Medical Assistant Graduate!

Wednesday, December 31, 2008

As of Monday, December 29th I am no longer a "Student" Medical Assistant -- I am a graduated AND gainfully employed Medical Assistant!

I am over-the-moon thrilled at continuing on at the same practice I completed my externship at. I became sad at the thought of not being able to stay there because I became attached to a number of amazing patients -- and they have become attached to me, too.

With the exception of the Office Manager and the doctors (as far as I know anyway), I was the only other employee with the knowledge that there was a good possibility I would be asked to join the practice after my externship was over. I didn't even tell the patients I was working with. Even after they expressed their disappointment if I became employed elsewhere. That was tough to do, too!

Today I performed a wound care on a delightful 80-something year old woman. In the short span of three days, approximately two weeks ago, she was involved in an automobile accident (she was driving, totaled her van and received a black eye and a cut on her eyebrow) then she slipped and fell in her kitchen and scraped up both of her shins in ways you cannot begin to imagine.

I assisted the physician in removing both of her leg bandages to confirm everything was healing properly and that there was no infection present. Thanks to daily home health care, they are healing beautifully and there is currently no sign of infection.

She also scraped up one of her wrists but I cannot remember if that was from the auto accident or the slip and fall.

Today I learned another venipuncture technique -- drawing blood from a patient's foot. This patient was a retired LPN and when I entered the exam room to draw her blood she let me know right away that she was a difficult draw. She was NOT exaggerating! Her veins are teeny tiny AND could not be palpated to at least locate them -- even if we could not see them.

I hear that a lot from patients -- "I'm a difficult draw". I instantly think, inside my head of course, "I LOVE a challenge"! Nine times out of ten (in my head, of course!) I prove the patient wrong. Several times I have been either the ONLY MA in our office, or the only OTHER MA in our office do a successful draw in ONE poke.

I almost exclusively use a "butterfly" needle when drawing blood. Mostly because the needle is smaller in diameter, shorter in length and easier to manipulate if a vein "rolls" and I need to reposition it within the patient's arm.

I like the "butterfly" needle so much so that I tell my patients it's my "Magic" needle. I try to time the delivery of that information to occur just before I insert the needle into the patient's arm. As the patient ponders on how a needle could possibly be "Magic", I'm in and out of their vein.

Almost every single time I use my "Magic" needle the first thing the patient says when I've removed the needle from their arm is "That didn't hurt a bit!" I flash them a cheesy, dimpled smile and tell them "That's my "Magic" needle!"

The "Magic" needle is not the only distraction technique I employ when drawing blood. Because the "butterfly" needle is so low-profile, I come in low on the vein. Other MAs come in high on the vein.

In my humble opinion, here's the difference:

Coming in Low: Holding the "butterfly" between my thumb and first finger, I make sure that the rest of the hand (palm and three fingers) I'm holding the needle in is lightly resting on the patient's arm. Although I do this to steady my hand, I have found it is also a simple distraction for the patient. Because I have positioned the needle to be as close to parallel as possible to the arm, I allow my thumb and finger to softly drag across the patient's skin as I head for the vein. Instead of concentrating solely on the "poke" to come, they feel the warmth of my hand and the slight pressure of my fingers on their arm while they're pondering how a needle can be "Magic". :-)

Coming in High: I saw this a lot in school. It's not an "incorrect" way by any means, it is just my personal opinion that it is much more painful for the patient. Instead of resting your hands and fingers on the patient's arm, typically only the pinkie finger of the hand holding the "butterfly" makes contact with the patient's skin. The needle is typically positioned at a 20 to 30 degree angle.

A Brand New MA!

Chronicles of the escapades of a brand new MA coming soon!

Stay tuned!

Externship: Week 7

Wednesday, December 24, 2008

Week 7 of my externship flew by!

Tomorrow is the last day of my externship and today the Office Manager pulled me into her office and offered me a permanent position! She was highly complimentary of my professionalism and abilities as a Medical Assistant. She also shared with me the feedback she received from the physicians and patients and it appears I made quite an impression on everyone in the office. Boy did hearing all that feel GOOD!

A few weeks ago I had a slight problem with one of the other MAs. I was in the hallway with a patient when the other MA behaved in a very unprofessional manner toward me -- and in front of the patient. Her comments were out-of-line in general, but she definitely should not have shared them with me in front of a patient.

