First LP

Rachel Randell, MS2, Pediatrics

 

We first met Mr. M that morning on rounds. We tagged along, our short coats blending in to the flock of white fleeting from room to room. We eventually made it to the end of the hall, then darted around the corner and packed into a service elevator. It was eerily quiet as we stood still, no longer clicking shoes on the glossy floors and rustling white sleeves against white coat pockets. I felt very self-conscious of my own breath sounds. Then, with a resonant ding, the elevator opened to the seventh floor.

Mr. M’s room was very large, with a wall full of windows overlooking the delivery entrance behind the hospital. A flat screen television was installed in tall wooden armoire facing the bed. The shelves were filled with folded hospital gowns, tissue boxes and spare pillows. A single multicolored helium balloon dangled from the ceiling in the space between the windows and the armoire and the bed. In the closest corner, a Nurse Assistant wrapped in a yellow contact precaution gown sat typing away on the computer. I clasped my wrists behind my back to avoid touching anything in the room.

The resident spoke loudly and slowly. “Good morning, Mr. M,” she said, placing a gloved hand on his shoulder. “How are you feeling?”  His eyelids lifted about halfway. “How are you feeling?” she asked again. He mumbled something in response. She lifted his hand off the hospital bed and tugged it back and forth. His eyelids opened a little bit more. “Are you in any pain?” she asked. I could barely make out his mumbled response. “Do you know why you’re here?” she asked. He shook his head from side to side.

We gathered around our attending outside of the room. He spoke softly and quickly. “HIV negative, other labs are cooking, history of schizophrenia, girlfriend found him on the floor like this a week ago and we still have no idea what’s going on…” He went on to list a bunch of words I had never heard before and I found myself focusing on a black mark on the shiny floor next to my shoe. He turned to the fourth year student and pointed at his chest with a rolled up sheet of paper. “It’s your job to figure out what the heck is going on in there. Start with an LP.”

For some reason, I always expected a lumbar puncture, or spinal tap, to be a draw of cerebrospinal fluid up into a syringe. Instead, I stood by the window wall, looking down at Mr. M as he dozed off with his knees to his chest and a tube sticking out of his naked back. The fourth year sat just below him, holding a collection tube, watching it fill with clear fluid, drop by drop. “Do we have to do all four?” he asked the resident. “Yeah,” she said, nodding, “we might be here for a while.” I continued to clasp my wrists behind my back and tried to not lean up against the window.  I wondered what would happen if Mr. M awoke from his slumber, startled by the activity going on behind him, and rolled over onto the needle sticking in to his back. I imagined his droopy eyelids snapping open in shock, his arms flailing and ripping out the IVs and tubing tethering him to the bed. I imagined the needle pressing further into bone, passing through a tangle of nerves, and I felt my own lower back twitch for a second. Meanwhile, the fourth year student calmly sat as another drop of fluid rolled into the collection tube.

For a few seconds, I closed my eyes and imagined myself as the fourth year student sitting just below the hospital bed. My hands were shaky in too-large blue neoprene gloves. The collection tube trembled, anticipating each agonizing drop, and the white sheets rustled as Mr. M started to roll towards me.

I quickly opened my eyes and shook my head, as if to shake the image out of my mind.  The fourth year was calmly twisting a lid onto the last of the four collection tubes. We washed our hands and briskly exited the room, clicking down the hallway once again, leaving Mr. M with nothing more than a band aid taped to his lower back.