My Shiny Yet Horribly Inaccurate Medical Bling!

As some of you may or may not know, I am a huge jewelry fan. At almost any given time during the day, I'll be wearing 4 pairs of earrings, a Swiss Army watch (and as a quick shameless plug for the Swiss, basically everything they make is built to last), a necklace, and possibly a bracelet or two. My mother has known about my affinity for jewelry for years and she usually indulges me on my birthday and holidays, with an occasional "I saw this in the jewelry store today and thought you might like it" gift thrown in every now and then. Nothing too ostentatious or insanely expensive, mind you, but I've acquired quite a nice assortment of pieces over the years.

The latest addition to my collection came earlier this week, when my mother handed me one of those cute little boxes that jewelry stores package earrings/rings/pendants in. Before I opened it, she told me not to wear it until I graduated, and when I pointed out that that was still quite a way's away, she said, "Okay, you can wear it for inspiration until then."

So I opened the box, and lo and behold, I found this:



Now I'm never one to turn jewelry down and unless something is incredibly tacky, chances are that I'm going to like whatever you want to give me. And I really do like this pendant, but one thing that whomever designed it failed to realize is that the Caduceus isn't a symbol for medicine. In fact, our good friends at Wikipedia go as far as to suggest that it's associated with "theft, commerce, deception and death" (and since it's on Wikipedia, clearly it must be true). The less aesthetically pleasing but far more mythologically accurate Rod of Asclepius is what the designer should have aimed for, but apparently confusion between the 2 symbols arose as far back as the 19th century. (It's also noted that the Americans realized the mistake not too long afterward, but maybe everyone figured that it was just funnier to not clear up the matter, even over 100 years later.)

It's still a lovely pendant, though. All the inaccuracies aside, I am wearing it for inspiration. Partially in a "think of all the lives you'll save one day!" sort of way, but mostly in a "Okay, this actually has 'MD' on it. So if you fail medical school, you are going to look like a giant ass and a raging liar and you will be stuck $50,000 in the hole. For the love of God, don't flunk out!" sort of way.


I secretly hope that if I don't flunk out, I someday might end up making enough money to be able to trick myself out with bling à la Lil Wayne. But hopefully without, you know, going to jail.

My Second Needlestick Injury (Now with 50% less badass!)

I was originally going to start this entry with a thrilling yet entirely made-up narrative of how I'd received my second needlestick injury, (i.e., I'd gotten jabbed while trying to inject epinephrine into a patient in cardiac arrest, with special emphasis on how I looked so sexy doing this that the handsome trauma resident working with me continuously shot me "Come hither" looks as he did chest compressions). But then I realized that my extensive fan base (all 2 of you) would immediately see right through this and probably call me out on my BS. So I grudgingly decided to be forthcoming and truthful about my second needlestick injury, even at the risk of sounding completely incompetent and far less awesome than I fancy myself to be. (Feel free to thank me for my honesty.)

What really happened is that I recently attended a workshop in which medical students could practice a number of different skills (IV insertion, intubation, injections, etc.) under the watch of a physician, nurse, or clerk. Since my last attempt at IV insertion and venipuncture was nothing short of a disaster, I deliberately signed up for this session to improve my skills and show that damned butterfly needle who's boss. Now, one of the main reasons why I'd gotten stuck with a needle during my last venipuncture attempt (aside from my general lack of know-how) was that I was unsupervised as I tried it, resulting in no one stopping me from doing something stupid like pulling the rubber casing off of the needle. However, in the workshop session I signed up for, there were going to be 3 preceptors minding only 6 students, and I figured that as long as I did everything under the watchful eye of someone who knew their stuff, nothing could possibly go wrong.

Clearly the fact that I'm even writing this suggests that something went wrong.