I stewed for a little while about the incident with the other MA and finally decided to handle it properly -- the professional way.When I noticed the other MA had finished with her patient and was alone in one of the exam rooms, I asked her if she had a minute to talk and she said yes. I stepped into the exam room, closed the door behind me and in a business-like tone of voice I let her know that she was not only completely out of line, she should never have approached me to discuss anything like that in front of a patient.

That MA met with the Office Manager to let her know of the exchange between us and not only was the office manager completely impressed with the way I handled it, she totally agreed with what I said. Much to the dismay of that MA.

During Week 7 I assisted a different MA with an ear irrigation on a patient with impacted wax. I was not yet ready to perform this procedure on my own -- and this would only have been the second time I have observed -- so I offered to assist instead. It's not that I am not confident that I can perform this procedure, I am just a tiny bit hesitant because it takes very little to puncture an eardrum.

Our patient was a very sweet and funny, average height, but very thin, elderly woman. The MA and I took turns looking into the patient's ear with the scope trying to determine the severity of the situation. Absolutely none of those peeks prepared us for what we finally extracted from her ear.

For starters, the patient had very tiny ear canals -- similar to those of a young child -- which means it took quite a bit more water than usual.The apparatus we use to squirt water into the patient's ear reminds me of a metal cookie press with a (icing) decorating tip on the end. We also use an emesis basin (a small, odd-shaped bowl you find in hospitals) to catch the water as it drains from the ear.We draw warm water into the tube, gently insert the tip and, pointing the tip toward the top of the ear canal, begin squirting water into the ear. (Pointing the tip straight into the ear canal can severely damage -- or puncture -- the eardrum.)

We were able to dislodge small particles of wax and I think we were just finishing our third tube of water when the other MA stopped to draw the fourth. As the patient raised her hand to her ear, the other MA noticed a large object sitting right at the opening of the patient's ear canal and prevented her from touching it.The MA picked up a currette (tool) from the counter to scoop the object out of the patient's ear. Instead of successfully scooping it from the patient's ear it flopped out onto the floor near the MAs feet. By this time the three of us are giggling like crazy, the patient is thrilled she can hear again and the MA scoops the object off the floor and onto a paper towel.

Although my husband may disagree with me, I really do have a pretty strong stomach. (Baby, does last Christmas mean anything to you?) The combination of a hot, stuffy, small exam room, the marble-size, multicolored object on the paper towel, and the smell emanating from it, I quietly excused myself from the room.

The very important thing to remember is this: I did NOT vomit! I was gagging at the base of my throat, but I did NOT vomit!

After taking a few deep breaths and running cold water across my wrists, I returned to the exam room and assisted the other MA with finishing up.

Externship: Week 6

Tuesday, December 16, 2008

Well, my externship period is quickly winding down. Although most students complete theirs within the six-week time frame, mine will take a tad bit longer to log 180 hours because I am only working approximately 30 hours per week.

Today was an interesting day in the office. Not only were we wall-to-wall with patients to be seen but the incoming phone calls to our area were completely whacked! The volume of phone calls and voicemails were so high that it took one MA almost completely out of patient care to keep them under somewhat control.

My favorite elderly patient (the one who made me realize the inevitable) came in to the office today to be hooked up to a 24-hour Holter monitor. She, and her husband, are two of the sweetest people I know and I always enjoy working with them.

I was also blessed to work with a new patient (new to me) today, too. After pulling her lab requisition from the pocket on the wall outside her exam room door, I knocked on the door, then poked my head in to introduce myself and tell her I would be back in just a few minutes to draw blood from her. She had the saddest eyes I have seen in a long time and I knew it wouldn't take much for the tears collecting on her lower lid to spill over onto her cheeks.

After collecting my equipment and paperwork I returned to her room and sat down on the chair across from her. As I organized the tubes, needle, cotton balls and such, I made small talk with her.

Finally our eyes just kind of locked on each other and very quietly I said to her "You look so sad today..." As she reached for a tissue in her pocket to stop the avalanche of tears, I leaned over to her and wrapped my arms around her shoulders. After a few minutes she was able to tell me the reason for her sadness.

Her husband of 63 years fell recently and broke his hip and was in a nursing home. Because she had had one of her own hips replaced in 2004, she was no longer able to drive and had become reliant upon one of her daughters, who lives nearby, to take her to see her husband. She indicated today that the nursing facility her husband is in would be weaning him off of the trach tube soon.

