Painful procedure

I think we are mean sometimes in adult medicine.

Okay… Not this mean… Image from

I don’t mean the heartless jerky kind.  Well, at least I am not, although buddy who I refused to give a narcotic script for a knee sprain may argue that I am.

Today, I did a lumbar puncture.  A difficult lumbar puncture.  On someone who may have had a subarachnoid hemorrhage.  Meaning, they had the worst headache of life.  And then I came at them to stick a needle in their spine.

This is something you have to do from time to time.

I have done many lumbar punctures.  All of them to this point were in kids.  Sedated kids.

Now, I am doing one in a large, not sedated, uncomfortable adult.

Big difference here, boys and girls.

Sure, we use freezing.

That alone hurts like stink.

But we do all this.  And it took a few adjustments before we got fluid.  All without sedation.  Fully awake with just the pain meds for the head.

Image from

It seems mean.

Then, I saw someone with a huge laceration.

You know the bigger they are, the harder they fall?  Well, it is true.

I couldn’t find any topical anesthetic, so I had to inject lidocaine into the area.

Have you ever injected something that stings into the appendage of someone three times your size who is terrified of needles?

I can now say I have.

I actually had to get sedation.  And even that didn’t really help.

It took me and two people holding, as well as enough sedatives to make me comatose to get the freezing in, let alone suture the wound.

And then someone found something topical.

Just in time to make me feel like a big jerk.

We do that to kids.  But, they have topical cream and if they are really stressed we give them drugs to make them loopy.  And generally they aren’t big enough to kill me.

I also want to argue that adults should know how to suck it up.  But, that isn’t always the case.  But, sometimes I feel like we don’t do great when that is the case.  When someone has a legitimate phobia and can’t cope.

Why do we routinely sedate kids for lumbar punctures and make sure their procedures are as pain free as possible, but for adults, we often make them suck it up?  It isn’t that much more complicated to do it.  Sure, sometimes there are observation and airway concerns.  It is more time consuming.  But, sometimes, as someone who isn’t big on procedures, I think it would make the procedure easier on everyone.

Ah, sedation. Image from

Do I think everyone should get emla cream before needlesticks?

Heck no.

But, I do think we should offer options for more painful procedures more readily than we sometimes do.  Especially people with irrational fears.

And that is what I think makes us mean.  In, reality we are just doing what we can with the time, resources and training we have.  The culture is not always one such that change happens quickly, especially if it isn’t a huge safety concern.

I won’t be doing tons of procedures in my future career (thank goodness), but I hope that the combo of the peds experience with seeing people go through icky stuff with some procedures in the real world will make me remember to try to offer good pain/sedation options when doing procedures, especially those that are extremely anxiety provoking.  I know I won’t be perfect and sometimes things can’t be helped because it just isn’t practical or reasonable, but at least it will be worth a try.

And just so you know, sometimes painful procedures are painful for the person doing them.  Maybe not as much for the person on the receiving end, but nonetheless, it can still be unpleasant.

8 thoughts on “Painful procedure

  1. you continue to demonstrate to me you have a great heart ! Perfect for your calling. Kindness IS a fruit of the spirit as we both know 😉 DM

  2. There is trauma to both people when pain is inflicted, I certainly agree to that. That being said, for some adults, when they have no veins and one has to stick over and over, it is kindest to offer something. There is a in injectable CO2 cartridge that is painless and numbs within 2 minutes–have you ever used it? Lidocaine burns, but if the stick is going to be long and digging, it is kinder to offer. While I work with kids, as an adult with multiple medical conditions, I have had to do way too much “sucking up”, even though I have a high pain tolerance and don’t mind needles.

    • I agree, a bit of lidocaine or something is warranted when digging around is needed. I worked in blood collection for a summer a few years back and it made me never want to have someone have to root around for my veins (fortunately I have fantastic veins thus far in life).
      I am intrigued by the CO2 cartridge. I need to look into that.

      • Ok, here is my memory issue–it’s called J-? HAHAH–thank God for Google! I stopped this reply and searched for “lidocaine in a CO2 cartridge” and it’s called “J-tip”! Yippee, yeah for me! You have no idea how many times Google gives me the name of something!

  3. I completely agree with you. I’ve just come off 6 weeks of adult surgery and am now doing Ped Surgery, and I’m amazed at how much we offer the kids, when so many adults had to sit through painful procedures… I guess it’s a matter of scarce resources, but I feel bad for them too.

    • Sometimes it is scarce resources (including time), but sometimes, I wonder how tough or expensive it would be to throw a little drop of lidocaine jelly on someone’s gaping laceration at triage. But, I know it all costs money.
      The differences are crazy.

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