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.