she is curled on her side like a child —
eyes closed, back exposed.
the contractures in her legs
make the angle a challenge,
but she grips the bed rail hard,
pulls her knees to her chest
and unfurls her vertebrae
for me.
this is not her first lumbar puncture,
but it is mine.
under my attending’s watchful eye,
i map the topography of her back
with gloved hands,
finding peaks in spinous processes
and nestling my thumbs
into the valleys of her spine.
i mark the L4 space, sterilize my field,
give lidocaine, uncap the spinal needle.
place it,
(hope she is numb)
break skin,
advance.
i remove the needle every millimeter
or so to check for blood
drip, drip, dripping from the catheter.
there’s none.
“atraumatic,” i think,
looking at her tight grip on the bed rail
wondering if that’s true,
and advance.
it’s not right. she hisses in pain.
i’ve hit bone.
pull out
and try again.
“breathe. you’re doing fine,” says my attending,
to me, or to the patient, or to us both.
this time the needle glides through skin, fascia, muscles
and pops cleanly through the ligament
that protects her spine.
ligamentum flavum feels chalky,
and i move slowly,
infinitesimally.
another millimeter, no blood.
i picture her nerves like live wires
sparking just distal to my needle tip.
another millimeter. and another.
her vertebrae like calcified boulders
guarding the edges of my narrow path.
another millimeter, and another, and another,
and eventually, i’m in.
when i remove the needle,
there is a perfect drop
of clear cerebrospinal fluid
drip, drip, dripping
from the mouth of the catheter.
“i’m in,” i tell my attending. he responds by catching
the first perfect drop
into a vial.
more drops follow —
a steady stream of liquid diamonds
drip, drip, dripping
from the mouth of the catheter.
once this vial is full we will label it
and call it a specimen.
i will take it to the lab myself
for testing and analysis and distilling
into data.
tomorrow on rounds i will present,
“0 RBC 0 WBC normal glucose normal protein,”
and propose a plan
that will be mostly right,
and my attending will ask me questions,
and i will know some of the answers.
but for now i am breathless,
watching the body spill its secrets
openly,
vulnerably,
into the world,
just because i asked it to.
Image credit: Champagne (CC BY-SA 2.0) by Markfive
Poetry Thursdays is an initiative that highlights poems by medical students. If you are interested in contributing or would like to learn more, please contact our editors.
Contributing Writer
University of Pennsylvania School of Medicine
Julia is a third year medical student at the Perelman School of Medicine at the University of Pennsylvania. She graduated from Georgetown University in 2020 with a major in Health Care Policy. She loves curating oddly specific Spotify playlists, going to concerts, and keeping up her NYT crossword puzzle streak. Julia hopes to pursue a career in surgery.