The Back Stabber

You have a sterile gown wrapped around you, with tight rubber gloves over your hands. Your breath keeps steaming up your glasses because of the mask you have on over your mouth. The nurse prepares this tiny little girl's back by wiping iodine all over the area that you're going to do the "procedure" on. The area is draped and sterile. You walk up to the bed, where this cute, 2 day old little girl is laying on her side in fetal position, back facing you. You move towards the bed and stand next to the procedure kit, setting up the tubes you are going to fill. You move in slow motion so your sterile field isn't ruined (it feels like you are in outer space or scuba diving; like your breathing should have a "shhhhuuuck" sound every time you exhale). With the tubes in place, you now slowly pull the cap off of a large silver needle as thick as a tooth pick and just as long. You carefully and slowly approach the bed. The nurse cradles the infants head in one hand and legs in the other. You ready the needle, bevel up. The nurse bends the infants head toward it's legs, flexing it's back toward you (it's somehow delicate and brutally forceful at the same time). The infant begins to scream shrilly in protest. Your hand reaches out onto the crying baby and feels for the hip bones. You make a mental line across them, and feel for the spine in the middle of it. Your fingers feel up and down the ridges, finding the gap between them, the soft spot, the target. Without hesitation you quickly plunge this large tooth-pick of a needle between the spinal bones. The infant squeals louder, it arches it's back, but the nurse holds it forcefully in place. You push the needle deeper (half way in...not far enough), you keep pushing (almost 3/4's of the way in...is this too far?!?!?) Your attending insists you go on. The needle advances still further, until you feel a slight resistance and then it gives way. You pull the core of the needle out and a clear, watery fluid starts dribbling out of the middle and into your tubes that you are quickly placing under it. The infant is still screaming and fighting. The mother is crying, saying something in Spanish that you don't understand. Suddenly you realize you are sweating profusely. One after another you fill the bottom of the four tubes (can this little baby have that much fluid in her?). With space-man movement, you close the last tube and replace the core of the needle, the infant screams still louder as you quickly remove the steel from it's back. Everything goes back to regular speed after that. The nurse quickly places a bandage on the baby and feeds it, the trash is cleaned up, the tubes are sent to lab, and the mother is consoled. You walk out of the room, it seemed so slow in there, but now that you are done, it's happened so fast that it's hard to process.

Today was my first successful lumbar puncture on a newborn. I've done them many times on older kids and adults, but babies are so small and fragile. The fear you feel doing something so brutal to something so tiny...it still hasn't gotten any easier. I've done it three times now on an infant and so far it still seems just as crude and brutal as the first time...but it is necessary (telling myself that is the only way I can make myself do it each time). This little girl was admitted for "rule out sepsis", which means that we think she might have a really bad infection (she is showing all the physical signs)...but we don't know where it is. When something like this happens, you have to check all the places bacteria and viruses could hide, ie. blood, urine, and regrettably spinal fluid. Someone really needs to invent a better way of getting CSF (Cerebro-Spinal Fluid) out of the body, supposedly risk-wise it's not any worse than getting blood drawn from a vein, but there is something about LPs that makes them seem so violatory, crude, and really just plain wrong. I should be happy that I actually did something right today ;P but honestly I wish it had been something else I'd gotten to do correctly. Only jerks like being back stabbers.