The Counterproductive Jerk
You can learn a lot about a person by sticking a needle into them. I've seen 8 year old kids lie perfectly still without a whimper as I inject a painful anesthetic into their lacerations, and I've seen plenty of otherwise seemingly normal grown men and women scream, flop around, and bawl for their mommies with the first tiny prick of the smallest needle available. "Are you done yet?" they will sob, shuddering. Umm, no...I have to actually inject some of the medication for it to work. Try to keep still. The vast majority of people fall somewhere in between the two extremes.
I understand that the ER can be a scary and uncomfortable place, and I always try to make the process as painless and relaxing as possible for my patients. If you seem like the excitable low-pain-tolerance type and you have a driver, I'm happy to give you some medication to make the procedure go a little smoother. I have no problem seeing a few other patients for a half hour or so until you are mentally and pharmacologically prepared for the little 27 gauge needle and the torturous lidocaine injection that in your mind must burn like Satan's pitchfork.
And after I've finished the 8 year old's laceration and you are ready to accept my trident of hell, again, please try to keep still. But if you are going to jerk anyway, at least try to jerk AWAY from the needle. Ouch, that's gonna leave a mark. At least it'll be 1.25 inches deep, so it won't show.
Labels: lacerations, pain, tips, torture
posted by scalpel at 5:13 AM
36 Comments:
I feel so terrible after reading this.
I recently (in June) ha surgery to repair a torn ACL and almost bawled like a 12 ea old over the needles.
Now, I feel like a bigger whiner.
My self-esteem is broken.
I've just recently joined blogger and love what you write.
Hey, those needles do hurt. I have had a bit of trouble with ingrown toenails, and once I tried to give myself a digital block to cut out the offending part of the nail. I was able to insert the needle OK, but I couldn't make myself push the plunger down because the lidocaine was too painful.
I ended up just cutting off the nail with the scissors of my swiss army knife, without anesthesia. To me, that was less painful than the lidocaine.
I wouldn't recommend anyone else try that at home though.
Scalpel, you remind me of an anasthesiologist friend who would keep a little zofran, lido, and suture kits around that were left overs from surgery. It came in really handy at a neighborhood barbecue when a pregnant friend who had horrible nausea and vomiting and could barely function. He ran home got her a hit of zofran and she said she had never felt better while pregnant. She really hated needles, but she hated the nausea more.
I've had hundreds of needles stuck into me for a variety of reasons. Without question the absolute most painful of those were the 8 (or was it 12?) shots I got in the mouth and jaws before the dentist excavated my wisdom teeth. (The teeth had to be sawed and "delivered" in chunks.) I was only about 14, I think, and I tried really hard to be brave. I managed not to tense up, move, or make a single noise, but I was embarrassed that I couldn't prevent tears from sliding down from my eyes and into my ears. This was back in the old days before dentists gave you gas or anything for anxiety. Just shots and then the saw.
It really hurt.
None of the anesthesia shots I've had since then in other body parts have come even close to that kind of pain, though I agree, they do hurt worse than something like getting your blood drawn.
Not sure I would even feel a 27 ga. needle. But then again, I sorta' like pain.
I put off going to the doctor or dentist for as long as I possibly can because I have a strong fear of needles. I have a tendency of passing out (and convulsing) whenever I'm threatened with a needle. I've been called all sorts of things from "a baby" to "an idiot" by doctors because of this fear.
It's not the pain; oh no, that's not it. I waited 2 months with barely being able to open my mouth when my widsom teeth got infected and the only thing that helped was the constant use of antibiotics and percocet my mother gave me from her stash before I finally went to the dental surgeon to get them removed. I paid extra money to get IV sedation (which I had to be orally sedated BEFORE hand so I could actually receive the IV) and they had to give me twice the amount they normally would have because I was still wigging out.
Needles have nothing to do with pain for me. I have 2 tattos; they hurt like a son of a gun; or at least the outlines did. But I can't get a blood test. I get physically ill. My heart races. My palms get sweaty. I may vomit. I *will* pass out.
It is a phobia. An irrational fear. It's not because I'm a whimp. It's not because I'm scared of the pain. It's like someone being scared of moths or clowns or heights or peanut butter getting stuck to the roof of their mouths. There's no rhyme or reason. It's just a phobia.
