May 14 2011 Published by under Medical education, Medical Musings, Medicine

One of my early lessons in medicine was "listen to the nurses".  This isn't to say that nurses know everything and doctors nothing.  But we have very different knowledge sets, and it would be easy for a young medical student to simply dismiss anything told them by a "mere nurse" (in this case, "mere nurse" meaning someone who they think---often erroneously---cannot affect their grade).  Not only do nurses spend more time with the patients, but the have skills that med students need to learn.  Some of the essential skills taught to young physicians by nurses include how to draw blood and place IVs, how to turn patients, how to lift people safely.  At many hospitals special teams take care of IVs and blood draws, but many of us trained at hospitals where we were often responsible for these tasks.  During emergencies, it helps to know how to do everything---if someone's heart has stopped, waiting for the IV team would be a pretty bad idea.

In addition to the nurses, at least a dozen pregnant women taught me to place IVs.  Pregnant women often have nice, plump veins, making it easy for the novice to slip in a needle.  Getting in the needle and catheter is only a small part of it though;  you have to learn the preparation and the dance.  You have to learn how to tear the tape you need ahead of time, how to secure the IV and flush it, and all the other bits of knowledge that surround getting the needle into the vein.  Most important, you have to remember that the vein is attached to a human being, one who may be frightened and in pain, and needs your confidence, your ear, and all of your empathy and compassion.

I made it my business to learn as many of these lessons as I could.  I volunteered to start IVs and get blood from the most difficult "sticks".  I wanted to be the one people would call if they couldn't get the job done themselves.  While I rarely use these skills anymore (an excuse often tossed out by young docs who don't want to bother to learn them) I still value them, and especially now I need to send out a "thank you" to all of the doctors, nurses, techs, and patients who taught me.

This morning I hung a bag of IV fluids for my wife.  It seemed familiar.  It took me a second, but the understanding, the comfort with the process came back to me quickly.  Because of this, we can sit together at home instead of at the hospital.  This is worth every night I spent on call alone and tired, surrounded by other people's loved ones.

14 responses so far

  • Liz Ditz says:

    Glad to hear that Mrs. PalMD is home, and I hope that her recovery continues as speedily as possible.

    As for me, I'm really grateful to the nurse and the technician (I forget the initials behind his name, but I gather it is something akin to LPN) in Urgent Care on Sunday who gave me clues how to manage my own transfers from bed to walker to toilet and back again.

    I really didn't want to go to a skilled nursing facility.

  • pheski says:

    Thank you for reminding us all how many people from how many contexts can teach us things that help us - and our patients.

    Your post brought back a flood of memories. The nurse who simultaneously asked my permission and clamped the 'lethalfed' drip on the patient from the ED while I floundered, the nurse who talked me through closing after the obstetrician left the OR abruptly, the ward secretary who showed me how much easier, clearer and more complete my orders would be if I grouped them properly, the nurses who patiently taught me catheter placement and care, the pediatric nurses who showed me so many ways to gain the trust of children, the lab tech who taught me to call the lab to see if a test could be run on blood already drawn before ordering another stick, the nurse who taught me I could look hurried anywhere but at the bedside...the list seems to grow while I sit here.

    When I was still involved in inpatient teaching, I used to start rounds once or twice a week by asking the residents to share with the group something they had learned since yesterday, but not from a physician or in the library. With each new group, it was amazing how hard they found it the first few times, but how enthusiastic they became as the rotation went on.

    And, of course, the patients and their families who taught me about illness and health, fear and courage, grace, life, and death.

  • D. C. Sessions says:

    I volunteered to start IVs and get blood from the most difficult "sticks". I wanted to be the one people would call if they couldn't get the job done themselves.

    And boy, howdy! does that practice make a difference. Some people are absolute wizards at getting a needle in so smoothly that you can hardly tell they did it. For me, it's just an admirable skill -- appreciated, but no big deal. For someone who's hurting and afraid?

    Thanks for caring, Doc.

