difficult to see. One doesn’t have to be much of a magician to keep the business end of this little tool from the inquisitive eyes of nervous patients.

Actually, when it comes to sharps, all patients are nervous.

But lancets are excellent tools for incising small blisters. They are particularly effective for teasing out splinters. Although they were designed to puncture, lancets actually have a surprisingly useful cutting edge. Unfortunately, the development of mechanical spring-loaded lancets has made these little wonder tools difficult to find. I have hoarded all the ones I can put my hands on. We old Boy Scouts always want to be prepared.

Dr. Wilkoff practices general pediatrics in a multispecialty group practice in Brunswick, Maine. E-mail him at [email protected].