Dr. Shin Seonhan: The Doctor Who Sees The Future [EN]: Chapter 172

#172 Where He’s Headed (3)

Lumbar puncture (Spinal tap).

This procedure involves inserting a needle between the vertebrae to extract and examine cerebrospinal fluid.

Cerebrospinal fluid (CSF) is the fluid that circulates around the brain and spinal cord, acting as a cushion and transporting hormones and nutrients.

If bacteria grow in the CSF or there’s another problem, a lumbar puncture is needed to extract and analyze the fluid.

‘If this were an adult patient, it would be a task for an intern like me, but…’

This situation was different.

At Yonsei University Hospital’s pediatrics department, the attending physician always performed the lumbar puncture themselves.

Was it because they didn’t trust the interns?

More likely, it was because they felt interns were too inexperienced to handle potential complications in pediatric patients.

Of course, this policy prioritized patient safety, but I also appreciated the consideration for us interns, who were still learning the ropes.

At 2:30 PM, the scheduled time, I met Doctor Kang Ha-ni at the entrance to the ward.

“Shall we go in?”

“Yes!”

Creak—

I pushed the tray with the lumbar puncture set, following Doctor Kang Ha-ni toward the patient’s bed.

My role in this lumbar puncture procedure?

Simple.

Keeping the patient still.

As with surgery, proper positioning is crucial for all procedures.

However, children can’t easily tolerate or maintain uncomfortable positions.

For a safe and quick procedure, it’s essential to have someone who can properly hold the child in place.

“Hello~!”

Doctor Kang Ha-ni entered the ward with a cheerful expression.

The parents immediately stood up to greet her.

“Doctor, you’re here?”

“Our Seo-ah has a slightly uncomfortable test today. Fortunately, she seems to be sleeping soundly?”

“Yes, she took her medicine 15 minutes ago and just drifted off.”

Yoon Seo-ah, 7 years old.

She was the patient scheduled for the lumbar puncture today.

She was suspected of having meningitis due to an unexplained fever.

Therefore, we needed to extract and examine her spinal fluid via lumbar puncture.

“Even before falling asleep, she was asking for the doctor who gave her snacks yesterday.”

“Oh, really?”

“Seo-ah likes the doctor so much, we were surprised. She’s never been like this at other hospitals.”

I was surprised by their conversation.

Doctor Kang Ha-ni seemed to have a strong rapport with the parents.

I’d seen other doctors skillfully build rapport (a relationship of trust and understanding) with patients and their families.

However, this was the first time I’d witnessed such a friendly and familiar interaction.

‘Amazing!’

I thought admiringly.

I need to learn this.

Building rapport is just as important as technical skills.

I figured that learning only that during this month would be a success.

Doctor Kang Ha-ni looked at the patient’s face and smiled.

“Seo-ah needs to sleep deeply. It seems like she’s not fully asleep yet?”

“Ugh…”

The child mumbled and tossed and turned.

The people around her smiled at the cute sight.

Of course, this wasn’t ideal for the attending physician.

The child’s restlessness indicated that the sedative wasn’t fully effective.

“I’ll wait a little longer for the medicine to take full effect.”

“Yes.”

After a short while.

The child’s whimpering subsided as the sedative seemed to have fully taken hold.

Doctor Kang Ha-ni rechecked the lumbar puncture supplies on the tray and then turned to me.

“Doctor, have you performed this procedure on adults before?”

“Yes.”

“Please ensure she is well-positioned.”

I recalled the procedures I had done on adults and helped position the patient.

“Ugh…”

The child opened her mouth slightly as we tried to lay her on her side.

It was an uncomfortable position for her, but unavoidable.

We positioned the patient on her side near the edge of the bed, curling her up into a fetal position.

‘The whole body must be perpendicular to the floor…’

I climbed onto the bed, knelt down, and held the child.

I used my right arm to position the child’s head and my left hand to keep her legs bent.

I gently stabilized the child’s tilting belly with my knees.

Then, Doctor Kang Ha-ni emphasized as she filled a syringe with lidocaine (a local anesthetic).

“You have to hold her tight.”

The tone changed.

No more kindergarten teacher mode.

She was kind to the child and parents, but she needed to be clinical during the procedure.

Doctor Kang Ha-ni adopted a serious demeanor before proceeding.

While I held the child in position, the area was disinfected and a sterile drape was placed over her lower back.

Then, Doctor Kang Ha-ni moved the lumbar puncture needle into position.

Squeak—

The needle pierced the skin, attempting to enter the spinal canal between the vertebrae.

But at that moment.

Wriggle—

The child’s body jerked suddenly.

I quickly tightened my grip and firmly secured the child’s body.

Soon, Doctor Kang Ha-ni’s firm voice cut through the air.

“Intern, hold her tight. We can’t have a traumatic tap.”

“Yes.”

Traumatic tap (T-tap).

This occurs when the needle accidentally punctures a blood vessel near the spinal canal, causing blood to mix with the spinal fluid.

If this happens, the test results may be inaccurate.

Moreover, repeated incorrect insertions can cause a hematoma (a collection of blood) near the spinal canal.

Not to mention, it increases the child’s pain.

This was a critical moment requiring utmost attention.

‘This is the most important moment in this procedure… Seo-ah, please bear with it!’

I thought to myself, holding the child tightly.

‘Let’s finish this in one go!’

Doctor Kang Ha-ni must have been thinking the same thing.

Outside the curtain, the guardian’s ankles and slippers paced back and forth, unable to watch the procedure.

I could picture the guardian’s face, her lip tightly bitten, even without looking.

Thud—

As the needle went deeper, I focused even more intently on keeping the child’s back perfectly still.

