He was also given to screaming and squirming during arthrocentesis but at least he never pushed me. His arthritic knees frequently needed to be drained, and although the procedure didn’t hurt him physically, (a little local anesthetic works wonders), imagining a needle in his knee caused him intense mental suffering. I usually tried to put visual imagery to work for him by asking him to imagine he was someplace pleasant, but I didn’t have much success.
On one occasion, while drawing multiple vials of synovial fluid from his knee, I stopped working because he was moaning and groaning and squirming. I left the needle in his knee and asked, "Am I hurting you?"
He seemed surprised by the question. "No, Doc, why do you ask?"
"Oh, I don’t know – just curious I guess."
One of my few fond memories of internship was an exhortation from my resident: "No procedure should hurt." I always think of this lofty goal when I glove up for a procedure. Sometimes we fall short of the mark, but our professional pride always leads us to stretch the truth a bit and conclude our procedure note with the standard phrase, "The patient tolerated the procedure well." In some circumstances, the patient tolerated the procedure better than the doctor did.
This column, "Inside Rheum," regularly appears in Rheumatology News, an Elsevier publication. Dr. Greenbaum is a rheumatologist who practices in Greenwood, Ind. E-mail him.