As if that weren't quite enough stress for this beautiful lady, she is also trying to understand Medicare and the mumbo-jumbo that constitutes their "policy".

So, we just sat there together for several minutes. She poured her heart out and I listened. I did get around to the blood draw eventually, but at that particular moment in time, drawing blood was not nearly as important to me as it was for me to listen and to be human and compassionate to a very beautiful woman with the sad eyes.

Externship: Week 5

Monday, December 8, 2008

Today was THE busiest day I have had so far on my externship. Bar none. Every chair in the waiting room had a person in it and more than a few times every exam room had a patient in it waiting for something -- the doctor, labs, x-Rays, or EKG's. It was nuts!

I performed a chest x-Ray by myself today and boy was that an awesome feeling. I also performed a knee x-Ray -- with a little assistance from another MA.

Today a very sad realization smacked me hard in the face.

I had the honor of taking a particular patient completely through her visit to our office. From calling her out of the waiting room, through intake and vital signs, EKG, and chest x-Ray.

After calling her name from the waiting room door, I watched her husband stand up and help her to her feet. Taking her hand, they slowly crossed the waiting room floor to where I stood and that's when I noticed how frail her face and hands were.

I could not see much else of her because her head was covered with a very festive red-colored cap and her body covered with a heavy winter coat. When she looked up at me and smiled I noticed she was wearing bright red lipstick and mascara, too. I let her take my hand with her free one and her husband and I led her down the hall to the scale.

I had already looked in her chart and made a mental note of her age (80-something), height (155 cm) and previous weight, something I do with every patient, and in the dictation notes from her last visit in September there was a very prominent note stating she had gained a whopping 9 pounds and, on that day, she tipped the scale at 98 pounds.

As her husband and I helped her out of her heavy coat and onto the scale, I was almost afraid to look to see how little she weighed. Hearing their excited voices about her having gained two ounces -- the scale showed 91.2 pounds -- I became a little confused. After hearing that she weighed 91 pounds in a different physician's office the week before I began celebrating with them.

Having settled the patient in the chair in the exam room I began asking her and her husband standard questions like "what brought you in today?".

She stated she was having difficulty breathing -- which was clearly visible to me -- and when I sat down near her to obtain her blood pressure and pulse, I could also hear a whistling sound as she breathed. The patient also stated that she was having very terrible dreams and that they were waking her up at night. She stated that they felt very real to her and that they scare her badly. (This information was noted in her chart.)

When I finished with the interview I let them know that the doctor would be in shortly to see them.

A short while later I was making my normal rounds and checking the chart holders on each of the rooms to see if any lab work needed to be done when I noticed a request in the chart holder for this patient.

I knocked softly on the door and poked my head in to let them know I would be back in a few minutes to do an EKG and a chest x-Ray on her. The patient was sitting up on the exam table and I let her know she was perfect where she was and gave her and her husband instructions on removing clothing and donning a paper gown.

A few minutes later I was back at her door and I listened for a moment before knocking to determine which state of dress she was in but I could not tell so I knocked softly on the door again and was asked to enter.

Her husband had given a valiant effort in trying to remove the sweatshirt his wife was wearing but it was clear he needed a little help. She had removed her festive hat and I noticed how very little hair she had because it was sticking up every which way.

Her long, thin arms were each tangled in their respective sleeves and it appeared they were having difficulty getting the shirt over her head, too. She looked up at me with her big, bright blue eyes and my heart melted into my shoes. Her husband explained to me that she had had a stroke a few years ago and around the same time was diagnosed with Parkinson Disease.

I took a moment to assess the situation then quickly began running solutions through my head on how best to accomplish this task without hurting her. My solution was to undress her as you would a newborn.

Laying the gown across her lap, I was able to untangle and free her arms from the sleeves of the sweatshirt. The neck on the sweatshirt, however, wasn't as forgiving. I helped her slip her arms into the gown before I began working the shirt over her head. As I was concentrating on not pulling her hair she giggled that she hadn't had a problem getting it over her head earlier in the day!

I continued talking to the patient and her husband as I input information into the EKG machine. While she was still sitting upright I placed the pads on her chest. After slowly reclining the table so she was laying down I placed a pillow under her head and began connecting the leads to the pads. Once the test was complete, the EKG printed, leads and pads removed it was off to x-Ray.

