Monday, August 14, 2006

Blood II

This week started off a bit easier than last week, I got to go home at 2:30. We haven’t gotten any new patients since Friday (but we’re on call again tomorrow), so we just had to take care of the ones we’ve had for a couple days. The man with the UTI has become a real grouch (well, when I say “become” I actually mean “become more of a”--every morning I've gone to ask how he's feeling he looks at me like I'm an idiot and says "well I'm in the hospital, you should tell me"), he won’t let respiratory therapy give him breathing treatments and he won’t let the nurses give him his heparin shots that he needs so he won’t get clots in his legs from lying in bed all day. He also refuses to take oral antibiotics so we have to keep him on IV. He’s stable though, so as soon as we can we’re sending him off to transitional care.

The pleasant patient with the pleural effusion/ascites shocked everyone today by coming back positive for hepatitis C—we had just ordered the test as a formality since he doesn’t have any risk factors for it other than several blood transfusions decades ago. Unfortunately, this makes the likelihood of his having cancer even higher. He was supposed to get an ultrasound guided paracentesis today, but his liver function has decreased his clotting ability so the radiologist won’t do the procedure. We’re giving him vitamin K shots to get his clotting back to the point where he can have the procedure. He’s also getting a CT scan which should show any tumors (I think).

The man with the bacteria in his blood has to have blood drawn every day until his cultures come back negative, so I jumped at the chance to draw it today. My intern said I could do it unsupervised now that I’ve done it a couple times. I got all the stuff, got the front desk to print out the labels, and set up the stuff in his room. I found a vein in his left arm, went for it, got blood on the first try, and with needle in my right hand and syringe in my left in one smooth, intricate motion that was beautiful to behold got 20cc of the precious fluid in under a minute. Then I went to the right arm… Poor Mr. “G”. I tried twice to get the needle into a fairly prominent vein with no success (well, actually he did bleed, but unfortunately not into the needle). Crumpled with failure, and shoulders slumped under the blow of defeat I went to get my resident. But then she couldn’t do it either, so while I felt really bad for Mr. G (who remained placid through the entire ordeal), I felt a lot better about my own (lack of) skills. We had to get the IV team (nurses who spend their entire day doing nothing but sticking people) to come, and it even took them a couple tries although they eventually got 12cc which was just barely what we needed (to clarify this story, for blood cultures one must get blood from two different sites). They left him with a nice egg-shaped mass on his arm.


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