Broken Skin
Friday afternoon in a big teaching hospital, I had just finished observing a general neurology clinic which had been interesting - not because of the patients, but because the neurologist running the clinic had told me (quite politely) that I ought to shave as he didn't approve of my day-old stubble. I had glanced into the small mirror in the clinic room and instantly and wholeheartedly disagreed with the neurologist, thinking to myself that I looked rather dashing with a bit of facial hair and a shirt that was somewhat tight around my arms.
I lazily floated from the clinic to the café, foraging for food. I met two of the doctors from the neurology ward there, and since they didn't object to sharing a table with me for lunch, I sat with them and munched on my mustardy Quorny sandwich. They were (rightfully?) whingeing about their jobs and how they had to be on call etc., and I smiled stupidly thinking, "This is going to be me in a few years' time."
As part of the whingeing, one of the doctors was listing the jobs she had to do that afternoon, one of which was a lumbar puncture (I love how the caption under the picture on Wikipedia's lumbar puncture page says 'a patient undergoes a lumbar puncture at the hands of a neurologist' - doesn't sound persecutory at all...). The doctor turned to me and asked me, half playfully, "Do you want to do the LP?" using the sexier-sounding abbreviation.
With my mouth full of sticky bits of Quorn, lettuce and bread, I stopped chewing and gaped at her in disbelief. I nodded and agreed quickly in case she withdrew the offer.
After finishing lunch (which took a painfully long time), we went back to the neurology ward - not to do the LP, but to type up a letter for a different patient. Nearly bursting with excitement, I offered to type up the bloody letter for the doctor, in a bid to finish the 'small jobs' quickly so we could hurry down to the patient who needed an LP.
The patient arrived. Mr V was an elderly gentleman who had come in for some routine tests (LPs are "routine" for neurologists, as are MRI scans of the brain.. but I digress). The doctor went to see him first and explained what the procedure was going to involve and the associated risks etc. I patiently waited outside for Mr V to agree to letting me stab him quite deep with a fine needle. He agreed.
I went over the introduce myself to Mr V and his wife, who looked a bit hesitant (perhaps because I exuded inexperience). I then went to fetch the doctor so we could get the equipment ready and watched as the doctor assembled gloves, needles, swabs and specimen pots on to a trolley. We pushed the laden trolley and a cheerfully yellow sharps box to the patient's bedside. Once Mr V's back was adequately exposed, we asked him to lie on his side in the fetal position so we could have a feel of his backbones between which we would be inserting the needle for the LP. I marked the right spot on his lower back with an 'X' (which incidentally was a few centimeters off).
After making a fool of myself trying to put on a pair of sterile gloves as the unnerved Mrs V looked on, I proceeded to clean Mr V's back with some good old-fashioned iodine. The doctor then gave the local anesthetic, and we put our things together as we waited for the anesthetic to numb the area. I got the giant needle out of its packaging and saw Mrs V go a shade paler out of the corner of my eye as I began to insert the needle under the doctor's verbal instructions.
I hit bone the first time I went in. We withdrew the needle, reinserted it a different angle and then hit bone again! This went on for a good ten minutes with some pretty extreme repositioning, but I kept hitting bone. The doctor then tried on her own and managed to reach the border between the backbone and the spinal covering. Not wanting to take the glory of doing a successful LP away from me, the doctor handed over the rest of the procedure to me. I pushed the needle further in and lo, and behold! we had spinal fluid leaking out of the other side of the needle (which was facing me). We collected the spinal fluid in specimen bottles and testubes, withdrew the needle and put a disproportionately large surgical wound dressing over where the needle had broken his skin.
All throughout, Mr V remained calm and patient, mumbling a few words to his wife every now and then and to us when we needed him to. I was absolutely exhilarated, having done an LP. I relished the feeling of novelty and accomplishment at the time, fully aware that the procedure will become an oft-repeated, tedious chore for me if I am to carry on training as a physician.
