epidurals

I guess I haven't talked about work yet. I do spend more waking hours there than anywhere else so it is only fair to mention it. In anesthesiology, just like in all other residencies and med school, you spend a few weeks at a time working in different departments within the specialty.

For Anes., most of our time is spent in the operating room, but we might be assigned to different types of surgeries for the rotation, for example, neurosurgery, pediatric, heart surgery, etc. We also spend time in the ICU.

Right now, I'm assigned to the Pain service. I spend some time in the clinic seeing patients with chronic pain. Sometimes we change their medications around to optimize their pain control, and sometimes we do injections in their joint (mainly in their back) to help with their pain. And some days on the pain service we are assigned to the inpatients at the hospital that have epidurals, and we are in charge of the epidurals. We can increase the medication if they aren't getting adequate pain relief, decrease the medication if they are too numb, or add another medication if they are having itching or other side effects.

Everyone thinks of epidurals as being for pain relief during labor and delivery, and that is one very important use. If a woman has a c section, they stay in for two days, otherwise they are taken out right after the baby is born. It is fun to see the patients who have had c sections and they are all happy to have their baby. Sometimes i'll see the baby when I'm in their room. That's the neat part. I like saying "Congratulations" to all the new moms.

One thing that I didn't really know before working on this service was how many different types of surgeries use epidurals. They are often put in in the OR before the surgery, and then people sometimes have general anesthesia but sometimes we can use mainly the epidural and they are partially awake throughout the surgery. Then they are left in afterward, and it is very helpful for pain relief. It allows people to get pain medication but not be too groggy, and they are still able to get up and walk around. So in addition to C-sections, they are used for many abdominal surgeries, hip and knee surgeries, and surgeries in the chest like cutting out part of the lung. One of my favorite things about the job is seeing patients that are sitting up, walking around, and chatting happily with their families, even one or two days after a very invasive surgery, and they are very appreciative to the pain service, the epidural, and anesthesiology in general.

Pretty cool!

One thing I like to do is show the catheter tip to the patients when I pull it out. It is just a tiny tiny tube that sits in the back. Actually you can use them in other areas too, to block other nerves to help with post operative pain, but thats a topic for another post! The people are usually surprised about how it is so small.



Now, any of you ladies who are pregnant or wish to become pregnant may not want to see the next picture - it is the needle! It is a lot bigger than the needles we use for IVs and drawing blood.



I had a request for bloody hospital photos, but don't worry, I won't do it. :) I will try to come up with something interesting to write about work sometime soon.

Special thank you to Mabel for bringing me the epidural kit when I was dressed up for pain clinic and couldn't go in the OR area (because I wasn't wearing scrubs).