I think we are mean sometimes in adult medicine.
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.
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.
Do I think everyone should get emla cream before needlesticks?
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.