I spent Friday morning shadowing an anesthesiologist in the pain clinic. Walking in that morning, I had no idea what to expect, nor did I realize that I would be watching procedures. I wish they had told me beforehand; I would have worn sneakers. In spite of having to don scrubs and with my fabulous (thought not always fabulously comfortable) heels, it was a fascinating morning and I definitely learned a lot.
Dr. L was extremely knowledgeable and funny in that slightly sarcastic, somewhat cynical way which I find oddly comforting, probably because it so closely mirrors my own brand of humor. The patients were mostly elderly, suffering from chronic back pain, and scared out of their wits. The procedures themselves involved inserting frighteningly large needles into the patients' spines and injecting various cocktails of drugs into the epidural spaces. The needles were guided by x-ray, and several times the needle appeared to be in the correct position by feel and by radiograph, though once contrast was injected the dye simply spread all over the place, indicating that the needle needed repositioning. Moving the needles caused the patients a lot of pain, particularly if they had a lot of soft tissue (read: they were obese).
At one point, we were working on an 84-year old gentleman with severe degenerative disc disease, and the needle had been inserted and appeared to be positioned properly. Dr. L was a few feet from the table with his back turned, preparing the injection mix, and I was standing over the patient. Without warning, a champagne-colored fluid began flowing from the back end of the needle. It startled me, and I said "Uh-oh!" in a slightly panicked voice. Dr. L walked over and gently retracted the needle. "Do you know what that was?" I shook my head. "That was spinal fluid...exactly what we did not want to happen. We perfed the sac."
It was a good lesson. In spite of the fact that the x-ray showed the needle positioned correctly, this patient's anatomy had been so distorted by his disease that there was no way to know just how deep was too deep when inserting the needle. Thankfully, it wasn't a huge mistake - loss of spinal fluid can cause headaches and sometimes needs to be replaced with an injection of blood, but otherwise the patient was fine.
Overall, it was an exciting morning and I learned quite a bit, though I certainly walked away with a new sense of how easily the delicate balance of the body can be disturbed by one small slip of a needle tip.
Friday afternoon was spent shadowing an oncologist in the clinic. It was sad. Cancer patients have a way of making me feel badly about my own good health, since so many of them develop malignancies through no harmful actions of their own doing. This particular group of patients was particularly good-humored, alert, and desperately wanting to talk about things other than their tumors. Dr. O, to his credit, allowed the small talk to go on as long as her could, though by mid-afternoon we were an hour behind and had to cut the remainder of the office visits short. The afternoon was mostly a blur of offering treatment options; eventually the patients began to blend into one generic cancer case as the same complaints were mentioned over and over. I was exhausted by the end of the day, and I hadn't been there for more than a few hours. I wonder how the oncologists do it day after day, year after year. I don't think it's the right field for me.
Today I was observing in social work and case management. It was rather boring - lots of paperwork and phone calls. I guess I didn't realize exactly how much these people do in terms of arranging for patient discharge care and wrestling with insurance, but spending the entire day with them was probably a bit unnecessary. As it was, the case management nurse I was with this afternoon didn't have a whole lot to tell me and let me go after only an hour. I felt badly ducking out early because I have up to now made an effort to remain in my assigned area for the full time scheduled, but it really was pointless to watch her pull up patient chart and take notes. Easy day in general, though.
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