Feel

A lot in medicine is based on feel. The internal medicine doctor taps the belly to identify the liver, places a hand on the chest to feel an abnormally dilated heart. The obstetrician determines how dilated a cervix is, where the baby is within the birth canal. The orthopedist and rheumatologist estimate the amount of fluid within a joint. The neurologist assesses the tone of all the limbs.

It wasn't until I got facile with epidurals that I understood feel. Placement of an epidural catheter is primarily a tactile activity, and once I figured that out, I found it immensely satisfying. Like placement of IVs and arterial lines, I quickly learned that identifying the right location to start makes all the difference. Although it is a weird thing to say, touch is something that can be learned. Over this rotation, I have really begun to understand what the spine feels like, and consequently, I've become much more successful with epidural placements.

Part of the epidural is advancing a large needle through the tissues of the back into the proper space. As I've become more attuned to the process, I've learned the nuances of each type of tissue as I pass through. By the feel of the needle and the resistance I am getting, I know where I am, which ligament I'm in, and how close I am to the epidural space. It's a really fun epiphany and makes the process of placing the epidural extremely satisfying.