spinal anesthesia... misconstrued

let me buzz...

Injecting a small quantity of this colourless liquid into someone's back leads to a tingling tryst for the patient and fun for the anaesthetist. Welcome to the realm of sub arachnoid block or the colloquial spinal!

Being trained in patient care both preop and postoperative, we freshers were taught about the different aspects of the spinal world in quite mystique detail. Before being trained to needle a patient's spine, explaining the procedure to the subject in lay man terms proved quite arduous. " You will be made to lie down on your side crouched with your legs tucked in and head flexed. A tiny prick to your spine and u will loose all sensation on the lower half of your body for a short while" is what we intend to profer. This is how a brand new fresher did it..

"Tumhe littake peet me sui chubaayenge. Usse tumhe lakwa padega, operation ho jaayega". In grotesque parlance it meant, " With you lying down,we will prick your spine. you will get paralysed and the surgical procedure shall be completed!."
We last heard that the poor patient with inguinal hernia scooted from the OT complex because he preferred a lump to a limp, anytime!

Preoperative cacophony set aside, the actual procedure involved ceremonious steps being done exactly as told. A brand new way of holding a forceps to dipping guaze rolls in eerie smelling liquids in the name of antiseptics and sterilizing agents to promote asepsis all seemed new to us. The obligatory cleaning and draping done,a spinal needle in hand, i set about finding an elusive spinal canal in the roly poly waist of a plump lady who i must confess took a lot of effort to get on the table. Prick and the needle went it, little by little. Think i hit something... the technician helping me quips cynically.."daactar saab, abhi dilli dhoor hai, aage jaao!" Some more millimeters later,i finally needled the elusive water front and proceded to inject the anesthetic agent. My consultant asks me in a husky voice,"how much will you inject?" Calculating the dose per kg and as per the surgical requirement, i say ,"2.5 ml,sir?". He says, "hmm... no, inject 2.4 ml". A difference of 0.1 ml in a 5 ml syrinje, are u kidding me?!" Guessomatics galore, the prescribed precise volume is injected and the patient placed supine for the drug to take effect.

Religious prods with a blunt needle counted by the dozen and an ounce of patience (which seemed to have gone into oblivion) later, our lady got her lump removed without much ado.

Till the spinal canal conjures up more patient friendly ways to anesthetize itself, here is me needle in hand, wishing that you get the esteemed privilege of being my subject for experimentation!

Have fun!

epidural care... freshers beware!

3^rd year made its debut with promises of more leisure time and academics. Earnest attempts at managing to not hog the limelight when question hour began amidst busy OT schedule were disastrous given the relentless perseverance that the consultants had to somehow drill the volatile gambit of knowledge into our proverbial thick skulls.

A refreshing change amidst dodging the bullets was the entry of the new recruits, the freshers or first years. Eager eyes waiting to rip out from obstinate restraints called eyelids perched on perky noses with an air of accomplishment about them is how the new debutants presented themselves. A deluge of icu postings managing to curb the enthusiasm a wee bit, gas science still meant an entirely unknown world. Having gone through the same drill 2 years back, fresh faces for us meant more fun and more comrades to aid epidural care and follow ups.

Shoving a thin plastic fiber down a patient’s spine in the name of epidural anesthesia meant a painless bump on the back for the patient and a pain in the neck for juniors. Having attended calls of epidural emergencies at weird hours courtesy ridiculously impossible senior residents made first yearship  a roller coaster ride for sure. The subtle training for epidural care usually began with the inevitable quiz on morphine and epidural analgesia. Once the importance of respiratory depression was well advocated (misconstrued fact as I am yet to see one), we were awarded the prestigious role of maintaining epidurals!

Novel yet implausible ideas such as connecting all epidurals to one giant console within reach to automated telepathic bolus injections were contemplated over tea breaks and ration time during our ritual tea club ceremonies.  

Till we imbibe better post op facilities to aid continuous epidural techniques and beyond, here is me wishing all freshmen a safe epidural free passage through the first year!

cheers

let me buzz...

ICU..i see u

13 beds laid out in a row, masonry walls 3 feet high almost but not yet isolating them and a bunch of sleep deprived white coats putting patients into slumber is what the ICU potrays to the eye.

