Beth's Contradictory Brain

Phlebotomy Advice

More than ever, I've realized that one of my most important skills in my job is that of making small talk, chit-chatting with patients.

Yes, being good with the needle is THE most important skill, but I think that might be easier to learn.

Making small talk is important because it takes the patient's mind off of the needle. Even when they know I'm trying to distract them, once the needle is out and I'm bandaging their arm, they saw, wow, I didn't know you were already done.

Now, you know how little patience I sometimes have with whiney or rude patients, so sucking it up and talking to them about their day, or the weather, or the weekend past, or the weekend upcoming, or the book they have with them, or an upcoming event, etc, etc, etc, really can be an art form.

I haven't been at this new job long, and already they had the "obnoxious" folks over to me too often. But I'm getting better at it. And you know what, they usually leave in a little better mood.

Because how hard is it when you're verifying their info to next ask, "How's your day been?" And then listening to the answer. Trust me, sick people will always have an answer.

Prescription Tips

As anyone who deals with doctor's prescriptions can tell you - it's not fun.

Here are a few tips for patients.

1. If there is anything on your prescription you can't read - don't assume the person you're going to give it to at the lab, x-ray facility, or pharmacy will be able to read it either.

This doesn't mean you have to know what a BMP or CBC or PT is... or know what the diagnosis code 787.91 stands for. But, if there are letters and numbers you can't make out - we won't be able to either!

And if it's after 3 or 4 pm on most days, and certainly Friday, you won't be able to call your doctor and ask what's on that prescription and you'll have to come back another time.

2. Make sure there are diagnosis codes. Insurance companies pay out based not only on what tests are ordered, but also on if those tests match up with what your doctor says is wrong with you, i.e., your diagnosis codes.

3. Please make sure you go over each test with your doctor. Ask them what they are specifically looking for with each test. AND, ask them what the course of action is if the result is positive OR negative.

If your doctor can't adequately explain what they're looking for, why, and what they're going to do next - I seriously think you should get a new doctor.

4. It's your health! Don't be passive and assume the doctor is all knowing. We get thirty patients or more a day from a certain doctor - and almost every set of lab work is the same for each patient. Are all the patients really that similar?? Maybe. Maybe not. Don't get a "rubber stamp" prescription.

On Being Afraid

One of the more interesting aspects of my job is over the coarse of the day seeing all the many ways being afraid makes people act.

I've never been afraid of needles or shots or having my blood drawn. Fortunately, I do tend to be empathetic. Still, sometimes it's hard for me to understand just how afraid some people are to have their blood drawn.

The subtle people just turn their heads so they can't see what I'm doing.

Men and women do react a little differently, but not necessarily a lot differently.

Sometimes the person who's the biggest jerk before and during the draw changes completely once I'm done and are so relieved it's over and I didn't hurt them they sometimes leave literally blessing me. I'm learning to be very patient and not get pissy with those kind of people.

Sometimes I just have to remind the person to keep breathing so they don't pass out. And in my experience, men have passed out about ten times as much as women. Usually young men.

And the worst people we generally deal with are parents who's kids have to have their blood drawn from a vein instead of a heel stick. These are parents I'd bet all my money are afraid of having their own blood drawn. Add to that the stress of having a sick kid - AND a sick kid who has to have their blood drawn - and it's not always a pretty picture. Generally we'll have one phleb hold the kid's arm still and one phleb do the actual draw - because parents usually are terrible at holding their kid still enough. Kids are really, really strong - and they hate nothing more than being held still/down.

Anyway. Fear has strange and sometimes strong affects on personality.

Memories

I used to sell plasma and this post pretty much nails it - and I swear, they used nails to draw blood. Needles come in gauges - the bigger the number, the smaller the needle - don't ask me why. Normally I use 21 or 23 gauge needles. For kids you use either 23 or 25. The plasma place went from 18 to 16, and that's when I stopped.

I couldn't even use college as an excuse, I was just a poor working person who'd already graduated college.

