Foleys, Phlebotomy, and Freezing

This week, rather than starting a new rotation, I am making up "required" procedures that I was supposed to have done while on my ER rotation earlier this year. I was in Portland, however, and I found it difficult to juggle the patient care/discussions with attendings (who were evaluating me) with doing the things like IVs, blood draws, and catheters on patients (not even necessarily mine) that needed them. So I thought I'd hold off on scouting out the procedures and just concentrate on patient care while working in the ED.

Which is why I'm now doing remediation :) I spent a few hours on Monday through Vascular Access Education first practicing blood draws on a mannekin's arm and then working with one of the phlebotomists in the subway level of Hilton to get some more experience on real patients. It is amazing to me that we can get to this fourth year of medical school without really feeling "comfortable" with these procedures. I mean, we (as doctors) would rarely have to do any of this (although the Mayo way of specialization may be more extreme than at most other institutions), but we really should feel competent at it! And, if a nurse is not able to start the IV, who do they turn to? Yup, the person (resident, physician, whatever) with far less experience. Maybe my classmates feel really comfortable doing all this, but I haven't done enough to really feel confident. I sort of wish sometimes that I went to one of those throw-you-into-the-fire medical schools where you are forced to learn by doing; however, we here are quite sheltered.

We learn IV-starting 2nd year and then go a year or so without doing one. We have some opportunity on our surgery rotation 3rd year to do IVs, phlebotomies, foleys, etc., but how much you do depends on the people you work with and your overall proactivity. I tend to be quite passive. Which is why I'm in remediation.

On Tuesday, I passed several hours with the Urology technicians (or the "Cath team") at Saint Mary's Hospital. I practiced doing Foleys on pelvic models and then went to work on "real" patients. It's actually quite fun! I feel WAY more comfortable. I don't really like urine enough to want to do this all the time, but I liked getting the experience. And (contrary to what one might think, because the female bladder is much closer to the urethral meatus than it is in men), males are WAY easier. No hunting around for the "winking" urethral meatus after iodine application. There is one hole. Perhaps that was too much information. In any case, it was a very valuable experience and all of the techs were great to work with.

Today, I passed the day in the Saint Mary's ED doing IVs and blood draws. I will likely have to go in tomorrow as well-- it was a bit slow. I don't really understand why they don't hook us up with the IV team (yes, there is a team for that at Mayo as well!), which I am looking into. Mayo has this crazy amount of division of labor that can, at times, be frustrating. I read about four magazines sitting around the ER waiting for people to "need" IVs. It is incredibly low-yield. But everyone was really nice and patient with me.

Lastly, about the weather... it's been COLD. I came back on Sunday to see it snow about 6 inches that afternoon and evening. And then, on Tuesday, it was -12 when I woke up. WITHOUT windchill. I think it may have gotten up to 10 that day, but I'm not sure. I was swearing that I was going to move to California. Check Wendi's blog from the weather report captured straight from the internet. It's scary that, when it gets into the teens or a high of 20, that is considered "warm." But today definitely felt warm. Eesh. Well, I'm about to put on my "getup" to venture back into the outdoors, so wish me luck :)