The first Lumbar puncture

Friday, August 17, 2007 10:29 AM

Suddenly, I am thinking about to write done my experiences as a pediatrician in China. It is true I worked as a pediatrician in China for 18 years even I did not have any work pictures and work dairy. But when I think back, there is lot of in memory and I want to write done it and share with others. I am not a very good English writer, but I certainly want to try. It also will be a good practice in writing for me anyway.

The first Lumbar puncture of my life


I stayed in the doctor’s break room and crying. I cried so hard that not only my tears but also my nose were running. “ The little boy has been through so much and we did so much work to get his permission to do the lumbar puncture, but I failed. I am so sorry and feel so guilty about it. I hate myself!” I was complaining of myself did not make my first lumbar puncture success.

It was in 1982, I first graduated from medical school in my hometown. I was sent to a pediatric department in the city’s hospital working as a resident. My attending doctor was Dr. Yang Xiu Mei.

As a resident, I basically act like a doctor independently for two years. But at the first three months, there was an attending doctor to work and watch me. I was still within the three months period.

Wang Dong was the patient. He was 5 years old with tuberculosis meningitis. We were using the intravenous and intrathecal anti-tuberculosis therapy to treat his disease. He was doing well. But before we discharge him, we need to do a last check of his cerebral spinal fluid to see if his meningitis was recovered.

As a 5 years old boy, he had been through lot. From the beginning of the therapy which require lumber puncture every other day for couple weeks and then once a week, and plus the use of steroids. His puncture area became thick and hard, it was very difficult to do the puncture. And the boy hate the puncture. Dr. Yong, me and the boy’s father, we work together to persuade the boy to agree of the last one and he finally nodded his head. It was my job to perform the operation.

The boy side lying on the operation table with the father and dr. Young’s help. I opened the sterile lumbar puncture kit and put on my sterile gloves, using a syringe get some lidocaine out of an ample. Put the sterile clothe around the puncture area. Applied local anesthesia and using the lumbar puncture needle to perform the puncture. It went well, but I could not get the CSF out. I checked the depth and the site, everything was correct but the cerebral spinal fluid did not come out. I had to give up …

Since the boy’s medications were weared down to oral and everything was normal except the CSF test was not done. He was discharged from the hospital and come visit as out patient. We performed the lumbar puncture again in put patient area at his first visit as an out patient. It was normal.

As for tuberculosis meningitis, the treatment plan at that time was after the CSF test was normal, it still was requiring additional two years anti-tuberculosis therapy and periodically check of the blood and CSF tests to be considered full recover. If there were any abnormal of the tests, the patient had to be hospitalized again to start the full treatment again. Dong went back to be hospitalized for few times since his first discharge due to incompliance of his medication. But finally at his 10 years old age, he was completely off of all medication and fully recovered.

With the time of my practice, I realized that not every attempt has to be successful since we are dealing with the deferent human bodies and deferent disease process. It requires practice, skills and the operator’s confidence. But I certainly appreciate the tears for my first lumbar puncture as newly graduated medical student. It stays in my memory forever and reminds me to improve my knowledge from time to time.