Anyway. If I have one word of advice for anyone getting their blood drawn for any reason - DRINK LOTS OF WATER before going. It makes a huge difference. I had a nice, healthy, fit woman about 50 years old today that I had to stick twice - the second time I got in a vein in the back of her hand, and the blood was so thick it wouldn't even drip into the tube. I made her drink a big glass of water and we tried again ten minutes later and finally got the tube we needed full.

And the reason they draw your blood at 4 a.m. when you're in the hospital is because your doctor wants the results from the lab before his/her 7 a.m. rounds. Trust me, we don't like waking you up to draw your blood anymore than you do. (Just one of the many, many reasons I do out-patient and not in-patient.)

Rambling about Health

It's interesting working "sick" people all day. I generally know nothing other than what tests the doctor has ordered and what color tube that corresponds to for me to draw.

Side note: the different colored tubes when you have your blood drawn are for different types of tests. The one with the gel in the bottom is so that after you centrifuge the tube - the serum and plasma are separated - the red stuff is on bottom and the clear stuff is on top. The plain red tube keeps the blood whole and lets it clot. All the other colors have different types of additives to keep the blood from clotting so the lab can see things like cell counts. For some tubes you can only run one or two tests, or some tests even if they use the same color tube have to be in their own tube - generally because different parts of the lab use it and evidently they don't like to share. You know, in case you were wondering and never asked. I tend to try to explain things like that to the patients.

Anyway. Unless I do the registration for a patient (the computer part) I don't know what their diagnosis is or why the doctor ordered those tests. The test themselves don't tell me anything about why a person is having their blood drawn - unless it's something obvious like HIV or Hepetitis - but even then I won't know if it's because the person already has those viruses or if they're checking to make sure they don't. And as a phleb I never see the results of the tests. And for most tests, even if I saw the results I wouldn't know what the numbers meant. Basically you don't have to worry about your phleb thinking weird stuff about you coming in for blood work.

None of that was the reason for this post...

What I was thinking about today is how dealing with different levels of sick and/or old people all day has different affects on me emotionally.

I have been an amazingly fortunate person regarding my health. I am rarely sick and have never had anything major wrong with me. Even when I broke my arm as a kid it didn't hurt.

So seeing my patients all day reminds me how lucky I am. And it also makes me think about how I would handle it if I were to get some sickness and have to have blood work all the time - or get something the doc couldn't figure out what it was. I'm not sure I'd make a good patient.

And dealing with the older people is both encouraging and discouraging. I mean, these are the people who are 85+ and are still getting out and around and coming to a lab and having bloodwork done. They're not in a retirement home or hospital all the time.

It makes me wonder what kind of old person I'll be. I don't like the idea of getting/being old - even if I've got my own house and car at 90. And I think there will be certain illnesses and I'll have it very clear that I want the plug pulled at X time.

So here's to good health for everyone!!

Bad Days

I really like the patients at my current hospital more than I liked the ones in KC. Then again, I generally like the people in the DC area more than those in KC. As I've said, I like the diversity here - and that people who choose to live here generally seem to be energetic people who want to "make it" in life.

But the last couple of days when I've walked into one of the draw rooms and asked the patient how they're doing, I've gotten a lot of people saying "not so good".

Today, I had an elderly gentleman say that his wife had died two months ago - on his birthday. That's so sad. I had another elderly gentleman say he was ready to die. I had a middle aged woman say her doctor told her she's about to die, but that they'd told her that three years ago as well, but if they couldn't find a way to stop all her pain, she was ready to die. Worst of all, today I had a couple, the woman six or so months pregnant, and they'd just been told some really, really bad news about the pregnancy (I didn't ever find out exactly what). Her husband had gone to get something just as I was finishing drawing her blood, and after I was done she started to cry. I told her it was ok to cry, that between the hormones and bad news of course she was crying, and I hugged her for a moment. It was all I could do to not cry with her.

It wasn't long after that I had my lunch break, which gave me some time to think.

I don't write much here about my faith in God, or my beliefs. Mostly because they're so ill defined. But I do have a lot of faith in God. And there's still a part of me that really wants to be a person God works through.