Two views later we were back in her exam room and I helped her dress again. After the doctor gave the "all clear" I helped her husband escort her back to the front desk to check out.

A little while later I was standing in the lab area when it hit me. One of "my" patients was going to die.

Not in the "everybody dies someday" way, but in the absolutely, without a doubt, too soon, kind of way.

Today I was blessed to have had this very beautiful woman and her husband cross my crazy-busy path.

My heart is full.

Externship: Week 4

Tuesday, December 2, 2008

Week 4 started quietly today. Although there were fewer doctors, we still had a lot of patients and with four MAs (Medical Assistants) the day flew by.

I cannot begin to tell you how positively thrilling it is to recognize repeat patients -- by name -- or have a patient ask for me to draw their blood.

Today, I gave my first "official" TB skin test to a teeny-tiny, 90-something year old woman. The wheal was perfect!

Externship: Week 3

Friday, November 28, 2008

"Paul Bunyan" returned last week for a follow-up visit. I knew one of the other MAs was working with him but I couldn't resist the urge to poke my head inside the exam room (the door was ajar) to ask him how he was doing.

When I tracked down other MA she was assembling paperwork and supplies in preparation of drawing more of his blood. She already knew about my first encounter with "Paul" and laughed when I picked up the tubes and needles.

As I walked away from her I told her I just wanted to have some fun with him. I could still hear her laughing as I glided into "Paul's" exam room and told him I would be drawing his blood again.

Now, I like to think I am pretty adept at deciphering a variety of facial expressions, but his had me completely stumped. Venturing a guess, I would have to say it was definitely a cross between "You've GOT to be joking!" and "God help me!" and pure terror.

I could still hear the other MA laughing, which started me laughing so I quickly confessed that I was only teasing him and the other MA would be drawing his blood. Imagine my surprise when he said "You can do it if you want to. It's okay."

After going back and forth a few times with him, and assuring him that I would try ONLY once, I relented and set to work. Well, it wasn't so much relenting as it was conquering a challenge. I tried, and failed, three times before and I refused to give up! After applying the tourniquet several times in various locations, I took my time in surveying both arms (and both hands) for the best vein to use.

Finally I located a vein that, although it was not visible through his skin, plumped up nicely when the tourniquet was applied and he made a fist. The first time I drew blood from "Paul" I used the smallest needle we have (called a "Butterfly"). This time I went for the standard needle -- along with high hopes that I would be successful.

I failed. Again. For the FOURTH time. The other MA failed, too. Which, in a way, kind of vindicates me. "Paul" will have to return to our office again soon so we can poke him again. This time neither I nor that particular MA will be doing it!

Externship: Week 2

Saturday, November 22, 2008

Overall the second week went very well. I felt much more at ease in the office environment and the various procedures seemed to flow more easily for me.

On Thursday I assisted another MA in irrigating both ears of impacted wax on an adult patient with Down Syndrome.

The patient was seated in a chair and his mom was seated nearby as we set to work on restoring the patient's hearing. First, the other MA instilled several drops of liquid to help soften the impacted ear wax. After putting a few drops on two pieces of cotton and gently inserting them in each ear we left the room to allow the drops to do their job.

When we returned, the mom giggled nervously as we set up the instruments and supplies that although she had noticed his diminished hearing, she didn't realize how bad his ears were clogged until the doctor pointed it out to her. Mom also indicated that this is something that frequently happens to her son and that she uses special drops at home in order to prevent it.

She decided at the conclusion of the irrigation that instead of using the drops every other month she would be using them much more frequently.

Because this was something new for me the other MA actually performed the procedure.

After draping the patient in blue pads to prevent him from getting wet, I knelt on the floor in front him and held the emesis basin under his right ear to catch the water and other materials as they exited his ear.

This also put me in the perfect position to talk to him, assist him in sitting up straight and not tilting his head forward.

Hint: when performing this procedure on a patient, continuously request him to keep their eyes open. This prevents the feeling of motion sickness.

***** WARNING ***** WARNING *****

You may want to skip the next part if you have a weak stomach!

Irrigating his right ear seemed rather easy at first. The ear drops had worked well and it didn't take much irrigation to dislodge what looked like a brown marble, only smaller. Apparently the other MA had not seen something of this size either and couldn't help but say so.

