surprised him. She confided that not only had she read about it, her sister had had it for her two deliveries. Jeffrey explained why he wouldn't be giving her the epidural immediately. When he told her that she could get some Demerol in the meantime if she wanted it, Patty relaxed.
Before leaving her, Jeffrey reminded her that any drugs she got, the baby got. Then he told her again there was no reason to worry; she was in good hands.
Coming out of Patty's labor room and suffering through another intestinal cramp, Jeffrey realized he would have to take more drastic steps against his own symptoms if he was to get through Patty's delivery. Despite the paregoric, he was feeling progressively worse.
Passing back through the connecting doors to the OR suite, Jeffrey returned to the anesthesia alcove next to the OR, where he'd spent most of the day.
The room was empty and probably wouldn't be used again until the following morning.
Glancing up and down the OR corridor to make sure the coast was clear,
Jeffrey pulled the drape closed. Although bed finally
acknowledged being sick, he wasn't about to admit it to anyone else.
From the drawer of his Narcomed III anesthesia machine, Jeffrey got out a small-gauge intravenous scalp needle and an infusion setup. He pulled a bottle of Ringer's Lactate IV fluid down from the shelf and snapped off the cover over the rubber port. With a decisive shove, he pushed the IV tubing into the bottle and hung the bottle up on the IV stand over the anesthesia machine. He ran fluid through the tubing until it was free of air bubbles, then he closed the plastic stopcock.
Jeffrey had only started IVs on himself a couple of times, but he was practiced enough in the procedure to be adept. Using his teeth to hold one end of the tourniquet, he secured it around his bicep and watched as his veins began to distend.
What Jeffrey had in mind was a trick that he'd learned as a resident. Back then, he and his colleagues, especially the surgical residents, refused to take any sick time for fear they'd lose the competitive edge. If they got the flu or symptoms like the ones Jeffrey was now experiencing, they would simply take time out to run in a liter of IV fluid. The results were almost guaranteed, suggesting most flu symptoms were due to dehydration. With a liter of Ringer's Lactate coursing through your veins, it was hard not to feel better. It had been ages since Jeffrey had last resorted to an IV. He only hoped the efficacy would be as strong as it had been when he'd been a resident. Now forty-two, he found it hard to believe that last time he had been almost twenty years younger.
Jeffrey was about to push the needle in when the curtain to the alcove was pulled aside. Jeffrey looked up into the surprised face of Regina Vinson, one of the evening nurses.
'Oh!' Regina exclaimed. 'Excuse me.'
'No problem,' Jeffrey started to say, but Regina was gone as quickly as she had appeared. As long as she'd inadvertently caught him in the act, Jeffrey had half a mind to ask her to lend a hand by attaching the IV to the scalp needle once he got it into the vein. Reaching out, he pulled back the curtain in hopes of catching her, but Regina was already far down the crowded hall. He let the curtain fall back into place. He was just as well off without her.
Once the IV tubing was attached, he opened the stopcock. Almost at once he felt the cool sensation of the fluid as it flowed rapidly into the arm. By the time most of the bottle had run in, Jeffrey's upper arm was cool to the touch. After he pulled out
the IV needle, he put an alcohol swab over the site and bent his elbow to hold it in place. He disposed of the IV paraphernalia in the wastebasket, then stood up. He waited for a moment to see how he felt. The light- headedness and headache were totally gone. So was the nausea. Pleased with the speedy results, Jeffrey pulled open the curtain and headed back to the locker room. Only his colon still troubled him.
The evening shift had now taken over and the day shift was in the process of leaving. The locker room was full of cheerful people. Most of the showers were occupied. First Jeffrey used the toilet. Then he got out his paregoric and took another hefty swig. He shuddered at the taste and wondered what made it so bitter. He tossed the now empty bottle into the wastebasket. Then he took a second shower and put on another set of clean scrub clothes.
When he walked out into the surgical lounge he almost felt human. He intended to sit down for a half hour or so and read the paper but before he had a chance his beeper went off. He recognized the number. It was delivery.
'Mrs. Owen is asking for you,' Monica Carver told him when he phoned.
'How is she doing?' Jeffrey asked.
'Just fine,' Monica said. 'She's a little apprehensive, but she hasn't even asked for analgesia even though her contractions are now coming frequently.
She's somewhere between five and six centimeters.'
'Perfect,' Jeffrey said. He was pleased. 'I'll be right over.'
En route to the delivery area, Jeffrey stopped at the anesthesia office to glance at the big board to see about the evening assignments. As he expected, everyone was busy with ongoing cases. He took a piece of chalk and wrote that whenever someone was free he or she should come over to delivery and relieve him.
When Jeffrey arrived in labor room fifteen, Patty was in the middle of a contraction. An experienced LPN was with her and the two women were functioning like a practiced team. Beads of sweat dotted Patty's brow. Her eyes were shut tightly, and she was gripping the nurse's hands with both of hers. Strapped to her abdomen was the rubber monitor keeping track of the progress of the labor as well as the fetal heartbeat.
'Ah, my white knight in blue,' Patty said as the pain abated and she opened her eyes to see Jeffrey standing at the foot of the bed. She smiled.
'How about that epidural?' Jeffrey suggested.
'How about it!' Patty echoed.
All the equipment Jeffrey needed was on a cart he had wheeled in with him upon his return. After putting a blood pressure cuff in place, Jeffrey removed the rubber monitor from Patty's abdomen and helped position her on her side. With gloved hands he prepped her back with an antiseptic solution.
'First I'm going to give you the local anesthetic we talked about,' Jeffrey said as he prepared the injection. He made a small weal with the tiny needle midline in Patty's lower back. She was so relieved to be getting it, she didn't even flinch.
Next, he took a Touhey needle from the epidural tray and made sure the stylet was in place. Then, using both hands, he pushed the needle into Patty's back, advancing it slowly but de liberately until he was certain he had reached the ligamentous covering of the spinal canal. Withdrawing the stylet, he attached
I an empty glass syringe. Jeffrey put slight pressure on the sy ringe's plunger. Feeling resistance, he expertly returned to ad vancing the needle. Suddenly the resistance on the plunger disappeared. Jeffrey was pleased: he knew he was in the epidural space.
'Are you okay?' Jeffrey asked as he used a glass syringe to draw up a test dose of 2 cc's of sterile water containing a tiny amount of epinephrine.
'Are you flnished?' Patty asked.
'Not quite,' Jeffrey said. 'Just a few minutes more.' He injected the test dose and immediately tested Patty's blood pressure and pulse. There was no change. If the needle had been in a blood vessel, Patty's heart rate would have increased immediately in response to the epinephrine.
Only then did Jeffrey seize the small epidural catheter. With practiced care, he threaded it up the Touhey needle.
'I feel something funny in my leg,' Patty said nervously.
Jeffrey stopped pushing the catheter. It was only in about one centimeter beyond the tip of the needle. He asked Patty about the sensation, then explained that it was common for the epidural catheter to touch peripheral nerves as they traversed the epidural space. That could account for what she was feeling. When the paresthesia subsided, Jeffrey gingerly advanced the catheter another one and a half centimeters. Patty didn't complain.
Finally, Jeffrey pulled the Touhey needle out, leaving the small plastic catheter in place. Then he prepared a second test
dose of 2 cc's of.25% spinal-grade Marcaine with epinephrine. After injecting this second dose, he monitored Patty's blood pressure and her sense of touch on her lower extremities. When there were no changes even after several minutes, Jeffrey was absolutely sure that his catheter was in the proper place. Finally, he injected the
