Wednesday, November 24, 2004
Epidural And Generous Women.
What is it about big women and non-working epidurals?
So I got called to put an epidural in this lady who was ridiculously large. Honestly you couldn't tell if she was pregnant. She had so much weight on that attempt at just sitting her up took about half an hour.
The midwife caught me staring at the the tripple folds under the scapula which wobbled with the adipose inertia as she shifted herself left (wobbles) and right (more wobbles). I avoided her staring at me staring at the wobbles. Continued setting up my epidural set.
I felt a heavily pregnant cloud encroaching, and reset my what started off as a happyish day.Now.. now please god let there be bone there, so I can make way. It didn't look good at all from where I was standing. The axiom is fat ladies and epidurals do not exist in one equation.
I placed my hand on the virgin back and my heart sank.
*Gulp* No bone..all fat. AAaaaaaaaaaaaa..*breath*
I dug and dug and noticed that the mum, the boyfriend, the mum's boyfriend and dad were looking at my wondering eyes and my proding fingers. No matter how many times I do these things the hoi polloi never failed to give me butterflies. Why lah people like to stare.
So I thought we will be here for longer than usual as this lady is not necessarily the ..stuff it no time to be nice. She was fat and that was the main problem. I am not talking about being overweight here. This lady was at least 120 kg. This was a grave, morbid obesity. Now please close your mouth.
30 minutes into proding with the Touhy needle, the contractions were getting stronger and she was by then a horrendous moving target. I huffed and puffed behind the mask. Was it just me or the room was insensibly warm?
40 minutes later I was close to climbing up the wall when I hit the space.The epidural was in. Hurrrahhh!! I was very much relieved. It kicked in 10 minutes later and the lady fell asleep blissfully, completely unaware of the building contractions. So chaffed, but dear dear me what a challenge.
So I thought that was it? I left the maternity ward to return to the intensive care unit only to be bleeped again 3 hours later regarding the same patient.
"It doesn't seem to work anymore, can you come and have a look please?"
So how do I volley that request?
Nooooooooooooooooo..
Returned to find the woman drenched in sweat, hogging the entonox noozle like there's no tomorrow. Felt sorry, very sorry actually when I saw the boyfriend sat across the room watching football on TV.No mood to be rude, but what on bloody earth did he bloody think he was bloody doing???
Did I say I don't mind this place? I would say it's the nicest labour suite I've ever been in. In every room you'd find a coffee making facility, a TV and of course it's en-suite. May I remind you that this is NHS and not a private hospital. Like little hotel room you know. I know, ungrateful bunch!
So I topped her up :
Bupivacaine 0.25% 20 ml: screaming and swearing
Bupivacaine 0.50% 10 ml :screaming and swearing and threatening to strangle the lovely boyfriend.
Feintly it sounded something like **^&%$$£^$plonker*(^^%%&^767f*ck*&*&^8you*&(^*twat&*^*^5don't youbloodyhoneyme&^*%&$$£goaway**^5don'ttouchme&**^*%
And a fair bit more.
Stop! She complained that the left leg was going numb. Ahah!
So 2 things really in favour of the epidural being perfectly in place :
1. It worked for 3 hours, if it wasn't in, wouldn't have worked to begin with.
2. The left leg going numb (which is not permanent) .
So I scratched my head, my chin and the back of my neck. After a brief conversation with Bramwell I decided it needed resiting. Oh well it's 20:20 and look who was there on time. Richard!!!! So he did the resiting in the end, bless his heart.
I came home with a mental note, you can only have one or the other really. Either pregnant or fat. Choose one.Unless you want to upset your anaesthetist.
So I got called to put an epidural in this lady who was ridiculously large. Honestly you couldn't tell if she was pregnant. She had so much weight on that attempt at just sitting her up took about half an hour.
The midwife caught me staring at the the tripple folds under the scapula which wobbled with the adipose inertia as she shifted herself left (wobbles) and right (more wobbles). I avoided her staring at me staring at the wobbles. Continued setting up my epidural set.
I felt a heavily pregnant cloud encroaching, and reset my what started off as a happyish day.Now.. now please god let there be bone there, so I can make way. It didn't look good at all from where I was standing. The axiom is fat ladies and epidurals do not exist in one equation.
I placed my hand on the virgin back and my heart sank.
*Gulp* No bone..all fat. AAaaaaaaaaaaaa..*breath*
I dug and dug and noticed that the mum, the boyfriend, the mum's boyfriend and dad were looking at my wondering eyes and my proding fingers. No matter how many times I do these things the hoi polloi never failed to give me butterflies. Why lah people like to stare.
So I thought we will be here for longer than usual as this lady is not necessarily the ..stuff it no time to be nice. She was fat and that was the main problem. I am not talking about being overweight here. This lady was at least 120 kg. This was a grave, morbid obesity. Now please close your mouth.
30 minutes into proding with the Touhy needle, the contractions were getting stronger and she was by then a horrendous moving target. I huffed and puffed behind the mask. Was it just me or the room was insensibly warm?
40 minutes later I was close to climbing up the wall when I hit the space.The epidural was in. Hurrrahhh!! I was very much relieved. It kicked in 10 minutes later and the lady fell asleep blissfully, completely unaware of the building contractions. So chaffed, but dear dear me what a challenge.
So I thought that was it? I left the maternity ward to return to the intensive care unit only to be bleeped again 3 hours later regarding the same patient.
"It doesn't seem to work anymore, can you come and have a look please?"
So how do I volley that request?
Nooooooooooooooooo..
Returned to find the woman drenched in sweat, hogging the entonox noozle like there's no tomorrow. Felt sorry, very sorry actually when I saw the boyfriend sat across the room watching football on TV.No mood to be rude, but what on bloody earth did he bloody think he was bloody doing???
Did I say I don't mind this place? I would say it's the nicest labour suite I've ever been in. In every room you'd find a coffee making facility, a TV and of course it's en-suite. May I remind you that this is NHS and not a private hospital. Like little hotel room you know. I know, ungrateful bunch!
So I topped her up :
Bupivacaine 0.25% 20 ml: screaming and swearing
Bupivacaine 0.50% 10 ml :screaming and swearing and threatening to strangle the lovely boyfriend.
Feintly it sounded something like **^&%$$£^$plonker*(^^%%&^767f*ck*&*&^8you*&(^*twat&*^*^5don't youbloodyhoneyme&^*%&$$£goaway**^5don'ttouchme&**^*%
And a fair bit more.
Stop! She complained that the left leg was going numb. Ahah!
So 2 things really in favour of the epidural being perfectly in place :
1. It worked for 3 hours, if it wasn't in, wouldn't have worked to begin with.
2. The left leg going numb (which is not permanent) .
So I scratched my head, my chin and the back of my neck. After a brief conversation with Bramwell I decided it needed resiting. Oh well it's 20:20 and look who was there on time. Richard!!!! So he did the resiting in the end, bless his heart.
I came home with a mental note, you can only have one or the other really. Either pregnant or fat. Choose one.Unless you want to upset your anaesthetist.