In very simple terms, I have two goals at work. One is to not fuck up. I don't want to miss when I try to hit a vein. I don't want to draw the wrong tube or order the wrong test. All of that because I don't want to cause a patient discomfort or for them to have to come back and redo a draw because of something I did. Two is that I really want every patient to feel "good" when they leave my part of my job. (Eventually my time will be split between registering patients on the computer and drawing blood.)

Now, is it necessary for God to be a part of any of that? I don't know. But some part of me still believes that God really does bless people - and he generally does so through other people. I truly believe even just smiling at strangers can make a difference.

What's funny is that one of my co-workers "found God" about two years ago - and she's one of my least favorite co-workers. She tells people "God bless you" after she draws their blood - and I've seen it make people uncomfortable. Another of my co-workers is leaving this job in a month to go begin the process to be a Franciscan Monk. He has no reverence that's visible.

I really have no idea what I feel diferentiates me from them.

Anyway. I thought this post would be something other than what it's ended up being. Something about dealing with the public and trying in some small way to make their day just a little better.

Patients

Patients don't care how many other patients you've already seen that day.

Patients don't care how much sleep you got last night.

Patients don't care how you feel about your boss or coworkers or other patients.

Patients don't care about much - other than you finding their vein and hitting it the first try without much pain.

And really, I can't disagree with any of it.

Kids

My job has expanded to include the one part of being a phlebotomist I really didn't want - that of being a torturer of small children. I think I've mentioned that our main lab also ends up staffing several other smaller offices. Lucky me has been chosen to spend a couple of days a week down at a family care office - which means I get to do four or five finger sticks or venipunctures on kids under 9 on days I'm down there. Fun.

Things go along swimmingly up until the moment they see the needle (the smallest possible). Then I swear they're overtaken by small demons of writhing and screaming. No amount of promises that no it really won't hurt that much does any good. I tell them that if it hurts as much as they think it will - then once it's over I'll let them punch me in the arm as hard as they can. And while that's good for giving them a pause, it doesn't always result in a complete end to said writhing and screaming. And not one has taken me up on the offer - because every time after the needle goes in they kinda stop and look at me like "that's it??"

It's really not the screaming that bothers me anymore - it's just the moving around that prevents me from getting the stick over and done with.

The finger sticks on kids under about 1 and 1/2 usually go better now that I'm learning the tricks of the trade (smallest possible gloves, where to stick the finger exactly, etc). Once the initial prick is over, they usually just watch and then get bored and frustrated they're being held still.

What surprises me most sometimes is how unhelpful the parents are. And even more fun is when they've got a couple of other kids along who get into everything while I'm dealing with the demon possessed one.

Note to self: make sure in the next job interview that there really will be NO children involved.

Must be the weather

I'm not sure why, but we've had patients be a little more fragile this week it seems. Two days in a row we had a patient faint. And today we had two young women who had to be drawn on the lay down station instead of the regular drawing chairs.

Yesterday I was supervising a student and it was one of her first ten or so draws - she was just about done with the third tube and about to pull out the needle when the patient said "I'm going to faint" I said "seriously" he said "yes" so I was going to get some water and as I did - out he went. Thankfully the chairs are designed so if they fall foward the arm bar thing is there to keep them from falling out of the chair. The funny part is he's a paramedic!

I've also found that men tend to be either a lot more onery or a lot more of a wuss than women.

Work

Things are just sort of going along these days. If you'd asked me a week ago if I really, really thought I'd rather work downtown than up north, I'd have said - no, not really. But after this week, I am kinda looking forward to working downtown starting Monday.

This week I've filled in for the 11:30 to 8 shift, and I must say, it's not my favorite. I don't get up early enough to really get a lot done before work - you know, other than feeding the pets, watering the plants, going to get the mail, and getting breakfast. (Anyone else addicted to Panera bread bagels? It's the blueberry ones for me. Although, the switched to organic chocolate milk - uh, no thanks.) And getting home about 8:20 at night just feels like too late to do much more than find something to eat and walk the dog.