Fresher year was time for us to develop this undying bond of unrelenting rendezvous with tube suction, infusions, ventilators and of course, patients who were critically ill. Liquid debris of vivid origin and content had to be removed from intubated patients on ventilators so that the lungs wouldn’t retire hurt. My overzealous misdemeanor of joining the course a day well in advance culminated in discovery of the art called tube suction 1 on 1. Intricate details ceremoniously imparted by my senior to her newbie fellowman looked like a scene from some epic war movie where the sword gets passed on to the heir from the retired veteran! Quizzing me about the intricacies of the procedure which i had just been told about gave her grin a much regaled squeek. Decked up in proud blue, armed with a stethoscope, the new caretaker of the downtrodden (I mean dudes zonked on morphine with tubes down their throats) set about measuring up the momumental task at hand!

Once the medal for best tube suction was well ordained and pinned onto my blue attire (a figment of my imagination), sifting through patient files became imperative before I set about treating them. The staff nurses, so coveted to their role of occupying chairs and passing on instructions, sporadically vacating them to do errands, vociferously reminded me about the major event in every newbie’s duty… blood sampling! Haven done undergrad in a college with well equipped resources, sample collection came under the purview of the support staff rather than the doctor trainees. Having ventured into a well equipped, yet a government hospital at that, suddenly dawning on me, I set about penning down words in barely legible form for the lab technician to comprehend… lab request forms to accompany the vials of blood samples.

Back breaking rather back bending labor by the patients’ bedside yielded a variety of color labeled vials and syringes for blood processing. The orderly taking the rest of the day off for his movie time meant I had to trudge my weary feet down to the lab after an hour to collect reports. To taste success, we need to either invest brains or brawn. To enjoy success, join a govt hospital as support staff and stay there investing nothing! Ceremonious (laborious) clinical rounds lasting for over 2 hours, the consultant set about discussing each case in detail. The short bouts of vigorous head shakes did make me appreciate the resilience her neck showed to endure all the shakes that her head provided. Left side of the chest not moving much in all patients was a constant finding she picked up. Well, in my defense, all patients still had the left lung in situ! Be it a mirage playing on her eyes or our eyes too tired to notice them, the left lungs in all patients left much to be desired. Having done a 24 hr shift in the ICU straight, I left for the day only to return again. More left lungs needed rescuing, many samples needed to be sent, tubes to be suctioned…

Till I find the energy post duty to give you tips about the suction machine.. me signing off to enjoy a long long nap overdue… I shall see u,ICU…every week!

Cheers! 

Innovation : route to salvation!

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Utilizing resources to the maximum (abusing them at times) is fine talent we imbibe as residents in a government setup . Tedious tenders denying basic equipment seem more of an annoyance than a problem given the way daily supplies excuse themselves promptly venturing into oblivion!

The only 2 entities that never get into the top 10 list of NA (not available) are Doctors and the Diseased. The innovative mind becomes a blessing when faced with shortage of drugs or equipment due to administrative incompetence or the abject poverty that patients seem to be blessed with. Me designing a CVP manometer out of 3 IV lines and a Three way to monitor CVP for a poor critically ill patient is a memorable high in my short stint as a fresher. When we looking around for smart thinking, each cadre in the hospital workforce has something to offer be it trivial or not.

A sweeper having to do without a pickup and dusting pan picking up infected waste with just a broom still comes to mind. Rather than sweeping it all around town, he used gloved hands to use the broom as a modified chopstick to pick it up effortlessly to transfer it to the designated bin. Move into the wards and we see cartons doubling up as elevation for propping head ends of beds up as the complex automated machinery working the beds,procured at mind numbing prices, have gone kaput thanks to overzealous use. Nails drilled into the walls doubling up as IV stands, padded cardboard substituting efficiently for arm rests, freshers working as educated monitors are common yet effective innovations.

Beauty is bought by judgement of the eye..says Shakespeare in Love's Labours Lost.The most uncanny of innovations happened in the operating room where the maintenance folk were short on protective footwear. IV tubing, ryle tube and extension lines post expiry were tested for use as binding twine and there was born a unique slipper with sleek fasteners! My surgeon friend bringing it to everyone’s notice sure made it surface on the blog! (thanks shyam!)

Till we get tired of making ridiculously helpless situations look humorous and interesting, here is me signing off hoping to be a serious nut as the American entrepreneur and the co-founder and CEO of Oracle corporation Larry Ellison puts it.. When you innovate, you've got to be prepared for everyone telling you you're nuts!
Cheers!