A fitting end and a student 'eye' opening

Today was my second-to-last day as part of the 'official' a.m. phlebotomy team.

When I leave a job, I try to do it as quietly as possible; no sense in making a production of it, in my opinion, but sometimes the gods have a way of making it a memorable leave-taking.

My goal in these last few days has been to try to finish up as much as possible with the trainees - the very ones who have been hired to take the places of me and the others who are bailing out for better, less stressful opportunities.

Today I had the fortune (or perhaps misfortune) to take out the one student I had last semester who absolutely drove me crazy in class. But, one thing I've managed to get through this thick skull is sometimes the most trying of students can have a marvelous track record once they bypass the books and begin working. Such is the case with Trainee N., hereafter known as TN. We received marvelous reports from TN's clinical experience; I'd guess it's one of the best reports the program has gotten in the last four years.

But, I was not looking forward to being assigned to TN. First of all, there's a major language barrier; this is a surprise because I generally have no trouble with accented speech. And, if she carried on the same way she did in class, I might have had to cause bodily harm. (I do carry a tray filled with needles, after all...)

To top it off, we were assigned to the psych floor.

Typically, psych isn't a problem. I'm especially grateful for that when I'm working with a trainee; movies and television have given many people an unfair notion of what a psychiatric unit is. My goal is not only to assure the newbie that they don't have to fear working that floor, but that it's one of the easiest floors a person can be assigned as a rule. The patients are generally in good physical health and have good veins. They are just having problems with their grey matter.

So, TN and I trotted off to the psych unit, me reaffirming all the things we'd discussed in class. We arrived at the first unit. I showed TN the routine stuff, like to pay attention to the "elopement precautions" sign, and how to get into the unit in case she spotted someone hidden behind the doorway waiting to make a run for it.

Introductions were made, and I went over the patient list with the staff. Two people needed to have "walk alongs". Those two would be my patients, for there's no way I'm going to require a trainee to draw someone like that, unless I have confidence in his or her abilities.

Patient "A" was a paranoid. The nursing staff asked her if the draw could be done, and she refused. I cringed because the test she needed was a drug level assay, and when they order that particular one, it's pretty important that the patient let us do the draw. But, we cancelled the test, tried the next one on the "walk along" list. He feigned sleep. He wouldn't budge for anyone, so we were asked to wait till the end to draw him.

TN attempted to pick up the next three patients. She did a fairly good job, overall. She's got straight needle sticks down pretty well, but she's a little rocky on use of a butterfly needle and syringe - something it's important to be good at in psych; that 12 inches of butterfly line can give you the ability to duck a blow and quickly pull a needle away from a violent patient if need be.

After we finished those three, another attempt was made to wake Patient "B". No luck, so the order was cancelled till p.m. draws.

Patient A, in the meantime, had changed her mind about getting blood drawn. I walked over to her, intro'd myself and TN and was met with a tremendous amount of resistance. She wrote down my name, TN's name, let me look at her arm, accused me of lying to her when I told her she just had one test ordered, said she didn't trust me or anyone, especially her doctor, and then informed me that I needed to wipe off the needle with alcohol before I could stick her. I explained to her that the needle was in a sterile package and wiping it off with alcohol would more than likely risk more contamination than not. But, to no avail. I told her I would be glad to wipe the needle off if that was her request.

I did the draw, she had a clenched fist aimed at my face ("oh shit, not this again...I've had enough of fists connecting with my face in the psych unit already, dammit!"). I filled the tube, she was pissed because it didn't fill fast enough in her opinion. I pulled the needle and tried to gauze and tape her, and she got even more pissed and refused. TN was standing there with her eyes round as saucers, as she watched me handle it all.

We walked into the nurses station and the charge nurse was telling the other, new aides about me. She was giving quite a dissertation, guaranteed to make me feel good about myself for at least a week. I hated to tell her that I was leaving. She gave me a great big hug and said that I was the absolute best in the department. I wanted to say either, "I'll bet you say that to all the phlebotomists", or "Would you mind writing a rah-rah letter to that effect?"

TN and I headed to the next unit. Again, we went over the list of patients, and were told one needed a walk along. She was awake, so they asked that we do her first.

We walked into the room, and my assessment of the situation was to go ahead and let TN do the draw. As the walk along was chatting with the patient, I did as well; nothing unusual to that. TN palpated for a vein, and couldn't find one and asked me to check. We found one, TN began getting things ready.

Suddenly the patient started yelling, "HURRY UP AND GET THIS OVER WITH!"

TN panicked and asked me to do the draw. I started to do the draw and the patient yelled, "GET THE FUCK AWAY FROM ME!!!!! GET THE FUCK OUT OF MY ROOM! I WANT HER TO DO IT!" as she pointed at TN. Three other nurses and assistants came running in case a brawl was breaking out.

TN was quivering in the corner of the room. I gathered up my stuff and we got the hell out of there while the nursing assistant took her on - and not only was he dealing with her, but also with several of the other people who seemed to be ensconced within her as well. Not a pretty sight.

The charge nurse on that floor chewed my butt because she said that "some people are just not geared for trainees to go into their room."

Now, I ask you, is that MY fault? Just because they send a walk along to a room does not mean that the trainee can't draw them, nor that there is necessarily any danger involved; sometimes the walk along is simply there to be a familiar face and a comfort to the patient.

I must have had a strange look on my face during her diatribe. At any rate, she apologized to me about it. In many other cases, that charge nurse has asked me to go in alone to rooms when I've had trainees with me; my opinion is that she should have given me more information about what we were walking into. But, that was not the case, so unless I get a call into the office from my boss, I'm going to just gripe about it here and let it go.

But, it certainly made the day memorable. I hope Saturday, my real 'last' day on the team is much quieter!!!