Were the treatments really needed? That is sometimes difficult to determine. But the boy did need frequent suctioning, as his secretions were white and thick and sticky. Although, in my humble opinion, he did have a good cough. When I'd suction out via his nares, he would cough hard and then I'd have to suction out his mouth, which in itself was difficult, as, when he is angry at me, he also clenches his teeth. So getting him to open his mouth, and not bite down on the yanker, is quite the challenge.
So then the doctor ordered an ABG. And I'm like, "How the hell am I going to be able to draw an ABG on this kid?"" There's that moment of anger where you are like, "What the hell? Did the doctor not LOOK at this patient?"
And, of course, then I gain a grasp on my inner psyche and calmed myself down. This is a skill I learned a long time ago when I realized that so many doctor's orders are stupid. And, as a disclaimer, that is no knock on doctors as it is on the powers that are likely to sue them. So we do a lot more than is necessary. And, when you are already burned out from previous orders, the stupid ones sometimes set us on a rampage. And, so, long ago I learned to temper my anger at these. I throw my fit when no one is around. And as soon as I am by another person, be it a nurse, doctor or patient, or patient family member, I am my usual kind and nice self.
And so, I set off on gathering my ABG equipment. And, of course, I approach the doctor, who says, "Yeah. I understand it might be a challenge to get it. And if you don't I can always to a VBG. But, I just figured, since he has been here for 8 days and isn't getting any better, that I'd order some more tests and check some things out."
Okay. I respect that. I can't argue with that. And, so I enter the room to do the ABG. And I recruit the nicest nurse ever to help me hold the patient while I poked. And I did not feel a pulse. Calmly I check for pulses at various spots: right radial artery, left radial artery, right brachial. And then I realize I'm just going to have to poke blindly.
"Just poke. You can do it!" The nurse says with, with a graceful half smile.
I will do it once, I decide. And then I will tell the doctor I can't get it.
Now, for all sakes and purposes, I am pretty good at drawing blood gases. I have been doing this for 25 years now. So the nurse grasps the inside of the patient's elbow, and holds his arm stiff. And I say, "Can I get you to hold the elbow straight by another method?" And she says, "Sure." And I say, "Can you place your palm under the patient's elbow. That way he won't be able to bend it and you won't be obstructing the artery."
"Oh, yeah, that makes sense," she says, eager to help.
And so I pull out my syringe. The cap is already on it with needle. I prep the skin. I get a band aide and peel the sticker off the backside. And I stick one side of it to the edge of a table. This will make it easy to grab with one hand after I succeed at getting the ABG. And I feel for a pulse with the pointer finger of my left hand. I take my time. I do not find a pulse, as expected this time.
And so I let go and step back. And I say to the nurse. "See if you can find a pulse." So she ckecks for a pulse on the patients right side while I jump over to check for one on the other side. This is my last ditch effort to do the ABG the proper way, which is by palpating a pulse and putting the needle over the pulse. This greatly increases your odds of success. And she says, "I feel one. It's right here." And she holds her spot with the tip of her finger as I walk around the bed. And she removes her finger and I set my finger over the same spot. I patiently wait for the pulse to be felt.
I will be honest. I wasn't sure I could even feel the pulse. It was hard to tell if the pulse I might be feeling was the patients, if it existed at all, or me. And, there's also the fact that I am loaded with beta agonists from my morning dose of Symbicort. And I am also loaded with caffeine from my morning cup of tea. So, it was difficult to know if I was feeling a pulse or if it was just me tremoring.
"I do feel it, I think," I say. Was it a lie what I just says. Not really, because I did add in the "I think" part. "But it is so week. How do I isolate that weak pulse?"
And she says, "As best you can."
And so I decide to poke. And basically this is a blind poke, as that very, extremely, soft pulse is not enough to isolate his little artery in his little wrist. If you draw blood gasses on a regular basis you know what I mean.
So, rather than using the pulse to guide my poke, I use landmarks. Although, because I can feel maybe even the slightest faint of a pulse, I use this to guide my direction. And so I try to find the location where the artery usually rests under. And I poke. I readjust the needle three times and am about to give up when the patient jerks his arm. The nurse readjusts to grab a hold of the arm, and she does this while still holding the patients elboy. And this is no knock on the nurse as this is expected, and that's why she is there to help.
And she says, "Sorry." And I say, "No need to apologize. When the patient moved he moved his artery right into the tip of the needle." She and I both laughed at that. And I allow the blood to flow smoothly into the syringe. And I pull the needle out.
i have had times in the past where I go into droughts. I know that anyone who works in medicine and draws blood or puts in IVs does this from time to time. But, I have been doing this so long now that my success rate is very high. Usually, if I do miss, it's because the patient has no pulse. So it does feel nice when you succeed when expect to not succeed. It boosts the ego up from zero to one.
And, truly, there is a sense of satisfaction. Although you humbly suck it up because you know the next one might not come so easily. Someone once said that baseball is a humbling sport. In the same way, drawing blood is a humbling act in healthcare.
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