Sunday, December 07, 2008

A Nurse Who Does Everything

On Friday, I saw Dr. Feinberg, my oncologist, for the six-month check up. Part of the visit to the office that houses his oncology group includes having blood drawn from a vein for evaluation in the lab there. Dr. Feinberg does not do the blood drawing. Instead, there is a unit of phlebotomists, technicians who specialize in finding the right vein (or artery, now and then: ugh!).

I had a new phlebotomist on Friday, a lady from Colombia. She had her own style, as each of the phlebotomists there does, and hers was minimalist. I sit down in the chair, lay my right arm out, elbow down and open on the special pad which is part of the arm of the chair. The chair is next to a small table where she sits, facing in my direction, and holds various small bottles and things to stick with.

Now and then (not often) I get a tube tied around my upper arm like a tourniquet and something to squeeze in my fist. Then the technician starts looking for a good vein, sometimes commenting on their being deep or "there's a good one" or "did you drink a lot of water today?" Sometimes, though rarely, they will want to look at both arms. When they finally do the stick, it is not painful. The phlebotomists there are really good (I've been going there for I think 15 years.) But there seems to be an inverse relationship between the amount of chatter I hear from them, as they articulate their search-and-stick process, and how easy the procedure that day turns out to be.

The Colombian lady is friendly and says very little, really, that has anything to do with her work. She simply dabs a spot with alcohol on the inside of my elbow and sticks the needle in, and I feel virtually nothing: no tourniquet, no ball to squeeze, no looking around for veins, maybe a tap or two with her finger on the one she seems instantly to find, absolutely no fuss. I like this lady.

As we are sitting there waiting for the blood to come out and as she otherwise finishes, I ask her whether the doctors know how to do what she does. She says that not even the nurses "in this country [USA]" can do what she does, especially when it comes to a deep blood vessel. She states that in Colombia, nurses who are "registered" are people who mainly handle paper. She was not such a registered nurse, she said, and she did everything, from drawing blood to emptying bed-pans to changing the sheets. She commented on how one gets to know the patient that way and that how that aspect of care, getting to know the patient, had a higher value there than here in the US. I couldn't tell whether she meant that the physicians had that higher value there or whether it was limited to the sort of nursing she practices, a nursing where the nurse "does everything."

She said that doctors who know how to draw blood as she does are those who, during their own training, make it a point to learn, as if a medical student would not ordinarily pick up that skill if he or she did not decide that she was going to learn it. It made me wonder about missionary doctor preparation. Can (and should) a medical student preparing for that life equip himself or herself with the skills of a Colombian nurse who is not registered but who "does everything"?

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