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".