The Procedure, Part II

Every hollow tube, from a shotgun to a needle, has a gauge.

For those familiar with shotguns, its a bore diameter. The smaller the number, actually, the larger the hole. So a 22 gauge shotgun has a much smaller bore diameter, or hole, than a 12 gauge shotgun.

Same with a needle.

*Intermission for funny story from the ER*

To start an IV, nurses usually use a 24 gauge needle or smaller. Unlike drawing blood, which is bearable, having an IV started is painful. I know because we had to practice on each other in PA school.

So there was this nurse I knew at OU Presby's ER, who, if she ran into a teenager that had done something especially stupid; and was simultaneously disrespecting their parents; or the nursing staff; and then needed intravenous medication to be rescued-

Would always use an 18 gauge needle to start their IV.

"Don't be nobody in their right mind do something like that to their own mother," she would mutter as she searched for the big needle.

The pain from a 24 gauge needle to start an IV is significant. An 18 is torture.

*Back to the real story*

My needles for spinal taps are anywhere from one to three and a half inches long. Their gauge isn't too bad- usually about a 20.

But a bone marrow biopsy needle is an 8. And, its five inches long.

The Procedure, Part I

First thing most mornings, I grab a surgical consent form and a black magic marker.

The consent is usually for either a lumbar puncture (spinal tap), or a bone marrow biopsy. After all, we look in places where cancer hides. This can either be the spongy inner part of the hip bone where immature blood cells are made, or in a person's cerebral spinal fluid.

Hence, the Procedures.

The black magic marker is for marking. Marking exactly where on a child the numbing cream will go.

The consent... well that part's obvious.

It is in a procedure that I see how vastly different all children are. Some kids are so nervous they can barely sleep, up at 6 a.m. worrying about it. Some kids are just mad that they can't eat breakfast. Some kids want to know every time they are getting one. Some don't want to know at all. Some watch movies or read Where's Waldo? just prior to theirs. Some sob, some scream if the parents even think about laying them on the table. And some, some are silly right up to moment they fall asleep, laughing and joking about the funny dream they are about to have.

And then there's the rare child, that nothing, and I mean nothing, can get down. One such 4 year old child, laughing with a huge smile on her face (simultaneously the sickest girl in the hospital) once told our Child Life rep, Kristin:

When is my procedure?? I CAN'T WAIT FOR MY PROCEDURE!!

This is the same child I often see down on all fours, jumping up and down, excitedly barking like a dog.

And so you can clearly see why I prefer children over adults.

When we get to the procedure room, there are several things in hand. Toys in the Child Life person's hands. Syringes full of medicines and chemotherapy in the nurse's hands.

The child in the parent's hands.

And the sterile tray, sterile gloves, and big needle in my hands.