THE PHONE TAP (PART 2)
Rick and I returned to the emergency room to talk to the patient. I tried to sound confident, but I’m sure I failed. Even so, Bob agreed to be my first patient for this procedure, which was incredible—especially given the possibility of a permanent hip disability should I goof up.
As Louise and I prepared for the procedure, Rick called Bill from the ER phone. My patient was, thankfully, the only one in ER at the time. Rick was about fifteen feet from me as I scrubbed the front of the patient’s groin and placed sterile drapes around the skin overlying his hip.
Rick called out. “Walt, Bill says to feel for the femoral pulse.”
The pulse of the femoral artery was easy to palpate, just a couple of inches lateral to the pelvic bone.
“Bill wants to know if you remember the NAVEL acrostic.”
I nodded. The inguinal ligament ran from the anterior superior iliac spine—the bone point just above the waist—to the pubic bone. Just below the ligament, from the outside to the inside, were several critical structures—the Nerve, the Artery, the Vein, an Empty space, and then the Lacunar ligament. The first letter of each structure created the acrostic NAVEL.
“Bill says to numb the skin right over the empty space, just medial to the femoral vein. Okay?”
I nodded and then looked at the patient. “I’m going to numb the skin over the hip, okay?”
He nodded, and I quickly anesthetized the skin and underlying tissues with the lidocaine.
“Bill says to use a 22-gauge spinal needle on a 20cc syringe with a Luer lock. Be sure you have several cc’s of sterile lidocaine in the syringe.”
Louise and I nodded. As she turned to get the needle, I looked down at the patient. “Bob, I’d suggest you turn your head. The needle is very narrow, but it’s real long. You won’t feel any pain and if you do, I’ll immediately numb it. But the needle can be scary to look at, and if you’re looking at it, you might accidentally move. I’ll need you to hold absolutely still. If you move even a little bit, the needle might do some damage we wouldn’t want. Can you help me out with this?”
He nodded and turned his head.
Rick continued with Dr. Garrett’s instructions. “Walt, Bill says to slowly advance the needle, aspirating and injecting lidocaine as you go. When you get to the bone, continue to inject lidocaine to numb the tissue over the bone.”
I nodded as Louise handed the needle to me. It was scary looking—and almost six inches long. I attached it to the syringe and drew up several cc’s of lidocaine. Then, holding the needle like a pencil, I penetrated the skin and slowly advanced the needle, aspirating (just to be sure I wasn’t in a major vessel) and then injecting the anesthetic every few millimeters—until I felt the needle tip finally hit bone.
“I’m there, Rick!”
“He’s there, Bill,” Rick relayed. As he listened, I waited. After Bill finished his next instruction, Rick looked back at me. “Bill says to slowly walk the tip of the needle laterally a millimeter at a time. It should easily enter the joint capsule. Okay?”
I nodded and began slowly moving the tip of the needle up and down, “walking” it across the surface of the bone. At one point, the patient moaned. “Sorry, Bob,” I apologized, and I injected a bit more lidocaine. “That better?” He nodded—still keeping his face turned away from me.
Suddenly I felt the needle tip sink into a soft space. This is not bone! I thought. It must be the joint lining! The needle easily advanced into the hip joint space.
Rick called out, “Walt, Bill says when the needle passes through the joint lining, you don’t want to go too far in. When you’re just underneath the joint lining, inject some lidocaine. It should flow easily into the joint. Then aspirate as much fluid as you can.”
“Will the lidocaine that’s left in the syringe hurt the sample in any way?” I asked. “Or do I need to aspirate into another sterile syringe?”
Rick repeated the questions and then called out, “Use the same syringe, Walt. Bill says the lidocaine won’t affect the specimen, and changing the syringe could cause the needle to move somewhere you wouldn’t want it to.”
I could see Bob smile, and then he said, “Hey, Doc. Let’s not let that needle move where you and I don’t want it to—especially when you’re so close to my family jewels.”
I could hear Louise snicker as I smiled. I looked over to Rick, who was also smiling.
Then I injected the lidocaine. It passed into the joint effortlessly, which was my confirmation that I was in the joint space since injecting lidocaine into tissue requires much more pressure. Then I watched the syringe as I began to aspirate. A spout of yellow-green pus entered the syringe. It was like striking oil!
“Tell him it’s pus!” I exclaimed.
As Rick shared the news with Dr. Garrett, I explained to the patient, “Bob, there’s pus in your joint. That means there’s an infection there. We’re going to have to get you to surgery this evening to clean out the infection. But it should allow us to save your hip joint. Sound okay?”
Rick called across the room. “Bill sends his congratulations on a successful tap, Walt. He said it’s the first time he’s participated in a phone tap.”
I laughed. “Tell him thanks, Rick. And ask him to give my love to Janine and the boys.”
“Will do,” Rick called.
As Rick finished the phone call, I removed the needle from the patient, capped the syringe, and handed it to Louise. “Best get this to Betty in the lab. We’ll need cultures with antibiotic sensitivity, as well as a Gram’s stain and white count.”
