Epidoodles*

This is not boasting but merely a statement of fact: I have sited more epidural catheters than some of you have had hot dinners. Most of these have been for ladies despairing of their life amidst the onslaught of pain during childbirth. The pain relief thus delivered is almost miraculously effective. Within minutes, a screaming suicidal mother-to-be is transformed into a snoozing kitten, and her labour continues safely onwards. In the event that delivery needs assistance by forceps or caesarean, the epidural just gets topped up and away we go.

I had a great teacher: Jane, an immaculate English rose with perfect diction, was one of my first bosses. Her voice rather resembled Lady Penelope’s from Thunderbirds. I like to think I was her Parker (Yeshh, milady!). She was a graduate cum laude of the famous Oxford Pain Clinic and was a mistress of her art. She taught me the then rarely used paramedian approach to the epidural space, which I still use to this day. I have since passed on this invaluable skill to innumerable pupils over the years.

Epidurals are actually potentially very dangerous. A whoppingly huge needle gets advanced through the skin, subcutaneous fat and ligaments of the spine until its tip lies within a millimetre of the dural sac containing the spinal cord or the nerve roots arising from it. Then either drugs are injected directly, or a fine plastic catheter is fed through the needle so that several centimetres of it lie in the epidural space. The needle gets removed over the catheter and a sterile filter hub gets affixed to the free end of the tubing thus sealing it off from germs. Via this route, all manner of medications can be delivered directly to the near vicinity of the central nervous system: local anaesthetics, opiates, clonidine, depot-steroids, and others have all been tried and found useful.

One of my finest moments happened when I was confronted by a woman who was riddled with advanced and widely metastasised breast cancer. She was in unbearable pain. Her heavy oral morphine dosage was insufficiently effective and was giving her unbearable side effects, nausea and constipation mainly. I provided her with an epidural catheter and injected a very modest 5mg of diamorphine through it. Within minutes, her pains were negligible, and she heartily sighed with relief. She did not have long to live, but her oral meds were stopped and the side effects from them melted away. Her pain relief was provided purely via the epidural instead. She died unharassed by physical agony.

Another of my talents, not mentioned on my CV, is songwriting. I composed this little ditty for one of the hospital Christmas shows I participated in:

Labour,
Everybody is in labour!
With a little epidural
-You could have a baby everyday!
Labour is now consumer-friendly
Thanks to your gasman, and Oh-Dee-Ay**.

(this should be sung to the tune of “Neighbours”)

 

*My 4 year old daughter asked me why I had to leave the dinner table in such a hurry. I explained that I had to do an epidural. The next day at school, she was telling everyone that her daddy did “epidoodles”, apparently.

** An ODA is every anaesthetist’s assistant/saviour/mentor/bloody-great-mate. They are the great unsung heroes of the NHS, to whom I am perpetually indebted: Operating Department Assistant. (Apparently they are now called “Practitioners”).