Friday, April 13, 2012

Memorable patient experience - PART I

PA school interviewers often ask applicants about memorable patient interactions.

As a veteran of several physician assistant school interviews, and I sat in several group interviews where I listened to fellow applicants detail how they had "made a difference" for elderly residents of nursing homes they volunteered at or had assisted a stressed out patient in the emergency room as they transported them through the hospital.

I, too, had many remarkable patient interactions during my years as a lactation consultant in Baton Rouge.  As well as a few interactions with patients at hospitals and clinics where I worked as a clinical lab scientist.  And one of my most memorable and poignant patient experiences, is one I chose NOT to share during any of my interviews.*

Well, here's the patient experience (in two installments) I didn't share:

*I really hesitated to write about this experience because it is anything but warm and fuzzy.  It is counter to everything that people want to hear about.  But the memories are still sharp and the take away message feels strong.

A patient I won't forget...

It was Easter week and I was working several overtime shifts in the lab at a small regional hospital in Louisiana.   (Southern Louisiana is predominantly Catholic, and Good Friday is a big holiday.)  Most businesses are closed and families often gather for the first crawfish boil of the season as they prepare for traditional Easter church and family activities.

Blood gases
Drawing an arterial blood gas sample

I was training to draw arterial blood gases.   I was eager to learn how to draw blood gases, even though I was in the microbiology division of the lab, because I craved patient interaction and I aspired to become a physician assistant.  So I badgered the techs in chemistry incessantly to bring me with them when they went out on the wards or to the ER to draw arterial blood gases.
And I got to practice my arterial sticking skills (which were not too awesome).

Blood gas assay
Good Friday

It was Good Friday, when I accompanied a tech to the ER to draw blood gases on a 25 year old man.  When I first saw him he was non-responsive, covered in homemade tattoos and had an obviously inflamed tracheostomy.  His restraints tethered him to the bed in a way that gave him a crucified appearance.   A couple of disinterested looking family members looked on.  I knew he had already coded once and I wondered why such a young person was in this situation.
The other tech showed me how to palpate the arterial pulse and I attempted an arterial stick unsuccessfully.
I felt sympathy for this young guy in the ER in restraints and wondered how he and his family came to spend Good Friday and indeed Easter weekend in the hospital.
We drew blood cultures in addition to the blood gases (thanks to my trusty senior tech) and returned to the lab.

Positive Blood Cultures

Blood cultures should never be positive.
But this guy's blood cultures were all positive with the same Streptococcus pneumoniae that his tracheal aspirate cultures were growing.  Strep pneumo is a frequent causative agent of pneumonia and it is never an organism that you would want multiplying in your blood!  He was septic with an encapsulated strain of Strep pneumo that had probably set up housekeeping in his trachosteomy site partially as a result of his habitual the trach out.

The young man was moved to a bed in the ICU.  Over the course of the Easter weekend, I went to the patient's bed side to draw multiple sets of blood gases.  Or attempt to I should say.  He was on a respirator and was completely out of it--a good patient for me to practice drawing arterial blood gases on my senior tech pointed out.  Arterial punctures in the wrist are particularly painful due to the tight structure there with ligaments and such, and they are equally difficult to collect.

Throwing darts

I found myself holding his hand, feeling his wrist for an arterial pulse and studying where to insert the needle.

My preceptor advised me to hold the syringe like a dart.  Then after observing my next futile attempt she said, "hold it like a dart, don't throw it like a dart!"
I think I was likely the butt of more than one joke in the lab that day.  And I felt particularly sad that I was making a pin cushion out of this young guy in ICU who was now alone in the sterile environment there with no family.

But he was silent, on a respirator and deeply sedated as I tried again and again to hit an artery in his wrist...

Stay tuned for PART II.

*DISCLAIMER:  Please note that the above situation in no way identifies a patient.  No privacy rights have or ever will be violated here.

1 comment:

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