After peering in his ear to assess the progress we realized there was still quite a bit more earwax to remove and began irrigation again.

The earwax wouldn't budge so we switched to the other (left) ear, which proved to be even more difficult. After many minutes and lots of water, we were able to dislodge the earwax in large pieces and in the end removed all of it.

We returned to the right ear but were not able to clear it entirely and after cleaning up we let the doctor know. It turned out that the patient had a nasty ear infection and the doctor prescribed antibiotics for him.

***** END OF WARNING *****

Thursday afternoon, an in-home caregiver brought one of our patients in because she was not feeling well. The patient had been running a fever on and off for a day or so an had become very lethargic.

The in-home caregiver had just started her shift for the day and was frustrated that the other staff did not notice how sick the patient was. So sick, in fact, that medication (a pill) the patient had been given at breakfast, was still dissolving in her mouth in the middle of the afternoon. Meaning it was highly doubtful the patient had been given anything to drink all day.

Our office had the patient transported to the hospital via ambulance.

Friday I worked with a patient who is mentally impaired and extremely sweet. When I explained to him and his caregiver that I needed to draw his blood, poke his finger, do an EKG and an x-Ray he asked me if I had enough practice drawing blood because the previous person who drew it was "incompetent". I assured him I had plenty of practice and that after I was finished I would tell him a very funny story.

I have become quite attached to using butterfly needles almost exclusively when drawing blood from my patients so his blood draw went perfectly and he was quite thrilled to find out I was not incompetent. After I finished drawing his blood and poking his finger I told him I was a student Medical Assistant and he thought that was enormously funny and wanted to know if I was being serious. When I told him I was very serious he laughed even louder and thought that I did a great job!

What I learned this week: some people are perfectly content to create their own drama and not change their way of thinking, or change the way they do things in order to make the world a better place to be.

Externship: Week 2

Wednesday, November 19, 2008

After calling this particular patient (6' 4" tall, 50ish-year-old man), measuring his height, weight and BMI and escorting him to an examination room and closing the door, things became a little interesting.

As is routine for our particular office I asked the patient to sit in the chair with his feet flat on the floor then asked him the reason for his visit. He stated he had been suffering from a cold for a few days but today started feeling dizzy and lightheaded. (The exam rooms become hot and stuffy very quickly so I opened the door.)

It was at that point that I had a good look at his face and, as a mother, I could tell he was not feeling well at all. After measuring his blood pressure and pulse (both WNL) I explained to him that I would let the doctor know he was waiting for him.

I found the doctor quickly and explained the patient's symptoms to him and he asked me to measure his blood pressure laying down and then again standing up.

I returned to the patient's room and explained to him what I would be doing next and helped him onto the exam table. After helping him to lie down on the table I took a step backwards to grab the blood pressure machine -- but never made it that far. Sounding slightly panicked, the patient tells me he is going to throw up.

Sure enough, he does. In the sink (thank goodness!). For several awful (for him) minutes this big man is throwing up in the sink and in between chunks he is apologizing profusely to me! I stayed right next to him with my hand on his back reassuring him that if he was going to be sick, this was the place to do it.

When his active vomiting started spacing a little further out I asked him if he felt steady on his feet. He assured me he was so I left the room to summon the doctor. The patient stated to the doctor that he was feeling much better and felt able to drive himself home.

As I escorted him to the front desk to check out he was still apologizing to me for throwing up in the sink.

After the patient left I returned to the room and disinfected everything in the room -- even though he had only thrown up in the sink.

On a lighter note, a husband/wife I took care of last week returned to our office today and remembered me! By name!

Externship: Week 1

Thursday, November 13, 2008

Externship - Week 1 - OMG!

The first three days of my internship have been absolutely amazing! It has been "sink or swim" (with guidance of course!) since Day 1.

I am in an office with 9 physicians and 3 other Medical Assistants. We have 13 exam rooms, one Respiratory Therapy room and X-Ray (digital).

Except for one lab test, the HgB-A1C, and X-Rays, everything else is sent out. Including urine.

Lab orders are entered into a computer and to do that you need to know not only the diagnosis code but also the "order code". After entering the patient information and the various codes we print however many labels needed for all the tubes, as well as for the bag we put it all in to send out. We also print a sheet with barcodes to insert in the bag.

