CHAPTER 1
Cuts, Punctures, Lacerations and Bruises
Not long ago, Dr. P. invited us to Saturday-night dinner at histwo-story, brick Tudor home in the hills over looking the beautiful,rolling vineyards of Napa Valley. A prominent plastic surgeon byday and a gourmet chef of incomparable excellence by night, thedish he'd selected was the recipe of the year as selected by BonAppetite magazine: cod fish over mashed potatoes. The idea wasto use this variation of a simple-but-elegant, traditional Frenchpeasant meal to set off a sterling 1982 Cakebread Chardonnay,which had just reached its anticipated height of fermentation.
Needless say, the meal was exceptional and the wineoutstanding. But we noticed as Dr. P. ladled the sauce beurreover the cod, that his fingers were bandaged. "Bad day in theoperating room?" we inquired. "No," Dr. P. answered to oursurprise, "bad day in the kitchen."
The situation was such: Dr. P. had left a two-pound fillet offrozen cod, flash-frozen in the Pacific Ocean but 24 hours earlier,in the refrigerator to thaw. When the moment came to beginthe meal preparation, Dr. P. removed the fillet from the fridge,unwrapped it and washed it under cold water in the sink. Thecod felt a little cold to the touch, so Dr. P., holding the fillet inhis right hand, firmly prodded the white flesh of the cod with afork. The result was unexpected and something that had neverhappened to him in twenty-five years of surgical practice in theoperating room; the fork sailed through the cod fillet, went rightthrough Dr. P.'s hand and pierced it with five-pointed prongs.
As a physician, Dr. P. knew that wounds to the to the epidermallayer of the skin can range from minor (a scratch) to severe(deep). In this instance, Dr. P. watched five little red circles ofblood form on each of the inside fingers of his right hand.
Diagnosing the injury, Dr. P. first ran his hand under cold tapwater and cleansed the wounds with soap. The second step wasto staunch the blood flow with gauze, plentiful in the operatingroom, but absent in the kitchen. Thus, a towel sufficed for themoment.
Dr. P., again, from his operating room experience, knew itwas important to put an antiseptic and antibiotic on these smallpunctures. To prevent infection in his own system, but equallyimportant in this day and age, to insure that no-blood-borneviruses he may have encountered spread to any of the food hewas working with. While he'd been tested for hepatitis, HIVand other similar infectious pathogens, he was quite familiarwith the transmission routes of these diseases. He surely didn'twant to take the chance that his guests would leave with morethan memories of a good meal after they departed thanks tocarelessness on his part.
As the leeks in the oven reached their point of perfectionbefore burning, Dr. P. had to race to the bathroom medicinecabinet for adhesive bandages and an antiseptic. Then it wasback to the kitchen to continue to stir the leeks, just in time.
What happened here illustrates what can happen to anyonewhile making any of hundreds of different meats, fish, fowl andother preparations. And if it can happen to a skilled surgeon oflong practice, it can happen to the home gourmet chef who mayhave just raced home from the office to prepare or finish theevening dinner for family and friends.
Prodding a cod fillet with a pointy-pronged fork or knifewhile holding it in one's hand somehow becomes normal in thethrill of working in the gourmet kitchen—something neitheran experienced surgeon or outdoorsman would do in normalcontext. Yet it is but one of a hundreds of different similar skininjuries that can happen in the kitchen when handling sharpcutlery.
Most of us can probably also relate when we hear of handsor fingers being pierced while placing lamb and onion chunkson a barbecue skewers or while inserting sharp pointed bamboosticks into a sushi roll; of cases where hands punching aerationholes in aluminum foil-wrapped baked potatoes were pierced;of slicing a finger of the edge of a sharp can lid while opening acan, or impaling a hand on a submerged knife caught upright inthe sink's garbage disposal. Likewise, the nipped or sliced fingerwhile shaving or paring a small vegetable or fruit, like a kiwi, isall too well known. The upshot can range from a small scratch ordrop of blood to deep lacerations of veins or striking a nerve (asin acupuncture) and causing paralysis or neurological damage.
How much easier would it have been if the antiseptic, gauzeand adhesive bandages were in a handy first aid kit in a kitchencabinet, so that a minor accident could be repaired withoutneedlessly wasting time searching for first-aid items? (Chapter14.) Besides the obvious medical implications, five minutessolving a small and important emergency of this type couldmake the difference between a good meal and a great a meal,for example, as the heat on the range may need to be lowered orturned off, to stop sauces and reductions from congealing and/or depriving vegetables or meats of perfect flavor.
While not exhaustive, here are the main types of cuts,lacerations and bruises that can potentially occur in the kitchenaccidentally while one is distracted, or unclear about thetechniques of using sharp instruments. Again, nothing can replaceproper medical care from a qualified medical practitioner, andprofessional medical treatment should always be sought.
Deep puncture wounds
Deep puncture wounds—such as from a knife, skewer orwine corkscrew—are typically longer than one inch deep. Theyare also characterized by inability to stop the bleeding.