I had flashbacks of one of the other doctors telling us students - in jest, may I add - that we'd have to sleep with one of the junior doctors if we wanted to do an LP, and I silently rejoiced at the fact that I didn't have illicit relations with anyone in order to get this awesome opportunity to injure someone with a needle (for their own good).
I lazily floated from the clinic to the café, foraging for food. I met two of the doctors from the neurology ward there, and since they didn't object to sharing a table with me for lunch, I sat with them and munched on my mustardy Quorny sandwich. They were (rightfully?) whingeing about their jobs and how they had to be on call etc., and I smiled stupidly thinking, "This is going to be me in a few years' time."
As part of the whingeing, one of the doctors was listing the jobs she had to do that afternoon, one of which was a lumbar puncture (I love how the caption under the picture on Wikipedia's lumbar puncture page says 'a patient undergoes a lumbar puncture at the hands of a neurologist' - doesn't sound persecutory at all...). The doctor turned to me and asked me, half playfully, "Do you want to do the LP?" using the sexier-sounding abbreviation.
With my mouth full of sticky bits of Quorn, lettuce and bread, I stopped chewing and gaped at her in disbelief. I nodded and agreed quickly in case she withdrew the offer.
After finishing lunch (which took a painfully long time), we went back to the neurology ward - not to do the LP, but to type up a letter for a different patient. Nearly bursting with excitement, I offered to type up the bloody letter for the doctor, in a bid to finish the 'small jobs' quickly so we could hurry down to the patient who needed an LP.
The patient arrived. Mr V was an elderly gentleman who had come in for some routine tests (LPs are "routine" for neurologists, as are MRI scans of the brain.. but I digress). The doctor went to see him first and explained what the procedure was going to involve and the associated risks etc. I patiently waited outside for Mr V to agree to letting me stab him quite deep with a fine needle. He agreed.
I went over the introduce myself to Mr V and his wife, who looked a bit hesitant (perhaps because I exuded inexperience). I then went to fetch the doctor so we could get the equipment ready and watched as the doctor assembled gloves, needles, swabs and specimen pots on to a trolley. We pushed the laden trolley and a cheerfully yellow sharps box to the patient's bedside. Once Mr V's back was adequately exposed, we asked him to lie on his side in the fetal position so we could have a feel of his backbones between which we would be inserting the needle for the LP. I marked the right spot on his lower back with an 'X' (which incidentally was a few centimeters off).
After making a fool of myself trying to put on a pair of sterile gloves as the unnerved Mrs V looked on, I proceeded to clean Mr V's back with some good old-fashioned iodine. The doctor then gave the local anesthetic, and we put our things together as we waited for the anesthetic to numb the area. I got the giant needle out of its packaging and saw Mrs V go a shade paler out of the corner of my eye as I began to insert the needle under the doctor's verbal instructions.
I hit bone the first time I went in. We withdrew the needle, reinserted it a different angle and then hit bone again! This went on for a good ten minutes with some pretty extreme repositioning, but I kept hitting bone. The doctor then tried on her own and managed to reach the border between the backbone and the spinal covering. Not wanting to take the glory of doing a successful LP away from me, the doctor handed over the rest of the procedure to me. I pushed the needle further in and lo, and behold! we had spinal fluid leaking out of the other side of the needle (which was facing me). We collected the spinal fluid in specimen bottles and testubes, withdrew the needle and put a disproportionately large surgical wound dressing over where the needle had broken his skin.
All throughout, Mr V remained calm and patient, mumbling a few words to his wife every now and then and to us when we needed him to. I was absolutely exhilarated, having done an LP. I relished the feeling of novelty and accomplishment at the time, fully aware that the procedure will become an oft-repeated, tedious chore for me if I am to carry on training as a physician.
I had flashbacks of one of the other doctors telling us students - in jest, may I add - that we'd have to sleep with one of the junior doctors if we wanted to do an LP, and I silently rejoiced at the fact that I didn't have illicit relations with anyone in order to get this awesome opportunity to injure someone with a needle (for their own good).
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