‘First give-PUSH, Second give- STOP’
‘First give-PUSH, Second give- STOP’
‘First give-PUSH, Second give- STOP’
The thoughts rolled through my mine, repeatedly, again and again, as I scrubbed my hands. It had been quite a while since I last scrubbed into the OR. My head goes through the process again, picturing myself doing it. Briefly, swiftly. I have seen this many times, I can do it – I tried to deceive myself, or rather, encourage.
The emotion tensed. My MO pat my shoulder, as if giving reassurance.
I am ready.
I have to be.
I put on my surgical gown. Glove size 6 and a half. Latex.
I spread the sterile set, arranging the instruments the way I liked it to be.
With my right hand, I shaked the 0.5% heavy bupivacaine, to-and-fro. Then, break the vial.
I carefully attached the 21G green needle to the 5cc syringe. 2cc was syringed out from the vial.
I added 0.5cc fentanyl, making it a total of 2.5 cc.
In another syringe, I syringed out 2cc of Lignocaine 2% (Local Analgesia).
I folded the the sterile green gauze into triangular shapes , neatly and placed them into a galipod as my assistant poured some disinfectant inside.
I prepared the spinal 25G Pencan needle, putting it through a 21G needle.
Then, I took a deep breath.
It is time.
My patient was seated up on the operating table, with straight back, head looking down, arms hugging a pillow.
‘Encik, doctor nak cuci belakang ya. Sejuk sikit. Cuba relax’ I said, with my awfully broken bahasa, with attempts to comfort the patient.
With a sponge forceps holding the green gauze, I cleaned the procedure site in circular motion. I repeated this procedure again, and then draped the site with a grean cyst towel.
I run my fingers by the sides of the man, trying to feel for the protruding bone (PSIS) and palpating for the intravertebrae space, locating for L4-L5. I marked the area.
‘Doktor nak bagi ubat tahan sakit ya. Sakit sikit macam semut gigit ya. Encik sabar ya.’ I said and injected the local analgesia.
Then I took a deep breathe.
‘Encik relax ya, badan tegak, kepala tunduk bawah. Doktor nak injek ubat ya. Cuba jangan gerak’
I rechecked the marking and space.
With the 21G needle guiding my 25G spinal pencan needle, I inserted the needle into the marked area, towards L4-L5.
I felt a resistance at first, then a give. –THE FIRST GIVE, I reminded myself.
Then, I inserted the spinal needle further, then I felt some resistant, gritty sensation, then another give –THE SECOND GIVE.
YES, this should be it!
I removed the trochar (inner needle).
I felt almost euphoric when I saw what I saw.
Clear CSF flowing out, driping out at the end of it, drop by drop.
Thank you GOD! My heart shouted.
I reconfirmed the flow with a syringe, slowly. Good flow. Then, slowly, I injected the prepared anesthetic solution in.
With a breath, I removed the needle.
The Staff Nurse sprayed the operation site and plastered it with a gauze. ‘Bolehlah jadi MO GA nanti’, she teased me.
The patient was layed flat again.
I monitored the blood pressure, making sure it do not drop drastically.
‘Encik okay tak? Boleh cuba angkat kaki’ I said.
‘Tak bolehlah,' he said. 'Kaki berat’ he replied.
‘Jangan risau, Ini kesan daripada ubat bius. Kalau rasa sakit, beritahu ya’ I said.
The surgeon rechecked with a forcep. –No pain
‘You may proceed’
He made an incision –No Pain.
YES, the spinal worked.
The surgery went well, completed in 49minutes. Patient had good anesthesia. Thank God for that.
I documented – No difficulty during procedure, single attempt, atraumatic tip, clear CSF, good flow.
My MO teased me, ‘There, wasn’t that hard, isn’t it?’
YA RITE! (sarcastically)
THERE – my first spinal.
The satisfaction & feeling – PRICELESS!
Gee, I think I am starting to like GA!! (well, maybe)
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-For the benefit of Non-medical related fields reader,below are some terms and abbrevations used in the above article:
OR = Operating Room
MO=Medical Officer
CSF = CerebroSpinalFluid
PSIS =Posterior Superior Illiac Spine (at the level of L4-L5)
L4-L5 = Lumbar spine bone level 4 - 5
heavy bupivaccaine = anesthesia solution
Lignocaine = local analgesia
euphoric = high peak of joy, happiness
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DISCLAIMER: The author will not be responsible if this article or part of this article is used as a guide to one's medical practice. note that this is the author's personal experience and should never be used as a guideline.
ACKNOWLEDGEMENT:
Acknowledgement to Datin, The HOD, for permiting and encouraging House Officers to perform procedures under supervision and provide a good learning environment.
Acknowledgement to Medical Officers & Specialists for teaching us with patience and giving us the opportunity to learn and grow into better doctors.
Acknowledgement to my collegues and other House Officers for helping one another, and encouraging each other as we go through housemanship.
Acknowledgement to the hospital staff, staff nurses, PPKs, for being supportive.
Most importantly, Acknowledgement to patients, for having trust in us.
THANK YOU
