Today we learned to take basic vital signs – blood pressure, O2 saturation, pulse points, temperature, apical-radial pulse, orthostatic hypotension, respiratory rate, patient identification and hand-washing techniques. Everything is more simple and complicated than it seems. Hand-washing, for example – we do it so many times throughout the day, but who would think that we should rinse the soap off with our hands higher than our elbows (to prevent germs from running down onto our fingertips)? Respiratory rate was another deceiving one: We were given the tip to take the pulse for 30 seconds first, then, keeping our fingers on the pulse point, count the number of breaths in the remaining 30 seconds (to fake out the patient, essentially. It’s hard to breathe normally when you know someone is watching you). Not only is it hard to count/observe breaths surreptitiously, it’s also hard to count/observe them while watching the clock! Blood pressure, however, was much less complicated than I thought it would be. I have a sneaking suspicion that I should be able to hear what’s going on more clearly (i.e. doing it better), but I can hear well enough to get a decent reading. Pulse points were somewhere in between (I can find all of them, but some of them still take me a long time).
It was a bit of a free-for-all this afternoon, all of us practicing on one another. I touched feet (pedal pulses), armpits (turns out we were up too high looking for a brachial pulse in the upper arm), breast tissue (apical pulse), groins (femoral pulse), and had my body touched in return. It’s funny how un-personal it feels when you’re learning, but I know the intimacy of touch when you’re working with a “real” client. It was interesting to see the spread of normal, to learn what each of our baselines were. I found that my respiratory and pulse rates are lower than those of some of my peers (12-14 vs. 16-20 breaths/minute, 58-62 vs. 68-80 beats/minute), but that my blood pressure is higher (110/70 vs. 100/60). My pulse points are easier to find than most and my O2 sat was frightening low at first (turns out the machine just needed to warm up. It was 89 when I first put the reader on, but then jumped up to 98 after a while – preferred is above 95). It was exciting to do something hands-on after so much sitting and listening, exciting to get started on the clinical skills that are very much a part of learning to do what I came here to learn – that is, to care for people.
Linda finished up the day by talking to us about journaling. She’s very into narrative and reflection, which, as I think you all know, I am, too. I love that we are being actively encouraged to journal and process and reflect, and I thought it was interesting that this topic was included on the same day that we learned about vital signs. She told us to write so that we would remember our journeys and transformations – how we got from there to here, how if we didn’t write, we would forget. Her talk reminded me of a journal Kim gave me way back in high school (side note: As I get ready to celebrate my birthday this weekend, I realize that Kim and I have known one another for 13 years, which is just under half of our lives). It was a gift for my summer at UC Santa Barbara, the one where I spent my time assisting a PhD student dissect otoliths out of fish heads. Kim had labeled each page with a date, and chosen a quote for each page. I wrote down my experiences almost every day, missing just two or three days toward the end. At the time, I couldn’t imagine forgetting the content of those three days, but as I look back on them now, I realize that they are lost. And with this realization, I see and understand just how vital writing is.