My Fail

Typing this out while it’s still fresh in my mind like Beijing roast duck right out of oven then sliced in front of you and wrapped with cucumber scallions and tian jiang. So yesterday I had an elderly patient who had severe stomach pain, nausea, vomited, and also mid-back pain. Usually with those symptoms you usually think some sort of gastritis or pancreatitis. Pancreatitis is inflammation of the pancreas… that’s not fun. So to do a quick test, the doctor wanted a blood work done. Here’s how the following conversation went:

“Draw this patient’s blood.” Doctor told me
I looked at the patient’s swollen-veinless arms. “Um… don’t we usually let the lab do this?”
“It’s quicker if we do it here.”
“Um… doesn’t Anna [the nurse in the office] draw blood?”
“Anna’s out today.”
“(Damnit Anna) Alright, right this way Mrs. N.V.”

I took the patient to the back of the office and told her to sit on the blue chair for venipuncture that looked more like an electric chair. I prepped everything: the butterfly needle, two test tubes, gauze, band-aid, tourniquet, and alcohol wipe. Look for a vein. Then looked…then looked, but couldn’t find one on either arms. “I have bad veins,” she said. I knew that. I got the nurse’s assistant, to help me find a vein. She pointed to a small bump that could have been a vein… or it could be a tendon. Only one way to find out, right? Wrong. I prodded the needle into that bump hoping for the miracle flash in my syringe (if blood flashes into the chamber of the needle, it means u hit the vein). Nothing. I went deeper. Nothing. Frustrated I went a little right. Nope. Then a little left. Then more left. Then she screamed. Dejected, I took the needle out. “I can’t take this anymore, I’m going to the lab,” she said as she clenched her arm.

Today, in comes another patient for her blood work. The doctor tells Anna to draw her blood, but I tell Anna to let me do it to redeem myself. With Anna watching me, I felt much more confident this time. However, I was still nervous. I didn’t want to be 0/2 on blood draws. That’s like Shaq’s free throws. I got everything ready and inspected the patient’s arm. This patient also had very large arms, but I was able to find a nice juicy vein. Put the needle in and bam, there was my flash. Drew out two vials and bandaged the patient up in under 1 minute. Stood up and brushed my shoulders off like it was no big deal.

My Toilet

It was a long day. My roommate, MR, had worked a long shift at surgery. He kicked back and pounded down his chipotle burrito with guac, then went for a walk in the 90 degree weather outside. After his walk, he drove back to the house and blasted the A.C. in his room. It was the perfect storm. 10:00pm, he bolted to the bathroom and unleashed the chipotle monsoon. Subsequently the toilet clogged. I woke up at 4am needing to pee, one of my roommates was already up and about to shower. He told me that the toilet was clogged; still a little dazed, I whined and went back to bed. In the morning I had to pee so bad I took a water bottle and peed in it. Felt so wrong, but so good.

It’s the strangest feeling in the world when you aren’t allowed to pee. I felt almost claustrophobic. Like one of my God given rights was taken away from me. It definitely made me appreciate working toilets much more. Good thing for water bottles. Not sure what my other roommate who has to poo is going to do. Perhaps a waste basket?

My Greenness

It’s definitely been awhile since my last entry, but it’s been even longer since my last job. Technically this isn’t a “job”, it’s more like an unpaid internship, but hey, just pretend. So I’m at a family medicine clinic doing the whole 8-5 thing. I get to go in and take the patient’s history of present illness, past medical history, and even do a physical. On my first patients, I was literally shaking as I listened to their lung and cardiac sound I was so nervous and excited (I kept thinking oh boy this is happening). But I have never taken a history or done a physical unattended. Just because I have a stethoscope, they think I know what I’m doing, but the truth is… I probably couldn’t tell a murmur from a burp. The patients answer all my questions from illicit drug use (some do marijuana) to sexual history (some humped half of the east coast). I tell them to take off their clothes, they take off their clothes. I tell them to breathe, they breathe. I tell them to bend over; you get the idea. Sometimes I feel like there’s a game of deceit going on with the patients. I pretend like I’ve done something, even though I’ve never done it to show confidence, or else the patient might not let me do it (practice is crucial). For example, the other day I had to give a shot for migraines to a patient. The doctor told me to give the shot, she didn’t even ask the patient if that was ok. I had never given a shot before, but the patient didn’t know that. I had to show him I could do it. To calm myself down I went over the steps in my head. Take syringe, draw 2 ml air, then 2 ml of the ketorolac. Tap needle for bubbles, expel the air. Tell patient to expose his buttocks, alcohol swab it and go time. In a way I was glad it was in the glute because it would be harder for him to hit me if I messed up. When I went in for the kill, I didn’t go in quickly enough, so the needle penetrated the skin only slightly, then stopped. I had to jam harder to get it all the way in. That must have hurt. But he didn’t scream, or wince; he didn’t even complain. You know what he said? “Thank you.”

The very next patient, I had to give the same shot, but with the knowledge of my previous mistake etched in my mind, I gave her a flawless one. I really wanted to hi-five someone afterwards. There’s always someone you have to practice on, and then you subsequently learn from the previous experiences. Then hopefully, each time gets easier and easier. It’s just that the patients have no idea if they’re my first patient or my seventy first. For my third patient of the day, I had to give a PPD shot to test for tuberculosis. The patient was a college kid coming in for his physical and he asked me if I had given shots before. I looked him straight in the eye and said, “Plenty of times.”