I've also worked back in processing all week. One of the things that sucks about being a "temp" is that no one else wants to work processing, so they finagle it so I'm back there all the time. Then, just to make things better, I was the only phlebotomist there yesterday from 3 to 6. Thank God only three people came in to get their blood drawn. Back in processing we process all the blood drawn from the hospital floors, the ER and the people who come into the lab for outpatient draws. We put the appropriate tubes (of blood) in the centrifuge, receive them in the computer system, label them, and take them to the appropriate department. It's not the hardest work in the world, but you do have to be good at organizing things and paying at least a little attention to details.

Downtown I don't have to worry about any of that. It's simply a draw station. We fill out the req., draw the blood, and send it across the street to a big lab for the downtown hospital. (The lab up north fits in the space of what one of six departments downtown fits in.)

I have such a strange detachment from the idea of working. I think I carry around this idea that hey, I didn't work for so long, it's not really necessary that I work now, so I can take it or leave it. I don't know if that makes sense. I think part of it also this idea that we really hope to move, so there's no reason to get attached to this particular job anyway.

Are we gonna move? I have no idea. I think a lot of it is going to come down to what Nerdstar wants to do work-wise next. But that's neither here nor there for today.

Work

Nothing like a real job to make me appreciate weekends - and how short they are - again!

I really, really like being a phlebotomist. The actual job is a lot like I imagined it would be. What's funny is I think it's a lot like waiting tables. I'm on my feet all day and dealing with people for short amounts of time.

So far, I'm not half bad with the needle. I've learned which patients I can hit a vein on, and which ones I can't. I'm sure my coworkers will be very happy when I learn to hit the ones I currently can't. A couple think it's a lack of confidence, but I don't agree with that. It's just that I'm not comfortable trying for a vein I can't feel. My "feeling" finger is getting more sensitive though.

What I don't like about my current job - my coworkers. Burn out is a very ugly thing. What's funny is that while they've all been very nice and helpful with me - the newbie - they don't all get along very well. It's just a clash of personalities, but still. I've got two sets of coworkers - other phlebs, and then the med techs who run the actual tests on the blood back in the lab. All the med techs have been really helpful to me, too. I wish I could see what a lab would have looked like 20 years ago before these hi-tech machines did all the work for them!

If they're all being so nice to me, why don't I like them? A lot of it comes down to absolutely nothing in common, and personality clashes. But I am determined not to argue with anyone, and to maintain a good attitude. It helps that Nerdstar and I really, really intend to move (hopefully sometime this year)!

I had a patient the other day who was 100 years old. Wow. Of course, he was one of the "hard sticks" but I gave it a try - and missed. I felt horrible! I'm sure the back of his hand is still purple (from the blood pooling under the skin).

I'd say 70% of our patients are white people over 55. Not very exciting.

But, if I like doing my job this much in a workplace where I have nothing in common with my coworkers and see the same types of patients all day - just think how much more I'll enjoy it when we move to a place we actually like to live and I hopefully have more diverse coworkers and patients!

How Work Goes

Work has been interesting this week. I've felt like I've been thrown to the wolves a lot! I've been at the uptown hospital where the job includes working in the lab as well as drawing from patients. What's neat is that everyone takes turns rotating between working in the front (drawing) and the back (the lab).

Now, while I learned a lot in the class I took, I didn't really learn much about the lab part - processing the bloodwork. Tuesday was my first day of training in the back. Then I show up Wednesday for work only to find out that for some reason (I think someone called in) I was the only one working in the back that morning. Now, there are several Med Techs that work in the back who are very knowledgeable and mostly helpful, but still... it was a bit nervewracking. Then yesterday I worked the later shift up front and again was left up there to work alone for the last three hours.

I figure I'm at about 70% when it comes to really being proficient in both jobs, front and back. There are so many little details about paperwork, which tests are being ordered, or what colored tube to draw the blood in that I need to learn more about up front, and in back it's a question of which tubes require special handling.

One thing I didn't anticipate in this job was that there aren't more stringent black and white standards on some things. Like if we're drawing blood for TSH levels does it go in a plain red tube or a red tube with gel? Well, that depends on which Tech you ask. I don't like that. I know the stakes are high for getting the tests results right, and the last thing I want is for a patient to have to come back in to re-draw their blood because one tube was drawn instead of the other. That happens, but not very often. I think the cause for patients having to come back in most often is that a test required X amount of blood in the tube, and the phlebotomist just wasn't able to get that much for whatever reason.