I hate getting made fun of ESPECIALLY by doctors. When I had gout, the ER physician threatened that if I didn't have a needle shoved into the ankle joint so they could test the fluid there, it might be an infection and I may never walk right again. I said who cares. Better than getting a needle. He called me a foolish idiot. Because that DEFINITELY made my experience better.
And for those who haven't had gout in the ankle - it's probably the most excrutiating pain you'll ever go through. I've never been in such pain before. It's like someone's hacking away at your bone with a rusted hack saw. But a little needle could have fixed it - or at least determined for sure what it was.. and I refused it b/c of my phobia.
Needle phobia is why I didn't go in to nursing. I'm only now slowly - SLOWLY getting to the point I can watch injections on TV without having to look away or start to have a panic attack.
So - next time you have a full grown man or woman freaking out about the needle - maybe think that it's not the pain they're afraid of, but the needle itself. There are no true statistics on how many people die every year from this phobia - but I'm sure there are quite a few who do by refusing medical care b/c of the needles they'd need.
My husband is an ultracyclist: He cycles across country on fixed gear bikes. But he can't stand needles. He says he showed his love for me not by marrying me but by having blood tests done before the wedding. Is this a male thing?
It's like I always say: 'You play with knives on the street, you come to hospital and you cry.' Why is it always the ones who act toughest out there are the biggest babies on the inside?
What about those of us with tiny veins? I can tolerate most subcutaneous and IM shots with no problem, but if it's got to go through a vein, I turn into a mass of overwhelming anxiety. A blood draw is going to take a minimum of two (and usually three or four) tries, and you're not going to get the optimal amount because the vein will either collapse or just stop putting out. That thing with the IV and blood draw combined? Sorry, it's not happening. My last hospitalization (for pneumonia) took five tries to get the IV in, which was pretty good considering that the time before that, I went fourteen times with no success.
So either the medical personnel in my area really suck or there is something anatomically weird about me that makes this so difficult. I would hope professionals would understand why someone like me gets more than a little freaked out by anything involving needles and veins. Compassion goes a long way toward alleviating my anxiety. Derision just makes it worse and makes me more likely to refuse treatment.
I've never understood about this.
I've been in the Pediatrician's office and heard kids wailing away at even the mention of a shot.
The best thing I've found is to close your eyes. If you don't see it then you don't have to think about it.
Think about the Slurpee you'll get at the 7-11 on the way home!
The best thing I've found is to close your eyes.
I think this varies a lot for people. I find it hurts a lot less if I watch. While I'm watching, I use some Jedi mind trick on myself to convince myself that what I'm feeling is not pain, just a signal from the nerves to the brain that I can safely ignore in this case. Works surprisingly well for me.
If I don't watch, then it comes as more of a surprise and it is much harder to get my thought ducks in a row.
I donated bone marrow stem cells a few years ago. Talk about needles galore!
First there were the daily injections of filgrastim. One in each arm, for five days. They were "only" subcutaneous, but they stung like a son-of-a-bitch.
Then came the really fun part. Like one of the other commenters, I have crappy veins. I mean really crappy veins. When I was being screened for the procedure, the IV tech took one look at my arms and said, "You're going to need a central line."
Oh, joy.
Scalpel, when you inject lidocaine to numb an area, do you do it all at once, or do you inject a little, wait for the area to go numb, then advance the needle and inject some more? The interventional radiologist who put in my internal jugular line favored the former approach, and it felt like he was jamming the needle straight through my neck. (Any of you remember the scene in Terminator 2 when Linda Hamilton took a hostage by jamming a syringe of Windex in his neck? 'Nuff said.)
After that it was smooth sailing, though, and I'm really glad I did it. I even joked with the radiologist that I hoped he was better at doing central lines than I was as a resident! :-)
Welcome to my world. On good days I'm able to take the fearful patient in stride. Sometimes it's a little tougher.
I use 30 gauge needles for almost everything but a mandibular block. Mosquito bites hurt more than that.
I agree, kids can be the toughest hombres out there... and the IVDA's are the ABSOLUTE WORST. Why do they hate needles so much? Perhaps if they were muscling the lidocaine they would feel more at home.. Me, well I will just stick to doing my own dental procedures when needed. I don't mind sharp objects in the least! :)
I'm with you on the toe--I had a deep cut on my big toe, and the block was a serious owie. I like the scissors story though--gotta love swiss army knives...
