Sunday, March 4, 2018

Thoughts on Labor & Delivery #4: Epidural

I still had yet to swear during this process, for which I was proud of myself.  I am working very hard not to use profanity – and in the process breaking some fundamental rule of army culture, I’m sure, given the number of patients I’ve had who employ more than a dozen curse words just describing the symptoms of their cold.  However, I later realized I had the perfect pre-written expression of my suffering but I simply didn’t have the dedication (or really the foresight) to learn it. I wish I had memorized the short and mostly gibberish monologue from A Christmas Story where the dad is metaphorically battling the furnace, because it lacks actual profanity, would have been immensely satisfying to utter, and, I think, adequately captured my anguish.

Scene for reference (in the off chance everyone’s family does not watch that movie as obsessively as mine).  []

I haven’t mentioned up until this point that Partner-in-Crime / my baby daddy is an Anesthesiologist.  When choosing the father of your baby, I would recommend selecting one of this trade because they are immensely helpful.  He did not administer the actual medicine that took away my pain (somehow that’s less ethical than watching from the bleachers as your loved one writhes in pain and doing nothing to help… well, he wasn’t doing nothing to help, but it was nothing in the medicinal sense).

At this point in my pain journey, he felt it was time for an epidural.  I was hoping to somehow deliver baby without reaching death-defying levels of pain, but also without a potentially diaphragm paralyzing drug injected via needle inserted directly in my spine.  Another medical digression: a rare  (yet not so rare that I don’t know of 2 people personally who have suffered it) but possible complication of spinal anesthesia is that the drug gets too high in the spinal cord and paralyzes the diaphragm / makes it feel like it is paralyzed which results in the unfortunate consequence of not being able to breathe.  Since I like breathing, generally fear dying, and also don’t like large needles in my spine (I’m pretty sure despite my limited prior experience in this arena) I was hoping to not need an epidural.  For your trivial knowledge, this phenomenon is aptly named a “high spinal”.

I also believed that epidurals, as advertised by those who give them, would not take away all of my pain.  The misinterpretation I made was that it would take away approximately 50%, maybe less.  I would still be uncomfortable, because it’s a rite of passage that all afflicted with occupied uteri must somehow get through, obviously.  Why endure the torture of a needle in my spine only to suffer slightly less?  I would just keep going as I was.

I was also in denial about my ability to tolerate pain, inappropriately optimistic about my labor progression (I was totally at 10cm by now) and generally over the whole cervical exam process.

PIC gently brought me around by telling me I was wrong.  He assured me that a high spinal would not happen to me and that an epidural would make me significantly more comfortable.   He promised me I could do it.  He also promised me, in response to my repeated begging, that he would not let me die.  He also made the valid points that if I waited until the pain was more than I could take, it would be significantly harder to sit still for the procedure and a moving target is not the best thing when the goal is to insert a needle and miss several important structures including the spinal cord. 

For some reason, his pep talk occurred in the bathroom during one of my trips when he was given the honorable role of rolling the IV pole and partially making sure I didn’t accidentally have a baby in the toilet and not notice.  Did I mention that it’s next to impossible to escape this “miraculous” and “meaningful” process with your dignity intact? Little did I know, bathroom trips were not going to return to their former glory as a solitary experience for quite some time. 

We emerged changed. Serene. Ready. 

We informed the nurse of our decision. She paged anesthesia and told us we were number one on their list and they should be in my room to do the procedure within thirty minutes. Before I could panic and change my mind my uterus violently reminded me why I shouldn’t.

Shortly thereafter a cart was wheeled into my room by my two favorite people in the labor process, although I didn’t know it yet.  A white-haired smiling gentleman introduced himself as the CRNA who would be responsible for placing my epidural and his accomplice – a future CRNA currently just shadowing – who was fittingly named Captain Jolly. 