Each physician has been assigned a chart "color" (purple, brown, etc.) and a block of exam rooms for their use.

(Thank goodness not every physician is in the office at the same time!)

Memorable moments thus far:

Day 1: I received an order to administer a B12 shot to a very sweet elderly patient. I walked into his room and closed the door and let him know what I would be doing. Without skipping a beat, he stood up from the chair, dropped trou and leaned over the table. In between the giggles in my head I remember thinking "OH MY!" On his way to check out I passed him in the hall and he thanked me with a kiss on my cheek.

Later in the day I noticed a female patient exiting an exam room. She looked confused and wobbly on her feet so I assisted her to the front desk to check out. I stood close to her as she checked out then I escorted her to her car. When I returned to the office the Office Manager thanked me for helping the patient and that it was very nice of me to do so.

Day 2: I needed to draw blood from the equivalent of Paul Bunyon. Sassy me walked into the room and as I was setting up jokingly mentioned that this was my first time drawing blood. He actually laughed out loud at that. He stopped laughing right around the time I poked him a second time. I swear I saw a vein pop out on his forehead exclaiming "WTF?!?!" as I poked him a THIRD time. I told him I jinxed myself by telling him I had never drawn blood before and he honestly laughed out loud and hard at that.

First, I have to say, this dude was b-i-g. His skin was thick and the solid muscle underneath it made it enormously difficult to poke. Trust me, lesson learned!

Day 3: I walked into the office this morning and the first thing I discovered was there would be only 2 medical assistants today. Me, the newb, and the senior MA. I swear we drew blood and collected urine on every single patient we treated today!

One of my favorite patients today is a beautifully sweet 90-year-old woman in a wheelchair. She has the most amazing blue/white eyes I have ever seen.

I had orders to administer a flu shot to her. Now before I continue, you should envision in your head the diameter of a soda can. Ummm...yeah. Her arm was LESS than that in size. We typically use a shorter needle instead of the brutal IM one. Of course today we had none (shipment arrived late this afternoon) so I was forced to use the IM monster. Yep - I was freaking (inside) a LOT.

Although I knew how to handle the situation, I consulted with the other medical assistant anyway. We agreed that I should not insert the needle all the way in. (DUH!)

As many of my classmates can attest, the best way to give any type of shot is throwing-dart-fast because it's much less painful. I would not be able to do this with my patient and that made me sad because not only does she next to no muscle in her arms, her skin is like tissue paper.

After I drew up the flu shot, I returned to the room and explained to her (and her daughter) what I would be doing. Just my luck she would look at me with those way cool eyes and my heart melted into my shoes.

I swabbed her arm and prayed while the alcohol dried. I slowly inserted the needle a little more than 1/4" -- and softly touched her bone. It was all I could do to not visibly shiver. She didn't even flinch.

After the flu shot I had to draw two tubes of blood and used her hand with a butterfly needle.

The daughter thanked me profusely for taking such care of her mother and told me she wished other nurses were more like me. I gave her a big smile and thanked her in return.

My second favorite patient today was another elderly woman in her 80's and in a wheelchair (and her daughter). I had to draw blood and administer a flu shot -- with the last "small" needle we had. Her skin is also like tissue paper and the veins in her arm were barely visible so I chose to draw from her hand with a butterfly needle. The veins in her hand are very prominent so it didn't take long to fill two tubes.

As mother and daughter were preparing to leave, the daughter stepped out of the room and told me how much her mother loved me and the careful attention I paid to her while poking her. She went on to say that it is very rare for them to deal with such warm and friendly people and they really appreciated it. I beamed and thanked her for the opportunity for helping her mother.

Not everything has gone right, though. Today I drew a husband and wife and inadvertently used the wrong tubes to do so. Instead of the serum-separator tube (tiger top) I used an orange top. Because we were so overpowered today the blood in each tube clotted before I could get it transferred into the correct tube to send to the lab.

What's worse is that when drawing the wife (hand and butterfly) her vein stopped co-operating and she wouldn't let me poke her again to complete the draw. Worse still is that I drew from her left-hand (which is her dominant hand).

The final kick in my pants was that SHE has to drive because her husband can't hear.

I love opening the door to call a patient back and observing the looks on their faces before I call their name. Especially because I'm always smiling. When I call out a name and they look in my direction, their faces instantly light up.

Stay tuned for the next segment of "Carrie's Externship".