From the messy desk of a procrastinating med student

Wednesday, April 19, 2006

This won't hurt a bit*


After finishing my exams about a week ago in an over-caffeinated buzz, I was rostered straight on to a stint in a hospital ward to complete what the university calls a 'Nursing Attachment'.

The nurses in the teaching hospital must have some great advocates or negotiators, as they have managed to insist that all medical students complete a full week assigned to a registered nurse. The idea is that future doctors graduate with a good understanding and respect for the important work nurses do. After all, nurses really perform much of the work that makes the wheels of the hospital keep turning. They interpret, implement and improve the plans formulated by doctors. Provide meds. Provide comfort. Hand holding. Clean up poo. Wee. Blood. Tears.

The nurses enabled me to get involved in a lot of procedures I had never done before. I took blood, did ECGs, sorted out drips, administered antibiotics intravenously and even (I'm really excited about this, but you probably won't be unless you're a med student..) took an arterial blood gas.

You see, usually blood is taken out of a vein, which is a low pressure system. But to get a picture of the gases in the blood (eg oxygen, co2) you need to take blood from an artery, which is of the high pressure, spurty variety. The intern caught my attention and asked if I had ever seen one done before. I said 'no', so I watched and he talked me through it. Two minutes later he pulled me aside.

"Your turn."

(I gulp, and weirdly, my feet start sweating)

So the intern walks up to the next patient and says, here's Lish, she's a student doctor. She's going to take your arterial blood gas. Patient turns grey and looks worried (potentially looking at my ashen face).

"Don't worry," says the intern. "She's a good student, she won't hurt you."

Well, glad the intern was sounding confident. I opened my mouth to say something reassuring but only managed a feeble wincy smile. If I was the patient I would have grabbed my drip and run full pace and bare bummed down the corridor, the open blue stripy hospital gown flapping behind me.

Lucky for me, not him, he had a dreadful lung condition that prevented a speedy exit.

So, just as I had seen minutes earlier, after a needle of local anaesthetic, I gently felt the bounding (terrified) pulse in the poor man's wrist. And, with all the courage I could find, shoved the needle where I guessed the artery was, and there it came, first time. A vial full of bright red arterial blood.

I don't know who looked most surprised: the patient, me, or the intern!

I gave a little involuntary skip for joy as I left the patient's bedside. And my feet continued to sweat for an hour afterwards.

The problem with the profession of medicine is that, no matter what lecture theatre-type training you receive, there is nothing that can prepare you for the first time you do a new procedure on a real patient.

The 'nursing attachment' was worthwhile. Apart from all the hands-on skills I learnt, I did gain an appreciation for the hard work of nurses, their skill and dedication, their completion of nasty, dirty tasks, and the warmth and comfort they give patients at a time in their lives that they most need it.

The only thing I would change would be to enforce a 'Doctor's Attachment' for nurses. I could have smacked the nurses for their constant doctor bagging.

Because of the hierarchical system of health care, nurses are not privy to a lot of the deliberating and difficult decisions doctors make. They are often not told reasons for decisions. So nurses assume that the decisions that are made by doctors are not carefully thought out. Then they bitch. Endlessly.

Medics are making an effort to understand nurses. Why can't the courtesy apply the other way?

*No, that is not me in the picture. My legs are nicer. And I wouldn't be waving the thermometer around aimlessly like that. I'm am a med student after all: I understand that thermometers belong in orifices.


Anonymous Rita Martinez said...

I know what you mean... I was soooo excited the first time I sutured a patient :D...It was a tiny cut but still. And the guy knew it was probably my first time but he still thanked me and smiled when I finished.

8:39 AM GMT+9:30

Blogger Lish said...

Welcome to Watch One, Do One, Teach One, Rita!

I've only ever sutured on a dead pig's trotter. It didn't smile and thank me but it didn't cry either!

8:39 AM GMT+9:30

Blogger Rita Martinez said...

WEll hey there! Glad to read your blog :D
lol!! Well when I took the course They made us practice on "dead pig trotters", but at the end of the course we had to apply our knowledge volunteering at a random Hospital, 8 hours. Four hours one saturday and the other four the next one. I only sutured 2 guys. The first one on the knee, and the second one on his head. Yeah that second one really put a knot in my stomach I was so nervous but in the end it all turned out ok. :P

10:58 AM GMT+9:30

Anonymous Marinus said...

I loved the description of the picture and thermometers!

I learnt to suture on a piece of sterifoam dressing after seeing the real thing being done. Then I had to suture a scalp laceration five minutes later!

Now, to teach one... :-P

3:07 PM GMT+9:30

Blogger Luke said...

Um... the *legs are better* comment?
Sounds an empirical statement.
We are now proponents of evidence based medicine, I believe. Any evidence? ;)

10:10 AM GMT+9:30

Blogger Lish said...

Hey Luke


No RCTs but some anecdotal evidence in terms of a few favourable comments at the pub last night ;)

But there may have been a slight beer-goggle bias.

4:02 PM GMT+9:30

Blogger Shazam! said...

THe nursing attachment is a great idea, I advocated for that while I was a medical student. Our school didn't have such a thing.

11:38 AM GMT+9:30


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