They walked me through the entire procedure as they went (although verbally, I could have potentially given them a run for their money – PIC had walked me through this procedure 4 or 5 times in the past month so that I would be “ready”.  He reminded me to hold very still and to arch my back “like a cat” which invariably ended with me pointing out that he should try arching his back at 9 months pregnant.) They warned me of the cold when sterilizing my back, the slight touch as they marked the spot,  the sting when they administered the lidocaine (a small sting like when the dentist drills too long and hits a nerve – but disappeared quickly).  I don’t recall if he warned me when the needle went in – I was too busy bracing myself to hear anything, but before I realized anything he was administering the ‘test dose’.  This test dose is supposed to ensure that the needle is in the right place and minimize the risk of a high spinal.  I payed extra close attention to my body for the symptoms he listed: arm weakness, trouble breathing or death.  None of them seemed to appear.  Satisfied that everything was good, he taped everything in place, helped me lay down and asked my height. “I’m 5 foot 4”  I told him.  Then I asked why and he explained that the epidural is dosed by height… “Well, sometimes I am 5 foot 2, but you should dose it for less because I don’t want the epidural to go all the way up to my brain.” He reassured me that not reaching the full body height was, in fact, taken into consideration.  “Good.” After pressing some magic buttons, he told me to expect full effect within 30 minutes and said he would come back later.  Together he and Captain Jolly disappeared, off to soothe the suffering of the laboring masses. If ever someone deserved a super hero cape…

I contracted. I waited. I contracted. I waited.  The nurse got an ice pack and pressed it on my arms – cold.  She pressed it on my legs… not cold?  Weird. 

The pain diminished to a 4 – already I was sold. 

My face looks like 4 most of the time, even without distracting pain.

Now I only had pain in my right low back, like I had lifted a 45 lb bag of dog food and tossed it onto my shoulder because I’m an independent woman who don’t need no help(!) and hurt myself in the process but the pain from this injury only occurred every 3 minutes.  (Not that I have ever done anything like that).  It was still uncomfortable, but in a manageable, less than my former wanting to cut out my own uterus kind of way. 

Thank goodness for PIC.  Wincing regularly while simultaneously insisting that I was fine was apparently not as convincing as I thought. He decided to metaphorically take the situation in his hands and literally took the icepack in his hands.  Left hip – not cold. Right hip – cool, not cold.  Left abdomen – not cold. Right abdomen – cold.  

Cold on the right side of my abdomen was the wrong answer.  It was supposed to be not cold.  I told him it was fine – I could deal.  I did not want them to put in another epidural.  Wrong again – the magic buttons could fix everything.  He paged the nurse and without waiting for her assessment of this situation explained “Her level is too low on the right, she needs another bolus dose and if that doesn’t adequately control her pain, they will have to increase her rate.”  I wasn’t sure what exactly he meant, but I have never been more proud to have someone talk about me in front of me in a way that I couldn’t understand. 

He was right.  They pushed the magic buttons and 10 minutes later, it was like I wasn’t even in labor anymore.  Sure, I could no longer move my legs very efficiently, but who needs those?  The nurse inserted a catheter into my bladder to allow urine out – I didn’t feel a thing.  They checked my cervix – I didn’t flinch. (I also hadn’t made much progress and was now at a 4+… still not a 5.) My uterus which had previously demanded all of my attention with its recurring hissy fits was now silenced like an alarm clock that has been thrown against the wall and shattered into a million no longer annoying pieces.

Suddenly my text message status updates included lots of rainbow emojis.  I explained my sudden lack of pain to PIC in what I thought at the time was the most fitting metaphor “It’s like my body was the United states and my uterus was the south and it was trying to secede and it was stressing everyone out and poor Abraham Lincoln was just trying to keep everyone together but the south was having nothing to do with that and it was time to get out NOW by any exit possible, but then the epidural came and it was like mother Teresa showed up and made everyone chamomile tea and now we are all going to sit around and sing kumbaya.”

Clearly the epidural did not dull my flare for the dramatic. Or my gift for poetry.

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