Lumbar Puncture on your knees!

Lumbar puncture is one of the most sensitive bedside procedures we do at the medicine and neurology ward. If there's "one" bedside procedure that needs the most ideal textbook precautions, it is this one. (Notice how the "one" is in air-quotes - that's because All invasive procedures should have ideal precautions taken).

But with lumbar puncture the associated risks can be extremely debilitating. As an example, if appropriate sanitization is not maintained, you risk introducing microbes into your patients' spinal fluid - which has direct access to the brain. This can eventually lead to serious complications like meningitis or even encephalitis.

Or for example if you, the doctor, have not positioned yourself comfortably enough to have total control over your movements throughout the procedure, you might injure a few nerves that can leave a permanent damage - maybe you could paralyze a muscle, maybe your patient loses bladder control for the rest of their life! LP (short for lumbar puncture, not Liquidity Pools!) is a procedure that requires you to have absolute control over the fine movements of your fingers.

The needle pierces through 9 different layers and you have to stop exactly after you pierce the 9th layer. You do not see what layer you are at. You only weapon is the artistry of your fingers knowing exactly what to do - you know...like when to move around, when to push hard, when to go slow, when to pull back a bit, and most importantly "feel" when the final layer goes "pop" and stop! Legend has that, one who is an expert at doing LPs will also be legendary at a certain "room" behind closed doors 😂😂 If you know, you know! 😉🤣

I have done my fair share of LPs and I have failed to "pop" the spinal fluid out only once. But today was an extremely irritating experience. And no, I got the spinal fluid out alright!

But it's the setup that irritated me.

We have 12 units in our medicine ward and every unit gets 14-16 beds per gender. 14-16 beds for males, 14-16 for females. Combined, our unit has 30 beds. Yesterday was our unit's admission day. In those 30 beds, we had to admit 148 patients and no, this is not a joke!

So essentially nearly 80% of our patients were admitted on the floor. And as fate would have it, among the ones I was assigned there was one patient that required an LP for diagnosis. And he was on the floor. I scratched my head for a few good minutes in front of the patient and then some more as the round progressed as to how the f* am I going to do an LP on the floor! The positioning was going to be extremely uncomfortable and there was no way I was going to be able to get myself low enough to get my hand as the puncture level unless I slightly bent over! Again, no kidding! It was in fact one of my colleague's idea to kneel down and bend over!

There indeed was no other logical way to get the job done and hence, I cursed our health system for the zillionth time as my calf muscles started to feel the strain while I tried to remain very steady and pierce the needle through the layers till the spinal fluid started to drip out into the vial!