“Yes sir,” Louise replied as she took the syringe and left for the lab.
I held pressure on Bob’s groin for a few minutes and explained to him what would happen in the operating room.
“Dr. Cunningham will make a small incision in your groin and then open up the hip lining. He’ll wash out the joint to clean out the infection. He’ll leave a drain in for a day or two, so no further pus will accumulate. Bob, it’s the pus that causes all the damage in the joint. In the meantime, we’ll give you strong antibiotics by vein. And in a day or two, when there’s no more drainage, we’ll pull the drain, and you’ll be able to go home on antibiotics.”
“Hopefully everything will turn out just fine.”
He nodded again and then turned toward me.
“Doc, thanks for doing this. I know it was scary for you. I appreciate it.”
I was quiet for a moment. It had been scary for me. But I suspect it had been much scarier for Bob. Even so, he had been more cognizant of me than of himself.
And in that, Bob was not unique. Many times across my career, my patients, even when in extremely dangerous medical situations, would often be more concerned about me than themselves.
It’s just one of the unique aspects of one of those special relationships that exist between a doctor and his patient.
That night, as I sat on the bench behind our home, rather than looking across Deep Creek Valley, as was my habit, I bowed my head and silently prayed. I thanked the Lord for the success of the procedure. I thanked him for Dr. Garrett, Rick, and Louise. Although I had done the procedure, they had made it possible.
And I thanked the Lord for Bob. As a patient, he had given me a very special gift that day. He had helped me realize once again how blessed I was to be a family physician.
I smiled as I thought of the Great Physician and his grace in allowing me to join him in the healing of his children.
I could not imagine a higher calling.
TO BE CONTINUED
PAST STORIES FROM BRYSON CITY SEASONS
- Dead Man Standing (Part 1), (Part 2), (Part 3)
- Eyes Wide Open (Part 1), (Part 2)
- Auspicious Accidents (Part 1), (Part 2)
- Answered Prayers (Part 1), (Part 2), (Part 3), (Part 4)
- Rotary Luncheon
- Death by Emotion (Part 1), (Part 2), (Part 3), (Part 4)
- The Invitation (Part 1), (Part 2)
- Barbecue and Bacon (Part 1), (Part 2)
- A Touchy Subject
- Family Time (Part 1), (Part 2)
- Chicken Pops(Part 1), (Part 2)
- Swain County Football (Part 1), (Part 2)
- Hospital Politics (Part 1), (Part 2), (Part 3)
- The Bobcat Attacks (Part 1), (Part 2)
- Dungeons and Apples
- A Tale of Two Surgeons (Part 1), (Part 2), (Part 3)
- Tanned Feets (Part 1), (Part 2), (Part 3)
- Wise Counsel (Part 1), (Part 2)
- An Anniversary to Remember (Part 1), (Part 2)
- Mrs. Black Fox (Part 1), (Part 2)
- The Littlest Cherokee (Part 1), (Part 2)
- Christmas Firsts (Part 1), (Part 2)
- The Silver Torpedo
- Another New Year’s Catch
- Turned Tables
- Doctor Dad (Part 1), (Part 2), (Part 3)
- The Phone Tap (Part 1), (Part 2)
PAST STORIES FROM BRYSON CITY TALES
- The Murder (Part 1); (Part 2); (Part 3)
- The Arrival (Part 1); (Part 2)
- The Hemlock Inn (Part 1); (Part 2)
- The Grand Tour (Part 1); (Part 2)
- The Interview (Part 1); (Part 2); (Part 3)
- Settling In (Part 1); (Part 2)
- First-Day Jitters (Part 1); (Part 2)
- Emergency (Part 1); (Part 2)
- The Delivery (Part 1); (Part 2)
- The “Expert” (Part 1); (Part 2)
- The Trial (Part 1); (Part 2)
- Shiitake Sam (Part 1); (Part 2)
- Wet Behind the Ears (Part 1); (Part 2); (Part 3)
- Lessons in Daily Practice (Part 1) — Anal Angina; (Part 2); (Part 3); (Part 4)
- White Lies
- The Epiphany (Part 1); (Part 2)
- Becoming Part of the Team (Part 1); (Part 2)
- Monuments (Part 1); (Part 2)
- My First Home Victory (Part 1); (Part 2)
- Fisher of Men (Part 1); (Part 2)
- Fly-Fishing (Part 1); (Part 2)
- Something Fishy (Part 1); (Part 2)
- A Good Day at the Office
- An Evening to Remember
- Another New Doc Comes to Town
- ‘Twas the Night Before Christmas (Part 1); (Part 2)
- A Surprising Gift
- The New Year (Part 1); (Part 2)
- The Home Birth (Part1); (Part 2); (Part 3)
- The Showdown (Part1); (Part 2); (Part 3)
- The Initiation (Part 1); (Part 2); (Part 3)
- Home at Last (Part 1); (Part 2); (Part 3)
© Copyright WLL, INC. 2017. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.