Patients are called that for a reason

June 24, 2012

We didn’t wear gloves when I was a student

My medical training was traditional. None of this modern PBL (problem based learning) for us. No integration of pre-clinical and clinical. . Rote learning for two years then on to the wards to try to make sense of it all. It was a shock to the system to go from standard student life (albeit highly timetabled compared to todays lazy arse Arts students) to the clinical years where we had only four weeks holiday a year. We still got Wednesday afternoons off for sport, but basically we were on the wards before patients’ breakfast to take bloods and would be there till routine ward business finished around 5 or 6 ish. It was one of the student duties to do all the blood taking.

So before we were let loose on the patients we had a session being taught how to take blood. As with all medical training it was a case of ” see one, do one, teach one.”. We all watched the doctor quickly and easily extract about 10ml of blood from one of my fellow students.  It was over in a flash. We all then had to do it to each other. It was hardly brain surgery, but surprising how much of a performance it became. Working in pairs we are all looking over our shoulders seeing what others are doing. Are we doing it in the right order? Is that a vein? How do I know it’s not an artery? How do I open the needle to attach it to the syringe? How tight do I make the tourniquet? (Tight enough to stop the flow of venous blood, but not so tight it stops arterial – that way the  veins below the tourniquet will get full of blood as the tourniquet stops it going any further – a bit like a dam) . Questions questions. We are asking each other and ourselves, not the doctor of course. That would be cheating. And it’s only each other we are stabbing repeatedly, unable to find the enormous veins that inhabit the antecubital fossa (elbow). Of course we eventually all do take a sample successfully and the next day are let loose on patients.

This of course is an entirely different kettle of fish. We turn up on the wards and the Houseman (most junior doctor, just qualified) gives us a huge wad of forms. “You need to get these done” he says.”And there’s another load in the nurses station .” We divvy them up between us and set off to find the equipment we need from the treatment room. Each different blood test requires a specific bottle for the blood to go in. It is critical to get the right bottles for the right tests. Some bottles have special anti-clotting agents in, others have chelating agents and all are different colours to ensure easy identification, and different sizes as they require differing amounts of blood. Each bottle has to be labelled with the patient’s name, number date of birth, ward etc. If you are lucky there will be stickers with this info on in the notes. Otherwise it means writing them all by hand.

Approaching the first patient I was incredibly nervous. I had my bottles, syringe, needle, swab and cotton wool ball in a small tray and my tourniquet in my pocket.  I had worked out how many ml of blood I was going to need to do all the tests and was praying it was going to be OK. The patient  was a lovely old man who was wearing  pastel striped pyjamas. I remember his thin wrists were poking out.

I pulled up his sleeve and put the tourniquet on. He had blood vessels like ropes along his arms. My heart was hammering as I tore open the alcohol swab and cleaned the skin. I opened the needle  and attached it to the 20ml syringe. I felt his arm and found the brachial artery easily. I needed to avoid that. Next to it I could feel the fullness of a decent sized vein. With shaking hands I held his arm flat with my left hand and inserted the needle at about a 30′ angle to the skin. His skin was paper thin and there was no resistance. I pulled back the plunger on the syringe and hey presto blood appeared in the barrel. Phew!

I then had to continue to pull the plunger back and keep the needle in the vein. It’s not as easy as it sounds or looks. Especially if your hands are shaking. I had got about 5 ml of blood in when I inadvertently pulled the needle out of the vein. Blood oozed out of the hole. I couldn’t simply stick my needle back in because I couldn’t see where to put it. The blood was coming out at a fair lick. I didn’t know what to do so tried using the cotton wool ball to press on it. It soaked through the ball in no time. I asked the patient to press the sodden ball to try to stem the bleeding whilst I went to get some swabs or anything that would soak up the blood.

I came back and the blood was streaming down his arm. He was unperterbed and so nice to me. I got a handful of swabs and pressed as hard as I could. I got him to bend his arm up in an effort to stem the flow. After a couple of minutes I unbent his arm only for the blood to start pouring again. “I’m so sorry” I kept saying, having no real idea what to do next. I thought perhaps he had a clotting disorder and I should have read up about him in the notes before I started.

Just then one of my fellow students walked past and I beckoned her over with a scared rabbit expression. “He won’t stop bleeding” I hissed. She came closer. “Perhaps you should take the touniquet off ?”.

Poor man. I took it off and of course the blood was able to flow back to the heart instead of building up an increasing  head of pressure with its only release being to pour out of him, and so the bleeding stopped within a minute or so. And like so many patients he was so utterly charming and forgiving he let me attack his other arm as I hadn’t even managed to get the blood we needed for his tests.


8 Responses to “Patients are called that for a reason”

  1. Michaela Vogt Says:

    I am so glad I decided to be a vet. My patients bite and cratch,you always need someone with a firm grip to hold them, but they never complain, if you do not hit the vein. You just have to get rid of the owners….! So I started my ” first experiments” at a vet hospital during my studies.

  2. Natalie Says:

    lazy arts students?! I’ll have you know having 8 hours a week is extremely stressful…..
    But great blog- always well written and this one made me squirm! Keep it up xxx

    • hahaha. Wondered if anyone would notice that throwaway dig! Yes, tbh I don’t think I could have done an arts degree – being left to my own devices would have meant doing absoultely no work. At least this way we were spoon fed what we needed to know.

  3. Lorna Kyle Says:

    I LOVE these insights into your training. I’m taking notes so that next time I visit my doctor I can speak on equal terms rather than my forelock tugging ‘that you sir’ attitude at the moment.I remember going to have blood taken at those early stages of pregnancy. I was ushered into the ‘blood’ nurse who sat in a windowless cupboard in Ealing Hospital. ‘O, I remember you,a bit of a bleeder’ she said.I’ve had 4 pregnancies,2 years inbetween each one. I felt quite proud that the blood splattered wall was solely down to me.
    I feel your blog Sarah,is a screenplay in the making. I love it.

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