A Day In Anesthesia

Anesthesiology, one of the most competitive but good lifestyle jobs to consider for my future. I do not like surgery, but I like techniques and procedures. Tonight, I shadowed Dr. Landman, an anesthesiologist in Labor and Delivery.

First up, I learned how to perform an epidural. An epidural is a common procedure nowadays, an anesthetic that numbs from the waist down to decrease the pain experienced during labor. To begin, you have to enter a ‘sterile’ environment. That is, people in the room other than the doctors and nurses can stay.  You put on a cap for the head and shoes and cover your mouth with a mask. Then you can set up the sterile kit and start cleaning the area with iodine solution. You then feel for the most superior points of the iliac crests, which sit atop the hip bone. An imaginary horizontal line going across corresponds to the L4 vertebrae. Then you palpate for the lumbar spinous processes, and feel for the space between either L2/L3 or L3/L4. It is easier to feel for if the patient bends forward, sticking the back out a little. Next, you apply a numbing agent so as to reduce the pain when the doctor  searches for the epidural space. To make sure you are in the epidural space, you insert a syringe and push the plunger until it can be pushed down. If it is still ‘bouncy’ and resistant, then you are not in the epidural space.  Once you know you found the spot, then you can thread in the catheter. Inserting the catheter seems rather difficult, because you need to be in the epidural space where the fat and veins reside. Otherwise, you may pierce into the spinal cord or insert the anesthesia elsewhere. You also have to know how much catheter to thread in based on blue markings on the side. After the whole complicated fidgeting and injections, then you can finally administer the anesthetic.

I witnessed 2 epidurals today, one patient was cooperative and the other one was a big baby. With the difficult (and young) one, she would not keep still.  She cried hysterically from the pain. The nurse was practically hugging her shoulders as I was holding down her hands. She needed to be hunched over more and less resistant in order for the epidural to work. It didn’t help that her contractions were pounding away. She was transferred over to the OR where all the action took place.

Most groundbreaking, I witnessed a live birth. Well, technically, a C-section. The hysterical one laid down and prepared for surgery. The anesthesiologist and resident hooked her up to oxygen and blood pressure cuff to begin monitoring her vitals. Basically, the anesthesiologists stand where the patient’s head is, behind all the surgery action below. The anesthesiologists and I were not sterile, so we could not venture too close to anything ‘blue and sterile.’ I stood conveniently at the dividing line, so I kept peeking over at the surgeons delivering the baby. I guess Dr. Landman noticed, so she allowed me to move to the foot of the operating table, a little distance away from the sterile tools and blue stuff. From there, I had a much better view of the miracle of life. Well, it was not a vaginal birth where the doctor catches the baby. Instead, the doctors cut her abdomen from the bottom, opened up her uterus, and pulled out the little squealer. I saw the round purple head break through the pink uterus and bloody mess. The baby was not crying or screeching; it was silent. For a second, I thought he was a stillborn. Then the doctor said, “Umbilical cord is around the neck!” They proceeded to cut off the umbilical cord which was obstructing the baby’s ability to cry and make any bit of noise. Once that was done, the baby let out its first breathe, its first sign of life. Immediately, he was escorted to a little table where the pediatrician or neonatologist proceeded to the newborn examinations. While the afterbirth and stitching was happening, I kept looking over at the kicking and flailing baby. He turned more pink and alive by the minute. He was given a little hat for the scant head. He was an adorable, active lad. He was a beautiful baby. Oh hell with it, all babies are cute and cuddly. They have a brief ugly stage when they come fresh out of the womb, but that ends quickly. Now I can say I saw for myself, the miracle of life.

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