In the case of a severe puncture wound, the guiding principleis to dial 9-1-1 or go immediately to an emergency room ordoctor.
Ideally, use a piece of thick sterilized gauze to press on thewound. In the event clean gauze isn't available, use any cloth,the cleanest available, to press on the wound. In the kitchen, thiscould include towels, dishrags or napkins. Failing to find any ofthese, remove and use your shirt, socks or another clean clothingitem. If none of these are possibilities, use your hand, pressing thepalm firmly over the wound. It's always important to rememberthat whatever you use to staunch the wound, cleanliness of thematerial is necessary to prevent later infection.
It's also important to remember not to press directly on anyobject that might be stuck or impaled in the wound. Insteadpress around it. This is particularly important with eye injuriesor broken bones. And never try to remove something firmlystuck in a wound. Leave that to the doctor. In the event of ableeding eye wound, cover the eyes lightly (never put directpressure on an eye wound) with gauze or bandages, and headfor the emergency room on the double.
When the bleeding stops, the cloth being used should not beremoved. Leave it in place and use more cloths to cover it.
If the bleeding won't stop after several—say five—minutes,find an artery and apply pressure with your thumb. Points thatan artery can be found are in the neck, elbow (inside), wrist(inside), groin, knee (back) and top of the feet.
You may also wish to use a tourniquet to stop severe bleeding.The tourniquet should be applied above the wound toward theheart, so the blood flow from the heart to the wound is restricted.However, you must loosen the tourniquet periodically to preventgangrene from setting in. A simple tourniquet can be madefrom a strip of cloth wound on the limb (above the wound) anddrawn tight by twisting the end of the cloth with a stick or evena flat-edged dinner knife from the table. Rubber tourniquets canbe purchased, and the chef may consider keeping one in his orher kitchen medicine chest. Also, placing the injured limb higherthan the heart can reduce the flow of blood.
Nerve damage
Sharp pointed objects, such as many found in the homekitchen, are also capable of striking nerves. The result can betemporary paralysis of a limb, or worse, some form of permanentdamage to the nervous system.
In the kitchen, fish, meats and even some vegetablescould potentially pose this harm if not handled properly andcarefully. Take as an example the rockfish, as commonly foundin supermarkets as red snapper, or the catfish or puffer fish,which have bony spikes. Or any fish, for that matter, where thechef may be preparing or deboning a whole fish. A jab from apointed, razor-sharp bone (much like a needle) can easily gothrough the skin and strike a nerve. Many a sole Meunière hashad to be completed by a one-handed chef whose other hand wasrendered inoperative by a fish-boned hand. And heaven help theright-handed chef who, with the added pressure of hosting, hasgot to work with only his or her left hand.
The best advice in the event of such an occurrence is toconsult a neurologist if paralysis or numbness cannot be shakenoff or if it doesn't dissipate.
Small cuts, wounds and bruises
Small cuts are characterized as generally being less thanone-quarter inch deep and not too long.
Wash the wound with soap and water. Put an antiseptic orantibiotic on the cut or scrape to prevent infection. Then applyan adhesive bandage or similar bandage, such as a piece of gauzeheld by a surgical adhesive tape, or in a pinch, clear adhesivetape will suffice. Just remember not to apply the bandage sotightly that it stops the blood flowing to that area.
Remember that, as with any cut in or out of the kitchen, acut from metal, particularly metal with rust on it, may require atetanus shot.
Glass
Broken dishes, glasses and jars frequently occur in the homekitchen. And all present the opportunity for shards of glass tocut or get embedded in the chef's hand or finger.
Glass cuts should be treated as any other cut or puncture,with the following important exceptions:
Don't apply pressure on a glass cut. Do not press hard ongauze or cloth to staunch bleeding, nor apply a tight bandage toa glass cut. The reason being pieces of glass, even minute, maybe in the wound and pressing down would further complicatematters. Minute pieces of glass will eventually work their wayupward naturally and slough off.
If a glass shard is visible and can easily be removed with atweezers (from the chef's kitchen medical emergency kit), thenyou may attempt to carefully remove it. Otherwise, embeddedglass is best left alone for the moment. Trying to remove it couldseverely complicate matters by doing more damage to tissue,nerves and blood vessels. An immediate trip to the emergencyroom or an emergency medical facility is called for, in this case.
Should a glass sliver or shard get embedded in an eye, never,ever apply pressure to the eyeball. Get to the emergency roomimmediately, or dial 9-1-1.
And never eat food that's been contaminated by glass.Even if you think you've removed all the shards, tiny, minisculepieces may still be buried in the food. A companion and I onceobserved a group of highly educated physicians and medicalpractitioners devour exquisite and expensive caviar with glassfragments taken from a broken caviar jar top rather than throwthe delicate black fish eggs away. Better to be safe than sorry.As ingested glass fragments can cause internal bleeding and,potentially, perforations of the colon, among other horrors. As arule of thumb, then, spit out or throw out any food that's comein contact with broken or shattered glass. It's not worth thepotential danger.