It has all been a cakewalk compared to all the ABGs I had drawn on me during an acute illness back in the 1990s. Man those hurt! (But I sure didn't move!)
Long time lurker here...love your blog! Maybe this one is a little different--I cannot stop LAUGHING when I get needles or blood drawn. At least it gets everyone else in the room laughing too, so I guess it's good for something!
when in gard school I had no dental insurance. I also had five cavities in the front too teeth. Turned out these are ideal dental exam cavities. I got to be the board exam student for six different dentists at U Mich. Two shots in the top of my mouth and one in my gums, fill a cavity, then repeat-six times! that was over thrity shots in my mouth in one weekend.
My husband is a tatoos artist and he doesn't like the jumpers> it makes for crappy tattoos. i guess the worst are the girls who want ankle or foot tattoos where there is no fat. ouch.
As someone who has a strong vasovagal reflex and fibromyalgia, I can tell you that stereotyping your patients really doesn't help.
I've lost consciousness at the mere mention of a blood draw, and after a severe MRSA infection with 3 major and over a dozen minor surgical procedures, and the hundreds (literally) of shots and blood draws related to that, I can tell you it is not something you can just get over.
So please docs, the callous behaviour against patients with strong reactions to needles helps no one. Giving patients like us a few moments to mentally prepare, allowing us to lie down beforehand, etc. would be a much more effective course of action.
As someone who has a strong vasovagal reflex and fibromyalgia, I can tell you that stereotyping your patients really doesn't help.
I've lost consciousness at the mere mention of a blood draw, and after a severe MRSA infection with 3 major and over a dozen minor surgical procedures, and the hundreds (literally) of shots and blood draws related to that, I can tell you it is not something you can just get over.
So please docs, the callous behaviour against patients with strong reactions to needles helps no one. Giving patients like us a few moments to mentally prepare, allowing us to lie down beforehand, etc. would be a much more effective course of action.
As someone who has a strong vasovagal reflex and fibromyalgia, I can tell you that stereotyping your patients really doesn't help.
I've lost consciousness at the mere mention of a blood draw, and after a severe MRSA infection with 3 major and over a dozen minor surgical procedures, and the hundreds (literally) of shots and blood draws related to that, I can tell you it is not something you can just get over.
So please docs, the callous behaviour against patients with strong reactions to needles helps no one. Giving patients like us a few moments to mentally prepare, allowing us to lie down beforehand, etc. would be a much more effective course of action.
As someone who has a strong vasovagal reflex and fibromyalgia, I can tell you that stereotyping your patients really doesn't help.
I've lost consciousness at the mere mention of a blood draw, and after a severe MRSA infection with 3 major and over a dozen minor surgical procedures, and the hundreds (literally) of shots and blood draws related to that, I can tell you it is not something you can just get over.
So please docs, the callous behaviour against patients with strong reactions to needles helps no one. Giving patients like us a few moments to mentally prepare, allowing us to lie down beforehand, etc. would be a much more effective course of action.
You're great, Scalpel. My favorite--the guy who came to urgent care with a little laceration who FREAKED about the needle--he was COVERED in tattoos. I think that's the first time I've actually laughed out loud uncontrollably when someone told me they're afraid of needles.
Similar to the guy who got woozy watching me put eyedrops in his girlfriend's eye, telling me it was because he can't stand pain. He was not only covered in tatts, but also had those huge disk things in his earlobes. WTF? I was getting woozy looking at his freaky ears.
The fibro patients are beating their "compassion" drum again.
Lidocaine is freaking painful! The lidocaine shot in my, no-longer, private parts to sew up a second degree tear hurt way, WAY more then actually birthing the baby without any medications. The only reason I was able to hold still for it was my overwhelming fear of where the needle would end up if I did jerk!
Lidocaine hurts? I didn't know that.
I've only had it a few times. The most recent after 1.5 hours of trying to get an IV going, the nurses used lidocaine to...uh...relax the veins? Something like that.
I mean it pinched. And burned. But I've had worse.
The worst needle stick I can remember was an antibiotic shot. The nurse said I could take it in the ass like most people or in the arm. I was in the middle of infertility treatments at the time and tired of taking off my clothes for strangers, so I chose the arm thinking it would leave at least one doctor in the county who had not seen my bits. Big mistake. I didn't move my arm for two days. The shot felt like a bullet and I actually had chills.