One thing I can tell you, even though you'll never see the people who work in the lab who process everything, they are concerned about the patients whose tests they're running.

No sense of proportion

One type of patient I get to see is pregnant girls (as in under 25). I don't see as many uptown as downtown, downtown has a pre-natal clinic once a week and that lab does all their bloodwork.

It makes me laugh a little when they're all upset about the needle and the blood draw. I mean, if you're pregnant, then the needle is going to be one of the least painful parts of the next several months, if you can't handle that, how will you handle labor and delivery?

Choices

Today was day two up at the hospital closer to the house.

One thing I wouldn't have anticipated about working in phlebotomy/the lab is that all of the staffs are 95% women. After my last job in Austin, working with all women, it's not my favorite environment. I am smart enough to know that there are absolutely NO secrets. If you tell one person something, you can safely assume you've just told everyone. Well, except for the one or two women that particular woman isn't talking to. UGH!

From what I can tell, I have two fairly different work environments to choose from. The downtown lab is pretty chaotic, very loose, but things get done and the job is pretty simple. There are going to be several new employees soon, because half of the current staff is moving on to somewhere else. Downtown I would only be doing patient draws, not any lab work. Downtown is a 50 minute door to door commute, but it's only open 7:30 to 6 Monday thru Friday. I'd never have night or weekend hours.

The uptown lab is run very smoothly. Most of the women there have been there for a few years, several have been in this field, if not this particular hospital for more than ten or fifteen years. Not only will I be doing patient draws, I'll also rotate some days back in the lab and learn processing. This location is open 6:30 to 6:30 Monday through Friday and 7 to noon Saturdays for patients and the lab is 24/7. It's only a 20 minute door to door commute.

For now I'm working uptown tomorrow and all of next week. I lean toward staying uptown just because it's better to learn all that I can for when Nerdstar and I move and I have to find this type of job again. But a lot depends on how it goes working with those particular women all next week.

Early

Sorry for the light posting! Yesterday, today and tomorrow are the days I'm getting up at 2 a.m. to be at the hospital by 3:30 a.m. Someone in the hospital decided that doctors needed the lab results in time for 7 a.m. rounds. That means going to patients' rooms between four and five a.m. to draw their blood. Fun.

I have learned that I don't really want to do anything regarding in-patient care. I was pretty sure going into this that I would really enjoy dealing with people for, say, ten minutes at a time. I was right. One day last week I did my rotation over at the children's hospital. Again, not for me. Partly because it would be a year or two before I felt my skills were good enough to draw blood from little kids. And partly because it just broke my heart to see kids in the hospital, even in an out-patient setting.

Thursday is our final exam, then we just have half a day of more draws Friday. I'm pretty ready for the class to be over.

I don't have any solid info on a job yet, but will hopefully know something in the next week or two. I've heard it can take HR a while to process everything even if there's an opening.

Two Down, Two To Go

I'm halfway through this vampire class. It's going just about like I expected. We started with three days of classes, and have spent the last seven days in the various "draw stations" "sticking" real patients. It's been good to rotate through the three stations because they have such different patient populations. One has a lot of renal patients, one has a lot of children and pregnant women (it's next door to a pediatric office), and the third has a wide variety. It's not as hard to draw blood from the elderly as I would have thought.

We have to do 100 successful sticks. As of now I have 81 successful out of 95 total, 85% success rate after only seven days is decent. Of course, I'd like it to be higher. It was interesting Friday in that I learned that if I really can't feel the vein, I'm not likely to hit it. The bad side is that since I'm still learning, I need to try, the good side is that I only try once and then let the pros do it. It's nice for me, but not the patient, when they have trouble as well!

