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".