“Okay Mr. X, little poke… “
[Mr. X is beginning to not-so-subtly pull his hand away from me]
“Shoot. Okay…just a few more minutes….”
The above scenario lasted in fact only one more minute, and that is only because Person A (me) finally called it and relinquished the task of placing Mr. X’s IV to my (much) more experienced nursing colleague. And though Mr. X was exceedingly gracious and understanding of the “learning curve” throughout the affair, I couldn’t really begrudge his small sigh of relief as I passed the needle off to the more advanced learner/master. After all, there is only so much “I’ll-be-your-pincushion-in-the-name-of-the-future-of-medicine” that one person can take.
As you may have gathered from the above montage, I am now in the process of learning how to place IVs (short for IntraVenous lines), which are tubes that feed directly into the lower-pressure side of your circulatory system. I have been granted this amazing opportunity through the Anesthesiology Interest Group’s Student IV Placement Program, in which second-year medical students are trained by several staff Anesthesiologists to place lines which allow medical providers to quickly administer medications, fluids, draw blood samples, etc. We begin our training by practicing on mannequins before graduating to each other, and finally are deemed qualified to work with real, live, patients awaiting surgery in the PACU [this acronym actually has several possible meanings but in this case Peri (surrounding) Anesthesia Care Unit]. Now about four months in, I can say with certainty that this experience ranks among the most fun, the most frustrating, and above all the most humbling of med school to date. In short, awesome.
So, what am I actually doing? Well, every two weeks I set my alarm a few hours earlier than my normal early wake up time and join the throngs of scrubbed-out (code for getting to wear those official-looking blue medical uniforms) people making their way up or down the darkened streets of Marquam Hill into the brightly-lit building of OHSU hospital. Once there I stash my backpack (a dead-giveaway that I am in fact still a student, and even worse, a preclinical student) in the least obtrusive corner I can find and take a quick lap of the unit to see what’s going on that morning. I say hello to the staff, who I imagine recognize me as “that med student who’s here sometimes” (Or maybe, hopefully, Rachel). I load up my short white coat pockets with tourniquets, tape, IV needles, sterile gauze, and some cleaning pads (gauze soaked in alcohol). And then…I get started. After getting clearance from the supervising nurse I introduce myself to the patient. I explain my role on the “team” (with special emphasis on student
to ensure complete transparency), obtain their consent for placing the IV, and then smile extra big to hide/reveal my nervousness as I pull on my gloves.
One of the most interesting/frustrating things about placing IV’s is how hit-or-miss (literally) this skill still seems to me. I have reviewed my anatomy ad nauseum. I have a checklist of sequential steps that I follow every time: Lay out all of my equipment, check to ensure fluids are running smoothly through the tubing, chat with the patient to make sure he or she is as comfortable as possible, adjust the bed/arm/stool position, etc. But at some point you just have to do it and here is where the margin of variable success is still frustratingly large. The look of the vein isn’t always a reliable predictor either. Just this week I missed a vein that was popping out like one of those plasticized vessels at Body Worlds. Immediately afterwards I successfully slid a line into a wispy little whip of a vein on the back of my patient’s hand. It defies logic! And as someone who appreciates and relies on logic, this challenges me. But, it also makes me ridiculously, indescribably happy. Maybe because this experience, though just as often maddening as exhilarating, makes me feel like I have arrived in some small way. That and my shiny blue scrubs…so what if I have to give them back immediately afterwards?
A final note of appreciation for the patients I get to work with. And not just my patients, all patients who come to teaching hospitals with the understanding and tolerance that learners will be part of their management team, and that in the name of said learning things don’t always go perfectly. Delays are going to be had and extra pokes will sometimes be inevitable. I am amazed by the grace and encouragement most of these patients reserve for us – many of them even go so far as to reassure me in a parental, pat-my-arm way after yet another fail and remind me to “keep at it, you’ll get there.” For this, I offer my sincerest thanks. And a promise that I will stick to my two-attempt policy when it comes to sharp needles and your arm.