I work as a nurse practitioner in a hematology/oncology department. Although my formal role is the coordinator for the hemophilia & thrombosis treatment center, I also coordinate the bone marrow clinics performed by the NPs and physician assistants in our department.

As always, prior to a diagnostic bone marrow biopsy, I provide informed consent including the reasons for the procedure as well as the risks. This particular patient was anxious, but I was not fully aware just how anxious. After prepping the area, I provided adequate local anesthesia.  I checked with the patient and tested the area to ensure that the area was indeed anesthetized locally.

When I inserted the needle, the patient screamed to the heavens! Even our social worker heard it 100 yards away. Needless to say, I was shocked by her response.

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The social worker came and immediately started relaxation exercises and guided imagery with the patient.

I did not provide any further local anesthesia. I restarted the procedure, and this time I completed it in full. I then informed the patient that I had finished. She turned to me and said, “No you didn’t. I didn’t feel anything.”

This case reminds me that diversional activities, such as guided imagery, can play an enormous role in a patient’s perception of pain. After this experience, I am much more in-tune to my patients as I assess their anxiety levels and determine whether additional strategies need to be employed. Kudos to my social worker for her continued help!

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