Doing phlebotomy as a job is about what I expected as well. I really enjoy talking and interacting with patients on a short time basis. I like putting them at ease. What's funny at this point in my training is that I'm absolutely terrible at tying a turniquit!! Unfortunately, the patient sees me struggling with it and figures there's no way I'm not going to hurt them with a needle. Fortunately my "sticking" technique is nice and smooth and so far no one has complained of it hurting.

We have our first exam Tuesday. I don't expect it to be a problem. Then I think on Wednesday we get a lecture from a lady from a children's hospital and then later in the week we actually go spend a few hours at the children's hospital doing sticks with children patients. Having seen just a few already, I'm not sure I'm looking forward to that.

In addition to the children's hospital, we do a "shadowing" of a patient care tech and a ride along with the lady who does home draws. I'm really glad we get to see so many different settings to do phlebotomy.

Day Five

I was telling Nerdstar the other night, I just want to be good at something. It's been a long time since I felt like I was good at something. Certainly the last year or so of my last job, honestly, I sucked.

Today wasn't really discouraging, but it might should have been. I stuck about 18 people and only hit about 9 veins. Now, my saving grace is that I generally cause no pain. And this first week so I only try once and then let the pro do it. My pro for yesterday and today usually made it look pretty easy, but I'd say half of my misses weren't a piece of cake for her either. This particular lab gets renal patients and such. I'd still be happier if I'd hit more than 50% today!

Just so you know, if you're ever getting your blood drawn, yes, there are veins that are a little hard to find, but don't let any phlebotomist blame your body for their miss! Just the simple act of pulling the skin tight near the vein will make the needle going on a LOT less painful. And once in, the needle should barely move - and only forward and backward, not up or down or side to side. And never hesitate to ask that person to find someone else to try. At the hospital I'm training at the policy is one person gets 2 sticks, the next person 2 sticks, and one more person gets 1 more stick before calling the patient's doc to find another way to get the test.

So, one week down, three to go! Next week is all 8 a.m. to 4:30 and all day at the labs to do more sticks.

Day Four

I had a damn early start to my day today. I had to be at the hospital at 6 a.m., which meant my alarm went off at 4:30. Fortunately, I felt pretty energized all day, but now I'm starting to fade.

Today was my first day in the lab drawing real people's blood. I got 9 out of 10 sticks successfully. We have to do 100 successful sticks by the end of the training. I guess that's a pretty good start. Today I was in an outpatient little office within the hospital and this one lady usually works it alone, except when she's nice and helping out us students. I have to introduce myself and inform them that I'm a student and ask their consent. They were all very nice. I think I caused one or two a little pain, but nothing that anyone complained about.

I'm finding two things in my favor. One, I'm fairly confident. That helps me not have a shaky hand and helps me just get in there and do it. And when I had two back to back sticks that didn't go all that great, the next one was one of my best. It helps to know that just because one or two don't go smoothly, it doesn't mean the rest of your day is doomed. Two, I'm ambidextrious. Really, the only thing I do right-handed is handwriting. I've always done everything else left handed, drive, brush my teeth, bat. That means I can smoothly stick someone with a needle with my left hand - leaving my right hand free to do things like change tubes, release the tourniquit, apply the cotton ball, etc. Now, if I can just get patients to sit in the chair set up for lefties...

It's crazy that this is really only day 4 of our training. It seems like longer. I'll definitely be ready for a break this weekend.

Day One

Well, today was day one of official vampire school. It was a long day of lecture, but I really did learn a lot - mostly about what can go wrong when drawing someone's blood. I didn't know you could cause permanent nerve damage.

At the end of the day we practiced on a little skin like thing with various veins in it, then once on a fake arm that had actual liquids to draw out, then we went over to a draw station and drew each other's blood. I'm a little worried about finding veins by feel and not sight, my finger doesn't seem to be sensitive enough yet, but other than that I did just fine, as did my classmates.

Tomorrow and Wednesday are more lecture days, then starting at 6 a.m. Thursday and Friday I spend all day at a lab doing as many sticks as possible.

I really appreciate the 80% hands on learning they've set up for this class. We go to about five or six different settings with as many different people supervising us in the next three weeks.

I can only hope that all of the people I draw from feel like Eden did about her phlebotomist.