Monday, October 8, 2007

This is Spinal Tap

So, one of the things that I was too tired to post about last week was my morning with the spinal tap nurse. Spinal taps (also known as lumbar punctures) occur all over the hospital in a bunch of different situations, but this particular clinic is for pre-scheduled patients. Their taps are an important part of their diagnostic workup (for lymphoma, multiple sclerosis, and so on) but are not a very acute need (like someone in the emergency room with possible meningitis would be).

There were two patients on the schedule, so in the spirit of "see one, do one" (thank goodness I didn't have to "teach one," which is the last part of the medical school triad), the nurse demonstrated on the first patient and then I did the tap on the second. I was quite alarmed at the prospect of sticking a giant needle into someone's back, no matter how many times I reminded myself that it was well below the end of the spinal cord, but just like that first cut in the anatomy lab, I had to take a deep breath and do it. The worst part was probably fumbling around with the setup tray, drawing up the anesthetic and getting the different needles on and off the syringes, feeling thoroughly incompetent and slippery-fingered.

I needed to give some extra anesthetic partway through (this happens, different people have different responses to the stuff), but as soon as I did that and repositioned the patient ("tuck your head down more! Bring your knees up farther!"), I got the spinal needle right into the desired space. The patient did screech once (apparently one moment of pain is pretty common at the moment of pushing through the covering of the cord), and luckily the nurse, anticipating my alarm, motioned frantically that everything was fine and not to pull the needle back out! Then we just waited for the appropriate amount of cerebrospinal fluid to drip out, and that was that.

There's a small chance I will get to do this again, either in the emergency room or on the inpatient floor, during the rest of my rotation. It's certainly something I'll need to be competent at as a resident...luckily, it turns out not to be difficult at all!

ps - I was reminded by A to explain the "This is Spinal Tap" reference. The best part of the movie is learning that amplifiers that go to 11 are, by definition, better. Now, that's my kind of math.

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