Tuesday, July 25, 2006

back in the saddle again

As I dressed for work yesterday, I gave myself a little pep talk:

"Come on, it'll be good to see everyone there."

"I'm sure your brain hasn't really atrophied during your four weeks off work."

"It'll probably be an easy morning; stop getting your knickers in a knot!"

Armed with a suitably perky smile, I strode into work, greeting various other staff members, and replying that yes indeedy, my holiday HAD been good. Very good. Too good!

The morning was running pretty well, and I was beginning to relax, when I called in 'Jenny'. She looked uncomfortable yet sheepish at the same time, as she explained she'd had this chest and left shoulder pain since yesterday afternoon. "I'm sure it's just a pulled muscle, but, you know, dad was only 62 when he died of a heart attack".

Right. "Let's just go get you on some oxygen," I suggest firmly, leading her to a treatment room. In many ways, a patient having angina or a heart attack is a straightforward scenario to manage (unless they go into an life-threatening arrhythmia or actually arrest in the surgery- which luckily is not too often). You have a certain formula to follow - check this, give that. Of course, as a suburban GP, there is one vital action to be taken - something a good doctor learns early, something that requires great wisdom and intellect. Want to know this most important step? Oh, alright, I'll share the secret. In an emergency, the most crucial job is .... asking the receptionist to call an ambulance. Pronto!

The ambulance arrived, with two burly paramedics. I had been about to insert an IV, but seeing as the paramedics can do IV's standing on their heads, and considering I only insert an IV about once a year (if that), I let them take over. Unfortunately, Jenny had tiny veins, and when one of the ambulancemen tried to put in a drip in Jenny's hand, it went right through the vein.

Now usually I am not especially confident as a doctor, and I would never put myself forward to take over a situation. But it just happens that the one procedural skill I have always been good at is inserting IVs. Even as an intern, I would be called to do the difficult drips. Once, a third-year resident saw me passing near the emergency department, and despite that fact I was on a day off, and was wearing a checked flannel shirt, called me to try to insert a drip in the arm of a large Fijian lady who'd already been 'stabbed' by various doctors half a dozen times (I don't know what the poor lady thought of the lady lumberjack who was poking her with a needle, but I got the drip in!) So it was very unlike me, but when the paramedic started talking about trying another vein in a position where the drip will often block up or fall out, I tentatively approached. "What about this vein here? I could have a try, if you like", I offered. "Sure doc", one of the ambulancemen replied. Now I really felt under pressure. Trying to get a wide needle into a small vein - was I going to stuff this up, and feel like a real goose?

No! I didn't stuff it up! Hooray and hallelujah!

It's amazing what a buzz I got from such a simple task. I can't explain why I should feel so pleased about such a silly thing. I suppose when skills don't get used, you wonder if you still have the skills at all. But it's OK. I can still whack an IV in.

And all of you who have nodded off can now wake up. This post is over!


susan said...

You really got back to the reality of work in a hurry! Chest pain and IV insertion on your first day back, obviously your mind was no longer on vacation!

John Cowart said...

It just like riding a bicycle, isn't it? Once you do it, you never forget how.

Glad you're back.

TUFFENUF said...

When I went to the emergency room with chest pain in 2001, the ER nurse was the wife of one of my fellow police officers. While I was happy to see a friendly face, she stuck me three times before she got a vein in my hand. I tried to be tough about it, but I ended up crying, probably a lot of the emotion was stress, but all the same, the woman felt really bad about it. Although I have been "stuck" many, many times - it still makes my hands sweat. This is why many people do not give blood. I am sure your patients are glad that you are home.

Mimi said...
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Mimi said...

You have one tough job. It's hard enough for me just to make decisions on the care of the six of us at home, nevermind caring for the world. Thank God for the good docs like you. Do not underestimate the small stuff either, it all adds up to the big stuff.


Franny said...

Wow, talk about getting chucked 'in medias res'! Good for you getting that IV in. I wish I had you around when I had to get an IV for my twins birth. They stabbed me and poked me and even hit the bone a few times. OMG, I still feel the pain!

Motherkitty said...
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Motherkitty said...

Wonderful for the patient that she had such good, competent care. I hope everything turned out okay for "Jenny."

It was fate that you returned from vacation in time to treat this patient appropriately. Pat yourself on the back for a job well done. I echo John Cowart's sentiments

Alice said...

I'm sure a certain percentage of the Brisbane community feels so much safer now that you have returned.

I'm glad you had such a good holiday, but I'm glad you're back. I've missed your wonderfully amusing posts.

The Four Bears in the Woods said...

Boy what I wouldn't give to have you here to do my IV's when I need them! I always cringe when I have to get an IV because half, or probably more than half the time they have trouble! I always am releived when someone comes in who can get it. It is very painful to be stuck so many times... so people like me appreciate people like you who can get an IV in with ease. I am sure the poor girl appreciated it to!

Glad you had a good holiday and glad to have you back. Loved the pictures.

Loved your post.

Mama Bear

Abandoned in Pasadena said...

It didn't take long for you to get thrust right back into work. Treating a patient with chest pain, inserting an IV line...it probably doesn't feel like you were ever gone now.

I think finding a vein and not blowing it out takes a special talent...not everyone can do it right on the first try. It is so painful for the patient when it takes several attempts. I'm sure Jenny was glad that you were able to find the vein. I know I would have been.

Kerri said...

Oh yeah, getting stuck with a needle is NOT my idea of fun, and when you find someone who can get it right the first time, oh what a relief it is! Good for you and lucky for Jenny! I hope she'll be OK.
So glad you're back and I'm very glad you enjoyed your nice long vacation. Getting back into the swing of things isn't always easy! Welome home Jelly! You were missed!!!

manababies said...

I've only had to have an IV 3 times so far in my life and that was for each of my c-sections. I'm not exaggerating when I say that part was the most uncomfortable each time. The stab and then the ongoing discomfort was rather unpleasant, especially the third time around. Bleh. How nice it would have been to have you there to do my IV. :) Not to mention, talk about great company too!

susan said...

Jelly, your comment on my post was ROFL! 'strangled choking noises by my side' - I am afraid to ask who is sleeping by your side - is it Fatty, or perhaps a pet?

Heather said...

I am always thrilled when I get to utilize my skills, too. Sitting behind a desk is a lot more boring than bedside care. :-)

doubleknot said...

Like riding a bike - you are back in the saddle again.
My room mate's daughter is so delicate that the doctors have to use a child's IV on her - she has learned to tell them straight out that the big needles won't work on her.