• W. Hoh replied to the topic We Are Failing At Accessibility in The OR in the forum Adults​ ​With​ ​Cystic Fibrosis 8 months, 4 weeks ago

    I’m a physician and have done “spinal taps” in a fluoroscopy suite, similar to an OR, on a large number of occasions. they are usually done in a procedure room, or if there is a real need, in the OR.

    I was also injured while serving in the U.S. Army Medical Corps, suffering a spinal cord injury. I’ve had lumbar punctures done on myself on a number of occasions. My wife had an “epidural” when she had my son, which involves a lumbar puncture.

    I’m sorry that you feel unheard and I understand anxiety regarding procedures, ESPECIALLY when someone is doing something involving your spinal canal.

    Regarding the lack of warning during the procedure, notice that the the doctor’s fingers localize the proper location between vertebrae and the patient prior to placing the needle. A suggestion: you could ask the doctor to have an assistant give you a tactile reminder (tap your hand several times or something) right before s/he enters with the needle, without violating sterile conditions.

    There really isn’t a danger to a lumbar puncture/LP, previously referred to as a spinal tap. They’re entering well below the level of the spinal cord, and the risk of damage to a nerve is very low, again because of the location of the procedure. Some physicians overemphasize the minimal risk because of fears about medical malpractice. if the physician or nurse who obtains informed consent doesn’t tell you all this, I apologize for them.

    Actual communication while doing the procedure is rarely needed. the procedure is routinely done on newborns with a fever, to rule out meningitis. Spanish-speaking only (SSO) patients did not require interpreters for this procedure where I did them in El Paso. Maybe that was a mistake, but as long as we explained what was going to happen before hand, they were comfortable with it. And I understood some basic Spanish words like stop, pain, no, wait, etc.

    I would insist that an interpreter be nearby after the procedure is done to communicate any postprocedural symptoms. like the postprocedural headache.

    Just talk to any physician who performs this procedure and they will verify everything that I’m saying.

    And in terms of an interpreter for deaf people in a medical setting, not many deaf individuals have proper training in medical terminology. That’s something you need to address directly with the hospital. As you’re well aware, it’s an ADA issue. The hospital may need to use a different deaf person interpreterservice… Or this individual needs additional training from the service that employs her.

    If I recall correctly from an earlier post, you mentioned that you have serious anxiety related to work situations also. There’s treatment for severe anxiety that most people would consider to be somewhat excessive. And while I’m not attempting to diagnose you, OCD is an anxiety disorder.

    And OCD is actually much more common in persons with chronic medical disorders like CF. My son has CF and seems to be developing some anxiety issues too.

    • Hey Dr Hoh. Thanks for your insight! Yes, I’ve had a lot of punctures at this point (including the headache and a blood patch- luckily just once), and just once before birth with my second daughter, as I had my first naturally. They have varied in whether I’m laying face down and cant see or hear anything, to sitting up and leaning over (like those given before L & D) which are less intimidating in terms of connection to cues around me.

      I wonder how much easier some procedures would be on those with language (or other) barriers if we re-imagined them as they would feel to us, you know? For example, your memory of your lumbar puncture or of a Spanish speaking patient’s experience would be very different from a Deaf person laying prone with no visual or auditory clue to the process, after a lifetime of being conditioned to tune in (and yes, feel some anxiety when you can’t) for survival.

      A nurse tapping is exactly the sort of ingenuity we need when rethinking the patient experience in situations such as these! (I actually had a nurse do that for one of the procedures last year, and it did help me astronomically in holding extra still and not trying to use my eyes!)

      Regarding the interpreter: Yeah, definitely right on it being a hospital issue technically (though it of course falls on the Deaf person to handle if the hospital didn’t thoroughly vet, which is tough if someone is sick/poorly, etc). Medical ‘terps differ in training from other fields of ASL interpreting- including Deaf Educators, theater interpreters, and onward.. many people don’t even know this!

      However, I think the sentence “not many deaf individuals have proper training in medical terminology” necessitates a quick kind note to the contrary (quick and kind and full of love, promise!), as I have Deaf friends who are actual medical doctors themselves, and we all deserve the same access to language and terminology as anyone else, regardless of if we think someone can or can’t understand it or hasn’t been given access. And I’m guessing that’s what you mean, because yes- Deaf education in this country is a travesty. Still, it’s actually a medical interpreter’s job (and part of their training) to learn how to explain procedures or terms in the off chance a Deaf person hasn’t had exposure. [I have a lot more insight into interpreting dynamics, training and Deaf experience if ever that’s of interest to anyone ever]

      It was taken up with the hospital, and he (the interpreter was a he) was apparently someone they hadn’t used before. Regardless, better vetting should be done because it’s critical to a Deaf patient who otherwise has no access.

      I don’t want my mention of anxiety to be taken too too out of context. Just as you’re at the top of your field, I’m at the top of mine, so luckily, I’m extremely privileged in that it doesn’t interrupt my life or my goals in that regard. I feel enormously for anyone who really struggles with because… that’s a beast! It does seem much more prevalent in those with chronic health, probably because so many variables are often out of our control?

      I opened up about it to make others feel more comfortable on the forum dialoguing about theirs. However, I do have anxiety before intense conversations- a meeting at work to discuss money (eek, hate discussing money) or intense medical conversations where I am my only advocate- so phew, yes.

      Thank you so much for all of these words and thoughts to ponder and consider!

      PS: My brother is a Colonel in the Army, was in charge of the Rangers, and onward, and most of my family is Army, so hoo-ah all the way!

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