Intensity

I think I've figured out why my posts dried up this past year. I like to tell stories, of people I've met and of the strange or crazy situations we've been in. For the past year and a half my routine steadily became sleep-shower-study in isolation as I grudgingly converted to the cult of lecture streamers. Why bother spending 5-6 hours at school everyday when I can speed through all of my lectures at 2.5x fast-forward in just three hours in my pj's? Nothing blog-worthy there.

If this is my last post, then you will know it was because I caught some bug from the scores of kids coughing into my face as I try to listen to their breath sounds. I've started my clinical rotations with pediatrics, and I absolutely love it. Today was my first day in the pediatric ER at the local children's hospital. I have been thinking of going into emergency medicine (just skim through some of my previous posts), but now that I am on pediatrics I'm not so sure I could go back into the adult world. Perhaps pediatric emergency medicine?


Lumbar punctures.

The pediatric ER attending delicately unwrapped a sterile tray that held the needle as wide as my clipboard. I looked at the pudgy preteen boy curled up into a soccer ball on the stretcher, then back to the needle. There was no way this was going to end well, I thought.

Instead of finding the landmarks for the needle, the attending started to screw together a strange contraption that resembled a chemistry set. The entire time the attending gave a steady running commentary of everything he was doing to keep the patient relaxed as possible. He promised to notify the patient every time any needles were involved- and to his credit he did so- all except when the humongous one finally went in. Kinda like ripping off the Bandaid at 2 instead of 3 I suppose. Anything to minimize the agony of having the contents of your spinal canal poked around.

Now I am not squeamish but I found myself holding my breath as the needle went in all directions in search of the elusive cerebral spinal fluid. Seconds slipped by and still nothing. What started as a low moan steadily grew as the poor kid's pain tolerance slowly broke down. The attending moved the needle in and out faster and faster as he checked for the clear drop of liquid that would indicate success.

Nothing. For now. Later that afternoon:

"I want you to burn this picture into your head, and never forget it." The strange wailing cry, the mottled purple of the tiny infant, and the sheer rigidness of her back was nothing like what a normal healthy baby should look or sound like. "She's getting the full sepsis work up," another attending explained to the gaggle of medical students in short white coats.

Do you remember the first time you saw an ultra-violent movie in the theaters? For me it was Saving Private Ryan. You aren't the same afterwards. Sure it is fake, but the constant exposure wears you down little by little almost imperceptibly.

I've already seen too much out on my ambulance, so for this little infant girl to give me chills, I knew something was extremely wrong. Microscopic invaders had so thoroughly conquered this tiny body that her organs were starting to give up. Starting to was the key word. If this lumbar puncture could work, our team could speed drugs through her system to combat this deadly intrusion. We were at a critical window however, and this stick needed to work.

A experienced nurse held the tiny baby in a firm motherly grip that forced the tiny torso to lean forward. She put a towel over the infant's head, then put her chin over the baby's head while holding the rest of the extremities with her hands. This must have caused explosions of pain as the diseased spinal cord and brain covering stretched out so that the attending could take a sample of the fluid that bathed the tiny brain. If I had cried as hard as the infant did I would have blown out my eyes.

Seconds turned into minutes as the needle poked around the spine, searching for an entrance into the spinal canal. Suddenly blood appeared and the doctor scrambled to hold a test tube to the open needle as precious drops of clear cerebral spinal fluid reluctantly left the body. I found myself exhaling slowly finally, and my train of thoughts picked up speed again. Okay little kids. Time to show me what you are made of. Cough all you want all over me, but I'm going to figure out how to fix you up right.