Selective Nerve Root Block—I should have walked away

(1995, age 48)

I have learned to avoid hospitals. There are just too many chances for error, and though a lot of good people do a lot of good work, there are exceptions. Here is a writeup I did after an experience at a local hospital:

I completed a Selective Nerve Root Block procedure a few days ago. My next appointment with the neurosurgeon who sent me for the procedure is still a month away. I’ll write down what happened during the procedure now so I’ll be able to answer questions when I’m asked later.

I showed up for my appointment and checked in at the desk. The waiting room was full. I watched each patient ahead of me get called, and then every patient who came in after me. Eventually the room was empty except for me. It was well after my appointed time, and no patients were being called. Finally, I overheard the desk clerk phone in and ask if they knew there still was a patient in the waiting area. It’s as if I wasn’t expected.

A medical assistant eventually came to get me and took me to a storage room that had been converted to an operating room. He explained I should wait while he found the doctor but that he wasn’t sure where the doctor was and that it might take a while. I pondered the contents of an uncovered wastebasket next to the operating table where surgical masks and other byproducts of earlier procedures were piled high while I waited.

I also noticed a form someone filled out about the procedure sitting on the operating table. I noticed that it indicated that they had called me on a particular date and time with instructions about the procedure. That call had never been received and that information on the form apparently was bogus. I wondered how much of the other information on the form was also made up.

A doctor eventually showed up, but it wasn’t the doctor I was told would do the procedure. He seemed very much in a hurry, and I even told him his haste made me nervous. He looked at my MRI films by holding them up to a ceiling flourescent light as there was no light box in the room. He wondered aloud which nerve was the intended target. I thought for sure that my neurosurgeon would have specified a particular target for the nerve root block. Then I was asked briefly about my symptoms and he decided what he would do. He made a comment that sometimes it’s the nerve below that gets the injection and I didn’t understand that—the word “sometimes” implied he had discretion and I really thought he would have had specific instructions.

He explained the procedure to me. As he explained what he would be injecting, the medical assistant commented that he had brought something else, something other than what the doctor was saying he would inject. Then they had a private discussion I did not hear and the assistant left the room.

I took my place on the table under the C-Arm fluoroscope and the procedure started. The doctor asked for a larger lateral area to be prepared for the SNRB. I got the feeling that the assistant wasn’t sure what that meant, since he prepared me just as I had been prepared for the previous three epidural steroid injections, without extending the pattern to the left as it should have been for a nerve root block.

During the procedure, several things happened that were disturbing.

I never imagined how many times the C-Arm would have to be adjusted. To distract myself from the procedure, I counted how many times the doctor instructed a repositioning of the fluoroscope—but I stopped counting at twenty times. Many of these were re-adjustments: he would ask for one thing, the assistant would move it somewhere else, he would say no not there and it would be moved again and again. As a patient in significant discomfort during the procedure it would have been nice to have an assistant who knew the procedure well enough to fly the C-Arm more efficiently and quickly.

I was not sure the doctor who had spoken to me and who was now threading a needle into my lower back was supposed to do the procedure at all. After working the needle in quite far, there were several intercom pages for the doctor I was told was supposed to do the procedure. When he did show up, his comment was something to the effect of “Well, you already are in there and only you know where you are so you might as well go on.” The first doctor continued and I never heard the other doctor’s voice again.

During the procedure I was told to expect to feel the same pain in my leg that I normally had. only perhaps sharper. That would mean they are near the correct nerve. I still don’t know which nerve he had chosen to block, and with all the C-Arm adjustments, I wonder if anyone knew. I didn’t care, though, I just was hoping that as he approached the nerve I would feel a heightened sensation of the pain in my left leg to verify the SNRB was in the right place.

Unfortunately, that never happened. I hoped that it would, and I hoped the injection would bring relief, even if for a few hours, so we would at least know which nerve was causing the pain. I never felt the tell- tale increase of pain down my leg during the procedure, and after the procedure in recovery I became discouraged as there was no change at all in the pain pattern I had felt before the procedure.

As the patient, I wondered if was I even expected, and did they have instructions on what to do? Would the assigned surgeon have had the same results? I think not. Did they hit the right nerve? I don’t think so, but was that because the wrong one was specified or did he just miss it?

There was a second assistant who appeared to be a trainee in the room for the procedure, and when it was all over and I was wheeled into the hall she stayed for a moment. Being a teacher, I asked her if she learned anything during the procedure. She replied “I’m just glad it wasn’t me on the table.”