The moral, always take it in the ass!
M
I used to always draw the brand-new corpsman with the big needle. I'm milk pale, with big ol' blue veins right up under the skin. There should be no reason to have to stab me again and again. I grew into my dislike of needles quite naturally.
Worst ER experience was during my second ER trip for my miscarriage (yeah, I didn't like going in twice in as many days either). Not only did the gal who stabbed me do a shitty job of it, but she bragged about how GOOD a job she'd done. "I got you in one!" Yeah. One jab, and two minutes of fishing around in my arm with the needle, trying to find a vein. I think I'd prefer multiple jabs over that 'technique.'
For those hard IV's nothing works better then a little Lido and a bedside sono...
Anonymous 11:11:00:
I have 2 tattoos; small paw prints but all the same they're tattoos. While the outline stung quite a bit, I never felt the coloring since they use more needles.
Getting a tattoo is different than getting a blood test. I can't explain why, but it is. Was I nervous? Hell ya. But not nearly as nervous about it as I am with blood tests or vaccinations.
Even with these tattoos (which I just got in May), I still cannot face a regular needle. There is just something different in the experiences.
A tattoo is different - I wish I knew what was so different - but it is.
It's like someone who's afraid of heights being okay to go 60 stories up in an elevator. Or to parachute.
I know exactly when my phobia of needles hit, I just don't know how to conquer that fear. I thought getting tattoos would squash it - but it didn't. Even my PCP thought that it, while extreme, was cheaper than therapy and might work. But it didn't.
So, just because your patient who is scared of needles while being covered in tattoos may seem ass backwards - it's not. It's just the way some things are.
I am not a fibro patient. Nor a chronic pain patient or anything. I don't go to the doctor or dentist unless things are dire and a lot of it has to do with my fear that I'll be sent for blood work.
One jab, and two minutes of fishing around in my arm with the needle
GARRRRRRRRRH, I HATE DIGGERS.
I teach my students NOT to do that...but then some nurse does it in front of them and they're taught bad habits.
Then of course, they get in the ambulance and realize that they don't have time to dig, that they need to learn how to get it first stick.
Then all is good.
So please docs, the callous behaviour against patients with strong reactions to needles helps no one. Giving patients like us a few moments to mentally prepare, allowing us to lie down beforehand, etc. would be a much more effective course of action.
Obviously didn't read the post.
Actually, I did read the post, and I wasn't referring to Scalpel per se, as he obviously gives patients some consideration, but more to all of the other docs who won't pay attention.
I once warned a doctor about my vasovagal reflex. He ignored my request for a table to lie down before a shot. When I passed out during the shot, I fell off the chair, hit my head, and spent the next 20 hours in an ER over a possible concussion. Because the doc thought he knew better than I how I "should" react to the shot.
This isn't about over-reacting, its about a physiological response that the patient has no control over except to warn the doctor about it beforehand.
I'm just having trouble finding a dentist that can understand that I don't mind the needles; put a damn maple syrup tap in my neck if you gotta, but make sure I can't feel a frickin' thing in my mouth before you start poking at my teeth.
I had some wisdom teeth removed last week and the numbing shots hurt so badly. I did in fact whine and tear up, but I didn't jerk and I apologized afterwards. I can get a shot or have blood taken just fine, but damn...dental work hurts a lot.
I used to work as a phlebotomist on the side. The hospital was a huge one with all of the specialty services. The psychiatric department was the most interesting place to draw blood. Children would lie there and not even move, since many of them had experienced so much abuse they appeared to have learned to just shut down any pain. The adults in the psychiatric department were behaving as you would expect the youngest kids to behave. Screaming, carrying on, making the whole process harder on them than it needed to be. A Through the Looking-Glass kind of experience.
My little sister had a condition that required weekly finger-prick blood tests. She was 4, but the nurses ADORED her because they would enter the room, ask what finger she wanted them to stick, get the blood, band-aid on prick, then walk out. Rarely any tears invovled.
They gave her lots of stickers as a reward. =)
I understand being scared of needles, but I simply look away and try to focus on something else. I might pass out at the sight of my own blood though. (I can handle eveyone's elses blood and guts, just not my own!)
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