Nov. 20th, 2014

c1: (Star of Life)
Got two IV starts in real live human beings who weren't the model of health. This was after blowing two attempts on an elderly lady with tough veins. The two I got required a certain amount of psychological heavy lifting, but the nurses saw to it that I got that encouragement and coaching. As a group, they're all trying hard to see us reach the finish line. I don't think any of them are so far removed from their own days as students that they've forgotten the pressure. Indeed, one of the doctors was relating his thoughts on the matter: "yeah, IVs are a pain." 

Mind blown: saw (most decidedly did *not* administer) TPA get administered to a patient. TPA= Tissue Plasminogen Activator, AKA "clot buster." If you've had a stroke or a heart attack, this is the "liquid plumbr" they shoot through your veins to smash the clot.
Trouble is, it busts clots.
So you chuck this into someone, but they've got a clot somewhere that's actually doing something positive for the patient, and next thing you know, your patient is bleeding from every hole in his/her body that you didn't realize was there. Including some you won't find out about until too late. You don't give TPA rashly; in fact, there were two nurses drawing it up with no side conversations, each checking the other's math, and so on. Oh, and there was a consult with the doctors at Mass General beforehand.
Cool thing is: it busts clots.
So much in medicine takes a long time to see. In this case, a woman with obvious stroke signs, notably slurred speech, was talking much more clearly within the hour. No kidding. Not quite perfectly, but certainly "hot damn, that stuff worked quick!"

Paradigm shift: patient came in and needed IV fluid. I didn't go near this one, as her vasculature was that of a frail old woman. Nurse A. tries twice and fails. We're all busy getting this patient wired for sound and then nurse B. comes in to try the IV. And here's where the magic happened.
She quietly takes a stool and sits by the patient's head, her head not much higher. "Hello, love. I'm going to give you an IV so we can make you feel better." And her voice is soft and empathetic and full of love. She reaches out and touches this woman's face, then strokes her hair, adjusts her pillow, and pulls the blanket up to her chin. The woman smiled warmly, with more than a slight bit of contentment and approval.

I asked her later how she got that obviously difficult IV, and she confessed it was "a wing and a prayer". But something about her voice that dropped the collective blood pressure in the room by several points probably helped, too.
The two IV starts that I ended up getting were done with her voice playing in my head, and me sitting on a stool, at the patient's level. (And OK, the phlebotomist coaching me on the last one didn't hurt either.) 

I'm working on establishing a happy place I can go to when I have to start IVs. Practically everyone has been telling me it's 99% mental, and only 1% physical; probably every concert pianist would say the same thing, as would every starting pitcher in the MLB.

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