Spring Semester 2009 Phlebotomy Class

A phone call roused me from slumber – and it was a freakin’ wrong number, whose disembodied voice wanted to argue with me about whether or not I had called them about an outage on my direct TV.

Problem: I don’t have direct TV; my cable is provided by my phone company. By the time I got that call finished, I was well past drowsy and pretty much into annoyed wakefulness. Ah, well, why go back to sleep when there’s laundry to be done? (I realize the idiocy in that statement, so no comment necessary, thanks! *grin* )

Checking email found a letter from the coordinator of the classes I teach. I realized I hadn’t told you about my classroom work for awhile.

Yeah, I know…you’re already wishing I’d told the caller to f*** herself and gone back to sleep. But, now you’re just stuck with reading whatever spills out of my keyboard;)

The economy has made community education in this area a hotbed of activity. Unemployed or people who’ve been laid off are frantic to find new careers which might make them viable in the job market again.

Healthcare work is a popular option right now. And, while many people don’t have the desire to go back to college, they are anxious to expand or acquire knowledge in things they may have been interested in, but didn’t want to give up a decent job to follow up on that interest.

Phlebotomy is one of those things. It’s a basic semester course that will give the student a way to get into health care in an entry-level position. They think it’s easy. You just stick a needle in someone’s arm, right? They bleed, you collect it in some sort of container and voila! you’re a phlebotomist!

Wrong. It ain’t that simple. There are roughly 13 separate steps a phlebotomist must take from beginning to end to attain that blood sample.

No! That cannot be true! many students think. It’s a common misconception because those of us who are good at it make it look easy. It is easy – for me. But it took many draws to get to that point of comfort where I can simply do the job, get the draw with minimum discomfort and still carry on a conversation with the patient or staff.

That’s what, in part, makes it so much fun to teach phlebotomy. I get the joy of seeing the bright anticipation of the students the first night of class when they’re still thinking this class will be easy.

It’s not. It ain’t all about the needles. The didactic portion of class is intense. We *do* expect you to have a clue about what basic tests go in what color tubes. We *do* expect you to know the difference between a tube with sodium heparin in it, and EDTA. We *do* expect you to be able to forego your Velcro mentality and learn how to tie a proper tourniquet…and make it smooth so it doesn’t tear up an old lady’s tissue paper skin.

And, you’re gonna get a quiz or an exam and homework to do, too. This isn’t a feelgood class – at least not at first. Your classmates are hoping that by the end of the semester you’ll be able to put a needle in a vein without a brightly colored hematoma making an appearance several hours later. Perhaps by the end of didactic we’ll be confident in your ability to go to clinicals and stick needles in people who are, not only strangers, but are sick, too!

The realization comes as a tremendous shock to a fair amount of the students. And, to our credit, we haven’t lost one yet because of the coursework. They all do their best to get through those first painful weeks of the boring stuff about national advisory boards, and privacy laws. Those who’ve never been in any sort of medical job suffer as they learn body systems and how to break down medical terminology. And they learn the mantras: Always properly ID your patient and Tourniquet, Tube, Needle!

In 12-16 weeks (including their clinicals) they should have a certificate of completion in their hands and the ability to find a job in a new career. But, that’s another post I’ll work on some other time.

This semester saw our largest class. We have 19 students this round, each with their own story to tell, and many with their own particular brand of drama they try to manipulate us with. In some cases, we have to make a difficult decision.

One of those decisions will be happening this afternoon. Tonight’s lesson plan is, in part, the second of three practical exams.

Each student will be given a fake requisition of a patient who must be drawn. We use artificial arms for this procedure to make sure all students have a level playing field.

One student may not be taking the exam. I don’t know whether to expect her in class tonight. And, the circumstances leading to this just sadden me completely.

You see, the student is a woman in her 40’s who was, at one time part of an EMT IV team. Her function was to get intravenous lines started in folks who were difficult draws. You have to be damn good to be on a team like that. You have to be able to walk into a room, do an almost immediate assessment of the situation and get your work started, because, in many cases, the patient’s life hangs in the balance.

She’s been away from that work for some years. She decided to take our course to refresh her skills, and get an opportunity to get back into the work force.

And, we can’t let her go to clinicals. She’s been at the top of her class academically from Day One. But practically? What we thought were the mere nerves of a student phlebotomist did not improve as time went by.

I had to be direct with her at her first practical exam. Her “nerves” were so bad that her shaking was out of control. Had that been a real person draw, the patient would have been suing the hospital before the phlebotomist walked out of the room.

I had to decide whether to dance around the subject in a nice, polite and politically correct way, or simply be blunt. I chose blunt.

I explained to the student that she couldn’t do sticks on real people with the shaking she was experiencing. And, though I did know this unofficially, the student confirmed to me that she was on medications which had a side effect of tremors. She said she would be talking to her doctor about upping her dosage to control the shaking.

I questioned the advisability of that; I mean, why would a person want to take a medicine which is doing its intended job and increase that dosage to control a side effect? At any rate, she said she planned to talk to her doctor. Then she listed out the medications she is on.

I think she should sit down with her doctor AND her pharmacist and get this figured out. The combination of medications she’s taking is giving her pharmaceutically-induced Parkinson’s Disease. The shaking will not get better any time soon. The only human she’s stuck is her own daughter, who’s also taking the class. We won’t let her stick anyone else. I felt badly about that – so much so I considered letting her do a hand stick on me last week, until it occurred to me that my hands are my livelihood. Then it was simple to drop that thought from my brain.

But, this makes me sick…this woman had “the touch” at one time. She has empathy for the patient. She’s warm and kind. And, if she didn’t have the problem she does, she’d be one I’d be recommending for a job with no hesitation whatsoever.

Life is just not fair sometimes.