  • HennaHonu says:

    I don't mind blood at all, but I hate the sight of needles going into flesh (mine or others). I still donate blood, but it's amazing how much better the process is when they ask me and are conscious of my discomfort. It wasn't until my 6th time donating that the plebotomist covered up the entry sight with gauze so I could sit comfortably without getting a glimpse of the needle in my arm. I don't think they've ever done it when giving me a vaccine or taking blood for tests.
    In my experience, ER visits are the worst. Nobody tells you anything and everyone is rushed and disinterested. Unless you become an unusual case and 12 residents come in to stare at you like a petri dish without warning. It's amazing how hard it is to feel comfortable with yourself in a patient robe, no bra, and no idea what's going on...

  • Dr. O says:

    I'm so glad to hear Mrs. PalMD is home!

  • DLC says:

    I hope Mrs Pal improves. sounds serious but manageable ?
    Best wishes for you and yours.

  • A. Marina Fournier says:

    Hurray for you in taking on the difficult sticks, like me.
    After one time, where the nurse took FIVE sticks, two on the right, which never gives up a drop, and three on the left (close to the Challenger disaster--I know I was at that clinic that week), I began asking for the senior phelbotomist. I had one in Santa Cruz county who was so good, I usually couldn't feel anything but pressure at insertion. There was also a nurse there who pummelled my deltoid so that I wouldn't feel the tetanus injection.

    However, the nurse who installed the IV lock while I was attempting inducement for birth did such a botched job that it hurt all the time it was in, about 24 hours. When that was pulled, and another one put in, I knew the earlier nurse had done it wrong. I wrote to the Head of Maternity or someone higher up, detailing all the things that went wrong during the visit, but never got a single reply.

    When we moved over to "Silly Valley", I seem to have merited those better at phlebotomy for those of us with small/slippery/phantom veins. More used a pediatric butterfly needle.

    On NYE 2010, when I had a bone spur removed from my right heel, the anasthesiologist NUMBED the IV sight first--what a great idea! He often handled kids iwth cancer, so he was extra gentle.

    I hope MrsPal recovers surely and swiftly, never to succumb to whatever it is she's been dealing with.

  • Namnezia says:

    You have no idea the amount of appreciation and respect that I have acquired for all the nurses that have helped me throughout.

    Here's hoping for a speedy recovery for Mrs. Pal.

  • "Pregnant women often have nice, plump veins, making it easy for the novice to slip in a needle."

    Not me, unfortunately. By the third nurse and the fifth try, everyone is always very apologetic. I'm calling you next time.

    Very glad Mrs. Pal is home! Best wishes for her a speedy recovery.

  • Vicki says:

    Very glad MrsPAL is home, and at-home IV is a wonderful thing. (OK, it's still an IV and a butterfly needle left in your hand, but it's much better to be at home with your family and in your own familiar bed, and the tea kettle available whenever you want it.

    One of my doctors very definitely has your attitude: when the appointment schedule runs late, if the nurse has gone home and a blood draw is needed, he just goes ahead and does it. Well and smoothly.

    On a smaller note, it helps a lot that if I am having blood drawn, I don't wait for them to ask whether I'm right- or left-handed, or to reach for the left arm on the assumption that most people prefer that, I just say "use the right arm, it works better." (For some reason,the veins in my left arm veins are much harder to find.) Which is an aspect of the "listen to patients" part of it.

  • daedalus2u says:

    The reason that pregnant women have big plump veins is because pregnancy is a state of high nitric oxide levels. Any kind of chronic inflammatory state will tend to reduce the NO level and make veins harder to find.

    Hope Mrs Pal recovers quickly.

  • Isis the Scientist says:

    I have a friend who just went through a very difficult procedure. She told me that when she woke up from the anesthesia, the first thing she did was look at the IV in her arm and think, "Isis wouldn't have bruised me so badly."

    I was kind of touched.

  • PalMD says:

    Update: she lost her IV again today and allowed me to try a couple of times. I kept getting a flash, but couldn't get the catheter in.

    The nurse came over later and had the same problem so I didn't feel so bad...but she did eventually get one in, and now MrsPal is cuddled up with her banana bag.

  • aidel says:

    Please send Mama Pal my wishes for a speedy and uncomplicated recovery. Appreciate your hat tip to nursing. Most people (unfortunately) have no idea what we do. (For example, at my hospital, we evaluate Attendings.) One thing is for sure, if you're really sick, you are far better off with an excellent nurse and a so-so doctor than you are with an excellent doctor and a so-so nurse.