I don’t know about you, but to me the words “spinal tap” have a comical air about them, even though I’ve never actually seen the movie people associate the phrase with. However, there’s definitely not much comical about the honest-to-goodness medical procedure.
I asked the doctor why this kind of procedure didn’t require an anesthesiologist, since it’s similar to an epidural. He said that an epidural is much more difficult because the area the doctor has to hit is so much smaller. He told me I was welcome to stay with Jade if I wanted to, but I could also wait outside if that would make me more comfortable. I told him I’d be a lot more uncomfortable outside, and basically promised him I wouldn’t get hysterical.
Since the idea is to put a needle into the person’s spine, and Jade’s yet a bit young to listen to the instructions “don’t move a muscle”, they gave her a dose of Midazolam, a sedative, mixed with Tylenol, which was to take the edge of any discomfort from the needle once everything else had worn off. Midazolam is supposed to take 10 to 15 minutes to work, but when that window had passed, Jade was still wide awake. The doctor ordered another dose. Then another. And then yet another. I was getting agitated about the massive amounts of drugs she was getting, but Jade was just high as a kite, giggling about everything and not looking the least bit sleepy. The doctor said that by the time the last dose was administered, the first dose would have been wearing off because it’s metabolized quickly, but I was still upset about how much of the stuff she got.
Another doctor, an anesthesiologist, came in and they decided to administer an intravenous sedative instead, convenient since she already had the IV thingy (Drat it! What’s it called?) in her arm. She got another dose of Midazolam intravenously, and then a dose of Ketamine. Apparently, Ketamine gives people weird dreams, but Midazolam induces mild amnesia. There might be other reasons for the combination, but that’s what I gleaned from the conversation. Anyway, the important thing is that it worked pretty close to instantly.
They curled Jade up in fetal position to get the spine to open up and the anesthesiologist helped the doctor to mark the spot with a pen. He actually kind of coached the doctor through much of the procedure, which I must say did nothing to calm my nerves. I realize that they don’t get to do these things very often here, and they want to have more people proficient at it, but it didn’t give me any warm fuzzies to realize the doctor hadn’t done this very often before.
The doctor swabbed Jade’s back with tincture of iodine. It ran everywhere; we were even cleaning it out of the folds of her ear afterward. The needle he inserted into her spine was pretty ordinary looking, except it didn’t have a syringe attached, just a little plastic opening. Spinal “tap” really is an apt name for the procedure. I couldn’t help thinking, as he held the collection vials under the opening (and some dripped onto the bed as he was switching between tubes), that it really was like watching sugar water drip from a tapped maple or birch tree. Only a lot more emotional. They all commented on how beautifully clear the cerebrospinal fluid was, I guess the first good indicator that she doesn’t have meningitis.
It took about 45 minutes for the Midazolam/Ketamine to wear off, and Jade was pretty weak for a while afterward. By this time it was about 3 in the afternoon; she’d spent most of the day sleeping. I got the nurse to make me a list of all the drugs Jade had had that day, so I could keep track, and also so that if she ever needs to be sedated again, I can tell them to bugger off when they suggest an oral dose of Midazolam.
Once the procedure was over and everyone was cleaning up, the doctor looked at me and said approvingly, “You did well, Mum!” I chuckled, wondering if he’s ever actually had a panicking parent watching him do a lumbar puncture. But all I said was, “More importantly: you did well.” I’m not sure whether or not he appreciated that.