After a moment of tense silence, Doctor Kang Ha-ni carefully withdrew the stylet [a thin wire inserted into a needle to keep it clear] from inside the spinal tap needle.

Then, she dabbed the stylet a few times against the surface of her gloved hand.

Swish, swish—

A small amount of clear liquid clung to the glove.

‘……!’

This indicated that the needle had been successfully placed within the spinal canal.

If the needle misses the spinal canal, no fluid will appear on the stylet.

In the event of a traumatic tap (T-tap), fluid tinged with blood would appear on the glove.

Drip, drip—

As if announcing the procedure’s success, clear cerebrospinal fluid began to slowly drip, following the path of the inserted needle.

‘Phew, successful on the first try!’

Doctor Kang Ha-ni smiled in relief and began to collect the cerebrospinal fluid, drop by drop, into a sterile plastic bottle.

Even in adults, this procedure can require multiple attempts, sometimes taking over an hour.

The more attempts and the longer the duration, the faster the patient’s trust erodes.

Fortunately, today’s spinal tap proceeded smoothly without any complications.

After measuring the spinal canal pressure and collecting the cerebrospinal fluid sample, we left the ward within twenty minutes.

“Good work, Seonhan.”

“It was nothing.”

I said that, but I was subtly perspiring.

Spinal taps on children always make me more anxious.

I worry that even a small lapse in holding the child securely could lead to a complication.

“It requires quite a bit of strength, doesn’t it?”

“Yes, even when the child seems to be sleeping, it demands more strength than I anticipate.”

“If a half-asleep child is like that, imagine dealing with one who’s fully awake!”

“…….”

“There will be many times when you’ll need to use your strength in the future~ Fighting!”

She’s back to her usual cheerful tone.

Doctor Kang Ha-ni clenched her fist, offered me encouragement, and moved on to the next task.

I absorbed my second lesson.

* * *

The third lesson unfolded during rounds.

I trailed Doctor Kang Ha-ni, assisting with rounds at each bedside.

The most significant difference from my previous rotations was the limited time available to speak directly with the patients.

“Doctor, my child…….”

“Is my child going to be okay?”

“My baby takes after her father and is very impatient. That’s why she can’t stay still.”

“My child isn’t usually like this…….”

The conversations primarily occurred with the guardians.

Moreover, the parents’ personalities varied widely.

Some parents were tearful and distraught, while others expressed their anxieties through lamentations.

Conversely, some parents grilled the attending physician as if conducting a hostile interrogation.

“The child has such a high fever and is trembling; shouldn’t you be doing something? This is Yonkuk University Hospital; how can this be happening here?”

It was an aggressive and accusatory tone.

It was a situation ripe for potential conflict.

However, Doctor Kang Ha-ni navigated it skillfully, smiling calmly as if she were accustomed to such encounters.

“Mother, you must be very worried, aren’t you?”

“Yes?”

“Parents are often understandably alarmed in these situations. The more this happens, the more composed the guardians need to be so that we can do our best to help.”

“Ah, yes…….”

“The medication is being administered, and various tests are underway, so please be patient. The fever will break soon. We’ll also identify the underlying cause and address it!”

Was it her unique tone and reassuring demeanor?

The prickly attitude of the guardians seemed to dissipate like snow under the sun.

It was a moment when I truly appreciated that the doctors who thrive in pediatrics possess exceptional interpersonal skills.

“Please take good care of us, Doctor…….”

“Yes, don’t worry!”

Observing Doctor Kang Ha-ni, I internalized the third lesson of pediatrics.

‘The doctors who work here must be adept at managing guardians!’

The patients in pediatrics are up to 18 years old.

Among them, adolescents can articulate their needs and concerns.

However, young children often lack the ability to express themselves effectively.

Therefore, the primary focus of communication naturally shifts to the guardians.

* * *

“Aigo, I’m beat.”

Thud—

That evening, I collapsed onto the sofa in the dormitory lounge.

Even for me, an 8-month intern and a seasoned veteran in the intern world, working in the pediatric ward was proving challenging.

It wasn’t so much physically demanding as it was mentally draining.

‘Pediatrics might not be my calling…….’

Thump—

After a while, Geun-uk pushed open the lounge door and threw himself onto the sofa beside me.

Judging by his expression, he seemed to have suffered a similar blow to his mental well-being.

“Wow— last month, the transplant surgery department was notorious for its brutal intern schedule, but pediatrics is in a league of its own.”

“I know.”

“We have to soothe the kids, and the guardians are scrutinizing our every move…….”

“Right…… I understand their feelings, but it’s far from easy.”

We sprawled on the sofa like discarded laundry.

.

The advice from other interns suddenly resonated deeply.

Just then, someone joined our conversation with a lighthearted laugh.

“That’s precisely why I was a pediatrics resident but ultimately stepped away.”

“Oh, Yeonseo, long time no see!”

Yeonseo, who had been working at the computer in the corner of the lounge, approached us.

“Come to think of it, Yeonseo, you initially wanted to specialize in pediatrics, right?”

“Babies are undeniably cute and wonderful, but the emotional toll is significant.”

“I can imagine. I got chewed out by both the guardians and the attending physician today, a double whammy.”

“Geun-uk, what was the highlight of your day?”

“I got scolded for not holding the child securely enough during the spinal tap.”

Huh?

That’s unexpected.

With Geun-uk’s physical strength, holding a child should have been effortless…….

As we voiced our surprise, Geun-uk sighed deeply and confessed,

“When the child was crying and struggling, my heart ached so much that I unconsciously loosened my grip.”

Well, Geun-uk is surprisingly sentimental, despite his tough exterior.

“But, I did gain some valuable self-awareness while rotating through pediatrics.”

“What is it?”

We listened attentively to Geun-uk’s words.