Obturator

Caveat:  the following entry contains some medical information.  Those who are squeamish may need to tread lightly.  There will be some euphemisms used for the sake of preservation of modesty.

The cortisone shot for Herself's hip was scheduled for this past Friday.  She was not at all happy about the situation. 

As you may remember, Herself has a medical history that is slightly colorful, requiring various surgical or otherwise invasive medical procedures periodically throughout her adult life.  She has always tried to be matter-of-fact, and has put on her brave face and marched through.  She has done what has needed to be done.

The recent years of relative good health have yielded a blessed respite from significant medical procedures.  Rather than attenuating the negative feelings that Herself associates with past events, though, time has caused the emotions -- apprehension, helplessness, worry, loneliness -- to solidify together with the memories of pain into a small, distinct, and definitive nugget of Fear.  

It is an ugly little monstrosity, the Fear. No amount of rational thought can quiet it.  It generates flashbacks to the cold of the operating room, the too-bright lights, the bustling masked strangers arranging Herself's body as if she were a mannequin, the voice of the unseen person behind her head announcing quietly, "I'm going to give you the sedative/anesthetic now" followed by the unbidden and automatic attempt to remain awake and lucid, even as the room turned to silent glass and disappeared.

The Fear perched unobtrusively in the corner while Herself solicited information and reassurance from other individuals who had undergone cortisone shots previously.  She was comforted a bit, although she still had that fidgety nervousness that accompanies the knowledge that an IV will be required.  Then, late Thursday afternoon, she was compiling the documentation she would need for the procedure -- insurance card, picture ID, directions to the location, and the slip of paper with the doctor's orders written upon it.  She read the orders.  They said:

Right obturator nerve block.

Nerve block?  That didn't seem right.  Why would the standard cortisone shot that the orthopedist had suggested would be helpful be called a nerve block?

She did a bit of online research.  All that she could gather was that the procedure on the orders appeared to be very different from the one she was expecting.  What did that mean? She did not know.  The orthopedist had provided her with practically no information on what would be transpiring. She would have to ask the pain management doctor when she arrived at the outpatient clinic in the morning.

The Fear, unspeaking, stepped out of its corner and sat tauntingly in the middle of the room.

She did her best to ignore it for the evening.  A twilight constitutional with comforting companionship alleviated her worry somewhat; however, she lay awake that night until past 2 AM, watching the Fear as it watched her back.  Who would blink first?

The morning of the procedure, Herself did her very best to maintain her composure.  It was difficult.  The Fear loomed like a boulder, blocking her view of the mountain trail.  She knew that she must get past it to continue on the path, but she could not see the other side, and she was afraid.

When they called her name, she explained to the intake nurse that she had several questions for the doctor and would like to speak to him before she was prepped for the procedure.  The nurse looked surprised and alarmed and stood there agog, holding the hospital gown intended for Herself.  Not wanting to be labeled as a difficult patient, Herself stated that she would be happy to change into the gown, but requested that she speak to the doctor before the IV was put in place. She might have cried just a tiny bit.  She might have hated herself for losing her composure.  Nevertheless, the nurse sent another person off to inform the doctor that Herself had questions, and handed Herself the gown.  "Everything off except your underpants," she advised. 

Herself was oddly reassured by the fact that she could keep on her underpants.  (She had wondered about this particular aspect of the procedure for quite some time. Usually the medical events have required nakedness under the gown, and given the proximity of the problem area of her hip to her groin, she anticipated that she might have to go bare again.  She had tidied the topiary of the area accordingly in anticipation, sadly contemplating how many total strangers have seen her foliage over the years in all the medical arenas.)  She dutifully put on the gown, and was installed in the intake-and-paperwork cubicle to await the doctor. 

The pain management doctor, Dr. V, arrived shortly thereafter.  What a shocking breath of fresh air was Dr. V.  He was cheerful, soothing, calm, patient.  He listened to all of Herself's questions. He explained the difference between what is typically called a "cortisone shot" and what would be used on Herself, and used technical terms when Herself let him know she has a scientific background. They went over the fact that what had been previously suspected to be hip flexor tendonitis might not, in fact, be tendonitis, but something else, and they acknowledged the difficulties associated with diagnosis in the pelvic and hip region given the vast array of muscles, tendons, organs, and nerves in the area.  The purpose of the prescribed nerve block was two-fold:  not only to treat an inflammation associated with a particular nerve (the most likely cause of the problem, given the history of the symptoms she had been experiencing), but also, to confirm a diagnosis.  If the injection did in fact resolve the pain, that would indicate that the problem had been affirmatively identified.

So marvelously wonderful to be spoken to by a doctor in an intelligent, conversational manner.  Herself was reassured not only by Dr. V, but by the scientific and biological facts they had discussed.  The Fear retreated, dejected, to the shadows, while Herself submitted to the IV. 

The procedure itself went well.  The sedative worked its magic, and Herself does not remember any of the finer points of the injections.  (She was later a tiny bit mortified, though not terribly surprised, to discover a small bandage at a site where they had angled one of the injections into the area. The bandage was rather adjacent -- even overlapping -- just a bit with the shrubbery.  Alas. At least she was not awake for that particular indignity. She idly wondered afterwards whether she should consider further deforestation should a repeat of the procedure be necessary. Perhaps.)

There were no untoward effects from the procedure, other than a rather odd limp that is dissipating with time and a quarter-sized bruise on the back of her hand from the IV.  We shall see whether the obturator nerve block has the desired long-term effect. We are ever hopeful. We know, too, that this particular procedure is Not So Bad, and that the Fear has been banished, at least temporarily.  We are glad to see it go.