The Other side, part 2

The next morning we were up and out, checked in at UAMS at 8am. Of course, when I got there, they had NO idea I was supposed to be there or what to do with me. I was warned that this would be the case since this had all been scheduled late the previous day. Luckily, they let me lay down while they figured it all out and got things moving. There was a lot of waiting and being wheeled from room to room. Again, I couldn't help note how scary this would be to the average patient......big, loud machines (which I have seen before) and a host of confused people.

Eventually, they figured everything out and got me prepped and ready for the myelogram. During a typical myelogram the patient lays face down while the neuroradiologist uses fluoroscopy to guide him in doing a lumbar puncture (spinal tap). Once in the correct space, he/she injects contrast dye into the spinal column, tilts the table up so that you are almost on your head (to move the dye around your spinal cord), and then puts you in the CT scanner to localize where the contrast is leaking out and find the defect. For reasons that are still unclear to all involved, Dr. H (the head of neurology and previously mentioned poor bedside manner physician) wanted to do the "stick." Instead of laying on my stomach and using fluoroscopy guidance, he wanted to do the traditional ("old school") blind stick. I would have really rather have had the neuroradiologist do it, but I didn't feel like I had a choice. No one asked me what I wanted and I certainly didn't assert myself because I didn't want to piss off anyone in charge of my care (i.e. aforementioned neurologist). It had been made clear to me by everyone involved that my case was very rare and Dr. H was the only physician around with any experience involving IIH (idiopathic intracranial hypotension). So, I just shut up and let him do the procedure. Again, I couldn't help but think about how ME, a doctor at U.AMS, didn't feel like I had any say in my healthcare. Imagine how many things are done to patients without their real consent or true knowledge of why/what is happening. Scary and ironic all at the same time. Dr. H comes storming into the room, admonishing Dr. VH because he got lost getting to the procedure room and "wasted his time." He came over to me, put me in the fetal position (which was 100x's more painful then laying on my stomach) and started feeling around my back. First, he numbed the space (bee sting my ass) and then he put the bigger needle in and started to withdraw fluid. All at once I felt hot and nauseated and was fighting the urge to pass out when he moved the needle again and OMG! Talk about pain! Sharp, shooting down my right leg and in my groin. I really thought I was going to be sick because the pain was so overwhelming. Then, they injected the dye. This time I screamed and jumped off of the table. It seemed like a bullet in my spine and an electric shock down both legs. It was sudden, sharp, searing, unexpected, and TERRIBLE. Luckily, Dr. VH took pity on me and essentially took over the procedure. After bringing me nothing but pain, Dr. H left and it was just us (Dr. VH, his nurse, and me). I rolled over and looked up at Dr. VH and he said, "just remember, I'm not the one who stuck you." This made us all laugh a little. Later I was told that the needle has been put in the wrong space and the dye had been injected into the wrong space. This resulted in the lower part of my spinal cord getting "lit up" and was the cause of a lot of pain. I also learned that Dr. H "skewered" my pudendal nerve, which caused considerable leg and groin pain for about a week. If you look up what the pudendal nerve innervates, it might make you squirm a little.

They wheeled me out of the room and into the CT scanner and then off to recovery to wait. The original plan was that they would scan my head and entire spine every 2 hours for 6-8 hours in hopes of finding the leak. Apparently, these leaks can be very tricky and Dr. VH said he had never found the leak with just one scan. After getting settled in recovery, Dr. VH came walking in, "I have good news and bad news." Shit. I knew I wasn't supposed to be seeing him so soon. Besides, didn't we have many more scans to do before the day was over? He continued, "Dr. H stuck you so many times and put so many holes in your dura that I can't see where the the leak is because the contrast dye is leaking through the holes he placed. So, we are going to have to do this all over again on Monday." The good news? "You get to go home." Oh, ok. On bedrest for the weekend and then we get to do it all over again. Of course I said, "next time you do all the sticking, right?"

Everyone kept saying, "aren't you mad??? I'd be furious." Luckily, Dr. VH paused after he said, "I have good news and bad news." In that brief pause, I had enough time to think of all the potential "bad" news that could be on the way. Trust me, doing it again was a picnic compared to the things I was imagining.

I could point out the 10 billion times throughout this encounter that I was thinking of my patients and taking mental notes. When you are the one on the gurney you hear and see everything. The smallest things can make you comfortable and happy vs nervous and scared. The reality? It doesn't take much to tip the scale one way or another. These are the things I have to take home and remember when I am tired, frustrated, or hurried. My role as a physician puts me in a place to have a dramatic impact on a patient (regardless of the healthcare being administered). Just being human, taking time, smiling...these are the things that make the big difference. There are a lot of people that can give the right chemotherapy or order the right tests, that is not what makes the difference. That is not what makes a good doctor. I hope I never forget this.