Thursday, January 28, 2010
I was doing a spinal for a patient seated in front of me on an operating table. In front of her, facing me, her nurse was holding her steady; behind me, a tall, young nursing student stood observing.
Three minutes passed between the time I prepped the skin with sterile solution and the moment I injected anesthetic into my patient's spinal canal. "You're all done," I said cheerfully and withdrew needle and syringe out of her back in one motion. "We'll have you lie down in just a second."
All of a sudden the nurse's eyes widened and she said in a firm voice, "Sit down. Sit down right now. Right now, sit down, RIGHT NOW." She was gazing past me. I put my hands on the patient's shoulders and turned my head to glance over my shoulder in time to see the nursing student teetering on her feet trying to make her way to the nearest wall. With me now in charge of holding our patient, the nurse rushed around the operating table toward the student and arrived just in time to support her crumpling body before it hit the floor.
Vasovagal syncope is a very real concern and not uncommon in bystanders observing procedures that involve the insertion of sharp objects into patients. I once saw a tall adolescent male fall back unconscious because of an I.V. In a case that would fill any conscientious anesthesiologist with dread, the husband of a woman who was getting an epidural for labor fell, hit his head, and DIED of an intracranial hemorrhage. This page has an interesting comparison of legal cases brought against hospitals on behalf of people who have fainted while observing medical procedures.
I don't think it's fair to assign blame for fainting. People can't help their physiologic reactions, which can sometimes be unpredictable. Different people have different triggers. Some can't stand needles; others, blood or fractures or internal organs; my Achilles heel is the drainage of pus. Even just thinking about that can provoke that unpleasant, pre-vomit tickle in my throat. Needles commonly seem to be problematic for the toughest-looking individuals, so I try not to judge by appearances. But it can be tricky, this business of trying to be mindful of observers' needs when all we really want to do is put 100% of our focus on our patients.
I hope that student is okay.