— A delivery suite blessing — January 2008 —
I had an exceptional and very humbling experience at work in January of 2008. I was reminded yet again how dependent we are upon the Lord in EVERY aspect of our lives.
On a given morning, I placed an epidural in a laboring patient who was pregnant with her first child. The placement of the catheter went smoothly, she received excellent relief from her contraction pains, I placed her on an epidural pump, and she continued to labor. I received a call about 3 hours later stating that we needed to do a semi-emergent Cesarean section for this patient due to persistent fetal heart-rate decelerations. I drew up the necessary drugs and started dosing her for surgery using the epidural catheter. Shortly after I started dosing, she complained of classic symptoms of an intravascular injection (dizziness, faintness, shortness of breath, rapid heart rate). I had stopped my dosing about 30 seconds prior to the occurrence of these symptoms. For a brief moment I thought she was going to lose consciousness, and I would have been in a terrible situation if that had occurred, as we were still in the labor suite, not in the operating room near my anesthesia machine and equipment. By this time I had noticed that there was indeed blood in the epidural catheter, indicating that the catheter was in an epidural vein. With administration of oxygen and ephedrine, the patient began to feel better and her symptoms improved. I had time to roll her over, un-tape the catheter, and pull it back one or two centimeters to extract it from the vein. I then continued dosing very slowly and carefully as we rolled her bed to the operating room. When I checked the level of her block in the operating room, I was amazed to discover that her block was excellent and just at the required level for a comfortable Cesarean section. I was amazed that the block was so dense because a good portion of the dose had obviously gone intravenously and not in the space itself. With a quick prayer of gratitude, I made final preparations for the surgery and the obstetricians delivered her baby. Later, as I prepared to put some duramorph (pain-relieving medication) in the epidural catheter, I was shocked to see that there was blood again in the catheter! Now I was truly amazed that this patient had done so well, because some of the dosing I did after I adjusted the catheter had gone intravascular as well! There is no way that this patient should have had such a good block with the blood that I saw in the catheter, not once, but TWICE! On a whim, I decided to give the duramorph slowly and see if she experienced any intravascular symptoms again. She didn’t, and I gave the entire dose over several minutes. She experienced wonderful pain relief for the next 18 to 24 hours, just as would be expected with a properly functioning epidural catheter! I was now convinced that the Lord had watched over both me and this patient, and the successful outcome was due to his “tender mercies” upon all involved.
Since the days of my residency, I have been in the habit of pleading with the Lord every morning before work for his watchful care, that I would be equal to the situations that I encountered that day, and that the patients would be blessed with a good outcome and no untoward problems. How grateful I was that day for the prayer offered and the assistance provided by the Lord.
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