Thursday, 22 November 2007

Keep Still!

“Why can’t you KEEP STILL? What’s the matter with you?”

I am 8 years old and am on the top deck of the bus with my mother. My young mind doesn’t really comprehend why my Mum is so angry, after all the bus seat was a bit springy and it seemed like good fun to bounce up and down on it like a trampoline. However, I’d learned not to mess around when she used that tone of voice and I considered myself told off.


“What’s the matter with you?”

“Huh?” I reply, bleary eyed and only just coming back to consciousness. The time is about 4am and I’m a second year medical student. I’m in the bed on my girlfriend at the time, but I can tell that she’s really pissed off and (not for the first time) I have no idea why.

“All you do is fidget, fidget, fidget all night bloody long! You keep kicking me and nicking all the fucking duvet! I never get a decent night’s sleep when you’re here. Why can’t you just KEEP STILL?!?”

Though I was only semi-conscious, I’d learned not to mess around when she used that tone of voice and I considered myself told off.


I was with my consultant in the anaesthetic room today, and we’d successfully put our patient, Mr Elwood, to sleep. She turns to me and says “Have you seen any femoral nerve blocks being done?”

“Yes,” I reply “but I’ve never done one myself.”

“Well, now’s your chance. Tell me, how would you go about doing it?”

“I’d get a nerve stimulator and an insulated needle, then I’d draw up 30ml of 0.25% Bupivicaine and flush the needle through. I’d sterilise the area and I’d feel for the femoral artery. I’m go 2cm lateral and 2cm caudal to the pulse and push the needle through the skin. I’m looking for twitching of the quadriceps at the patella and if the twitches are present between 0.3 and 0.7 mA, then I’m in the right spot and can inject the local anaesthetic.”

“Very good, go for it then.”

I’ve got the needle in the top of my patient’s leg but I’m getting twitching of the adductor muscles, not the quadriceps. I angle the needle to the right a little and his kneecap starts twitching.


The consultant turns the amplitude down to 0.3 and the twitches cease.

“That’s perfect,” she says. “You know the tip of the needle is in exactly the right spot. Now, all you have to do is KEEP STILL while I inject the Marcain.”

I take a breath out and hold it. I manage to keep myself, my hands and the needle perfectly still while the consultant inject the anaesthetic.

Three hours later, on the orthopaedic ward:

“Hello there, Mr Elwood.”
“Oh, hello doctor.”
“How are you feeling?”
“Not too bad, I’m a bit tired like, but I’m alright really.”
“Do you have any pain?”
“No, not really”
“How’s the knee feeling?”
“It’s fine, it feels a bit numb, like you said it would, but it’s not sore or anything”
(This means my femoral nerve block is working perfectly.)
“Fantastic, well I’ll leave you alone to have a rest. I reckon you’ll need it because the physios will be after you tomorrow. I wish you all the best, sir.”
“Thank you very much doctor.”

And I went home feeling very happy. I wonder if my mother and my ex-girlfriend would be proud of me if I told them how I’d finally learned to KEEP STILL…

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