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funniest sedation evar!
i don't know if i should write about this. i don't want to seem disrespectful. but the other day i did the funniest sedation ever. i mean, evar! i suppose i don't get many of these because i usually sedate preverbal children. usually teenagers will sit still through important procedures, see? in any case, i got called to sedate this young man, who was very quiet and stoic through the presedation teaching. i discussed the potential complications-- lowered blood pressure, respiratory depression, the dreaded vocal cord spasm-- as well as the usual side effects-- altered mental status (which is the whole point), jiggly eyes, dry mouth, and "dreams". i call them "dreams" because that is what they are, but i suppose "hallucinations" would also be an appropriate term for them. patient and mother expressed good understanding. he initially went down fairly well. just a touch of versed and half the usual dose of ketamine provided beautiful anxiolysis and comfort. about five minutes into it he started talking a little. i thought he was coming to, but he wasn't. first-pass metabolism i guess. his mumbles and words became sentences, and the sentences began to make sense. only the thing was, he was floridly hallucinating. he was seeing red fish swimming up on the ceiling. "mom! you see them fish? this is a great dream! i'm gonna have this dream more often. oh! where'd the fish go? come back! come back fish! oh. there you are. hey fish. gimme five, fish. yeah, that's right. you want to come home with us? come home for dinner? mom! can we have fish for dinner? and kevin's here, we're going to play playstation. [hands playing playstation] hey quit cheating! mom! kevin's cheating! [mike: quit cheating, kevin!] see? the doctor said quit cheating!" all the while, mike worked on his procedure. mike and i tried hard to keep straight faces, but the patient's mother was there the whole time, and she had a good laugh over it. it got a lot funnier but that is all i will say. notice i respected patient confidentiality so leave me alone hipaa!

most frustrating spinal tap evar!
oh. my. gosh.
spinal taps on babies are hard. no matter how skilled and experienced you are, they're just hard. the resident expressed displeasure at the having to perform the lumbar puncture, but it was her responsibility. after she failed, i had to step in. i have gotten so, so many of these on the first try with no difficulties. BUT. sometimes you just don't get them. in any case, i knew i had to do this because the baby was sick and needed it. i poked my head in the door and saw a little bitty baby, a preemie. crap, i thought. the resident was frustrated but stayed to help. i took the first needle and found my spot. i really wanted this to happen, so i positioned, and positioned, and palpated, and palpated. and palpated. finally, one, two, three. i was in the canal. blood filled the hub. crap. i removed a clot because i thought i saw CSF. and the flow stopped. i wiggled, and adjusted, and turned hub and bevel caudad and cephalad, and nothing. same with the second attempt. poke. bleed. flow-stop! adjust. clot. remove clot. readjust. flow-stop! clot. adjust. argh! the baby cried. i wanted to cry. i was so frustrated, because i really hate driving giant needles into babies' spines without getting the fluids we need to test. with the third needle i tried yet a different angle and the sucker went in ALL THE WAY TO THE HUB. that freaked me out. i pulled back. i had completely lost hope in getting any CSF but i was going through the motions because you just have to keep trying. i kept angling down, down, and was ready to quit several times over when suddenly, this time, the flow-stop! ended up being a flow-ooze. i held my breath— the drop swelled— CSF! beautiful, precious CSF! more valuable than gold. i was holding the needle at a completely bizarre angle and it, oddly enough, wouldn't stay there without me holding it. so i froze, and waited. it was the slowest flow i could have ever imagined, but i didn't care, i was so thrilled to have gotten this tap. i got one cc after maybe 20 minutes. fortunately the "patient tolerated the procedure well", because i didn't. baby, i'm sorry. i'm still sorry now. there wasn't anything i could have done differently, but still. i'm sorry. but you know what? hurrah and thank God that we got the CSF we needed, and i know the baby will do better for it.