Slicing off the tip of a finger
As ghastly as it may sound, the risk of slicing off the tip ormore of a finger in the kitchen is always there, especially forthe unwary, distracted, rushed or intoxicated chef. Just think ofthe many great recipes that require mincing, dicing or slicing ofvegetables with large chopping knives or cleavers and you'll getthe picture.
Needless to say, should a digit be chopped or sliced off, dial9-1-1 and/or drop everything and get to the closest emergencyroom.
As a first aid step, the blood flow should be stanched with athick, sterile gauze bandage, as would be done with a puncturewound.
Depending upon the size of the injury, steps should also betaken to preserve the severed finger. Put the fingertip in a plasticbag and put it in the freezer of your refrigerator. Or dependingupon time, fill the bag with ice from the freezer, and take it withyou to the emergency room.
Again, depending upon the size of the injury, it should benoted that small slices of skin should eventually regeneratethemselves.
Bruises
Bruises can occur in any number of ways in the home kitchen.A popular activity known among home chefs is smashing his orher thumb from pounding meat or fowl with a meat hammer.And just imagine how many fingers a contemporary corkscrewhas pinched?
The treatment for this easily-acquired wound is similar tosmall cuts. Simply wash the wound and apply an antiseptic.Additionally, ice or an ice pack (ice in a plastic bag or towel)may be placed on the bruise to alleviate pain and help reduceswelling.
Broken fingers should be treated as any broken bone(Chapter 3.)
Precautions and preventive measures
Most common kitchen injuries can be avoided by the chefsimply being aware of what he or she is doing and taking properpreventive measures. We recall an ancient patron of a notableFrench restaurant in midtown Manhattan toppling down thestairs to the men's room, glass goblet of red wine (no doubt ofgood vintage) in hand, resulting in large pieces of glass in andblood gushing form his forehead.
So:
• Slice away from you, never towards you.
• Never have a knife-edge or blade pointed toward you,always away.
• Never poke anything you're holding in your hand with asharp pointed utensil. If you're going to poke or impaleanything, put it on the kitchen counter or a cutting boardor plate. The same for slicing things such as cheeseblocks.
• Always make sure your fingers are sufficiently away fromthe part or section that's being cut. And take your time,don't rush.
• Always use properly sized knives and utensils, and usethem in the right manner. For example, do not use a largecleaver to whack off potato slices.
• Handle fish bones and spiny vegetables—such as theartichoke—with respect and care.
• Always stack knives and forks downside in the dish-washer,utensil drainer or sink drainer.
• Throw out any food that may have become contaminatedwith glass.
CHAPTER 2
Burns and Scalds
Of all the injuries that take place in the kitchen, burns andscalds are the most common. That's because unless you're anEskimo—on second thought, even then—most food preparationsin the kitchen require the use of heat in its many forms invarying degrees. Deep-frying oils, red-hot baking racks, boilingwaters and sauces, sizzling sauté oils and juices, hot pans andhandles are just a few of the many objects that can inflict injuryin the kitchen unless care is taken when working around them.Further, using millions of gallons of cooking oil, margarine andbutter for frying each year, Americans, in particular, should bewell informed on burns.
Any type of burn and scald, or multiple burns, can potentiallyoccur in the kitchen accidentally, while one is distracted orunclear about what one is doing. Hands and digits are not the onlyappendages susceptible to burns or scalds in the home chefferie.The groin, feet and ankles, for example, present vulnerabletargets from a hot soup missing the bowl as it's poured.
The face, hair and eyes are all vulnerable, from a furnace-hotblast in the face while peering into the oven or splatters from asauté pan, to be frizzed or crisped.
Beards depending on their length, can be a particular hazardin the kitchen. A beard might set easily ablaze as the chef, forexample, hangs too close to the saucepan to sniff a reductionsauce. (A variation of this is the beard gets caught in an electricmixer, automatic bread maker, or garbage disposal.) (Chapter 4.)
Nevertheless, the most and potentially serious commonkitchen accident that can inflict a serious burn, in particularof the hands, are water burns. And not just from boiling water.Most often, painful burns occur when the chef turns on the hotwater tap on the sink and puts his or her hand under it to testthe temperature. In cases like this, the chef can expect blisteringwith a resultant uncosmetic look. And in even more seriouscases, infection.
Other common burns of the hands and fingers can occurwhen one is removing pots from the stove. For example, thehome chef may, with naked hands, attempt to remove a hot potlid thinking it will take only a second to place on the counter. Notso: the chef may find, as is usually the case, that the lid needs tobe maneuvered on the counter. Considering the top is burninghot, this predicament unfailingly leads to burnt fingers. And ofcourse everyone's familiar, at least figuratively, with burningone's fingers from handling a hot potato.
Burns come in four degrees of seriousness, depending uponhow deep the heat has burnt into the skin.
(Continues...)
