Stand Down

Last Friday several us had the opportunity to attend Stand Down – an event where veterans can go to receive all kinds of services and resources.  This article has more information about the other stuff, but my classmates and I were there to provide some basic health care services.  Decked out in our scrubs for the first time, stethoscopes hanging around our necks (Linda keeps saying it’s “sexy,” but I am always surprised by how heavy it is.  Oh, the metaphor), we gave foot soaks, tetanus shots, PPDs, took blood pressures and glucose levels, tested peak flow and helped out in the dental and optometry tents.

My first assignment was in the foot bath tent – we were basically supposed to help the veterans soak their feet and bring any abnormalities to the attention of the podiatrist.  Ideally, these soaks were supposed to last about 10 minutes, but I sat at the feet of my last “patient” for a little over 20.  He showed me his toenails, which were long and curling inward, and explained that they were starting to become ingrown, but that he was afraid to cut them because he wasn’t sure what would happen if he did.  Privately, I thought that he should just cut them and his problems would be solved, but I found myself saying that I knew what he meant and asking about what it was like when he cut them last.  We talked for a while longer and I learned that he was a ballroom dancer and that he had some pain in his big toe.  I knew exactly where he was talking about because I have my own big toe pain, which I, too, think is from over-working it a bit.  I pressed on the area gently and he said it was sore to the touch.  For a moment, I wished that I had my mother’s sensitivity – she would be able to sense any subtle traces of injury (in the form of calcifications, I think?  I’ve been told that she can feel them in my toe and also my shoulder and ankle) and perhaps even release them a bit – but the conversation shifted back to his nails and then to the importance of good foot care.

After the foot soaks, I went back to the main tent to take some blood pressures.  Even though I had just learned how to do blood pressure and pulse rate, I felt fairly confident in my abilities, so I was surprised at the sudden anxiety I felt when it came time to place my fingers on the radial pulse of my first patient.  Thankfully, the steady beating of the heart has a soothing quality and I was soon comfortable again.  One of my patients told me that he was on medication for hypertension and that the last time he had his bp taken, he thought it was 170 over something, but couldn’t remember for sure.  So we were both pleased when we found that his bp was 120/72.  One of our preceptors came around and asked if we were happy with that number:

Patient:  Yeah, I’m happy with that number.
Preceptor:  Great, but I’m asking her.  (To me) Are *you* happy with that number?
Me (nervous):  Yeah, I’m happy.
Preceptor:  Is that normal?
Me (still nervous):  Yeah, it’s normal.
Preceptor:  Are you asking me or telling me?
Me:  Telling you?!?
Preceptor:  laughs

After blood pressure, I went to the glucose station, where I performed my first finger sticks.  Those were pretty easy – although I still don’t think I’d want to do it to myself.  The tetanus shots and PPDs were harder – I did two of each and still wouldn’t feel comfortable doing one without someone hovering over my shoulder.  I found that it wasn’t so much the needle stick and injection – it was everything else.  I would never have considered that syringes tend to stick when you first take them out of the package and I’m still not convinced that I’m properly drawing up a drug out of a vial.  I also cleaned my first arm incorrectly (Preceptor:  Okay, but first, when you swab an area, you make little circles to big circles.  None of this up and down stuff; try again.) and forgot to retract the needle on my first PPD syringe (unlike the syringes for the tetanus shot, you have to keep pushing down on the plunger once you’ve removed the needle from the skin).  And all of this while trying to put the patient at ease!  Although, as Linda pointed out, these people have been to war and been shot at and were probably injured in battle, so they’re not really afraid of a bunch of baby nurses with needles.  Her point was later proven when one young vet told me that I couldn’t possibly hurt him and that I should “just go for it” with the PPD injection.  I laughed and agreed that he was probably right and then scampered off to find a preceptor.

After lunch, my final station was at the demonstration table.  I was glad to be outside instead of in the hot tent and even though I had very little idea as to what I was supposed to be showing people, I found myself suddenly flooded with memories from OMSI and MSI and wanting to engage with people and share what little I knew.  At some point, Linda came over and told us everything about everything (which is something she can be infuriatingly good at) and then it was time to go.

I think I may still be digesting this experience, but one of the things that stands out to me is how safe I felt.  I knew I would enjoy talking to patients and hearing their stories and getting to practice clinical skills, but I didn’t expect to feel safe.  I expected to be anxious and awkward and uncomfortable and I was all those things at certain points, but in general it felt normal and “natural” (in the sense that it was natural to have no f-ing idea what I was doing 90% of the time).  The preceptors were all very approachable – I wasn’t afraid to ask when I didn’t know how to do something and they all taught with patience and care.  I’m sure that clinical will be much different, but it was a nice insight into what the process could be like.

Speaking of clinical – they start this week =)

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