The session started out deceptively well, probably because life likes screwing around with me in that sort of way. I tried doing an IV insertion first, making sure that one of the nurses running the session gave me the green light for each move. In retrospect, this probably annoyed her to no end ("Okay, so do I advance the catheter now?", "Should I pull out the needle now?", "I apply a strip of tape here, right?"), but I was hellbent on not getting hurt. My irritating diligence did pay off in the end, as I managed to insert the IV without sticking myself, although the mannequin arm I was practicing on lost a decent amount of fake blood. (I may have been a bit slow in doing things like staunching blood flow and actually hooking the damn IV up, but we take victories wherever we can get them, right?)

Successfully inserting the IV gave me the boost of confidence I needed to try my hand at venipuncture. After taking out the IV from the mannequin arm and applying a tourniquet to it, I gathered the equipment I would need for a venipuncture: a collection tube, a vacutainer, and of course, the dreaded butterfly needle. As you may recall, my first needlestick injury was from this type of needle - more specifically, the end of the it that is supposed to be inserted into the collection tube. With this in mind, I was understandably more careful when handling this portion of the needle. Rather than trying to tug the rubber sheath off of it, I screwed it into the vacutainer as the nurse instructed me to do. To my delight I realized that the vacutainer would not only hold the end of the needle in place when it came time to attach the collection tube, but it would also act as a barrier between the needle's sharp tip and my hands. (To help you visualize this, I included one of my MS Paint-modified pictures below.)



So there was some nice, thick plastic separating the rubber encased needle from my fingers. If you guessed that that prevented me from getting the same sort of needlestick injury I got before, you are absolutely right. However, if you look at the picture a little more closely, you will see that the other end of the needle is not surrounded by a similar protective barrier, but is rather ensheathed in a tight, thin plastic covering that is really difficult to take off.



To my credit, I do learn from my mistakes to an extent. I figured that if the plastic covering was as tightly wrapped around this end of the needle as the rubber sheath on the opposite end, yanking it off would cause the needle to shoot unpredictably in my general direction and stab me in the process. Armed with this bit of foresight, I turned to the nurse and asked, "Is there a safe way to take this off?"

She said to hold the base of the needle steady and slowly ease off the covering, which sounded about right. Grasping the base of the needle with my right hand, I used the thumb and index finger of my left hand to gently pull at the thin plastic sheath. The sheath didn't budge.

I pulled a bit harder. Still nothing.

I pulled slightly harder, and that's when shit happened, as shit is wont to do.

The plastic sheath instantly slid off the needle, much like the rubber sheath did when I got jabbed the first time. But since my right hand was holding the needle in place, it didn't fly towards me. Rather, my left hand recoiled and jerked towards the needle. If you want to see this for yourself, find a pen with a cap that's too tight to fit properly and try pulling the two apart. Unless your hands are incredibly steady, they'll probably snap toward each other once you pull the pen and the cap apart. (Or if not, there's always the possibility that I just have the manual dexterity of a cabbage and should never, ever handle sharp objects like needles.)

So my left hand jerked towards the needle. I felt the stab of pain before I had time to fully process what was happening, and I looked down to see a drop of blood welling on the tip of my left index finger. A moment later I heard someone next to me gasp. It was none other than the same girl who had been in my group during the very first IV insertion and venipuncture session we had, the girl I had made small talk with.

I'd gotten stuck with the exact same type of needle, in the exact same finger, doing the exact same procedure, in front of the exact same girl as before. You have got to be kidding me, I thought. You have got to be fucking kidding me.

The only point to the good was that I didn't get the same apathetic reaction from everyone else as I did the first time around. After the nurse realized what had happened, she quickly handed me a piece of gauze and said, "Oh no! Would you like me to try to find you a band-aid?"

You still don't have bandages on hand in the anatomy lab? What is wrong with this school? went my inner monologue.

Outwardly I flashed her an embarrassed smile, wrapped the gauze around my finger, and told her that no, she needn't bother since I probably had a band-aid in my purse. She then asked if I was all right, and I assured her that yes, I was fine, and that I was used to being poked with needles, oftentimes willingly.

The uncomfortable look that crossed her face suggested that what I'd just said could probably be grossly misinterpreted (e.g., intravenous drug user!). I quickly flipped back my hair and gestured to the four piercings I had in each ear, which was I had meant when I said that I was used to being willingly poked with needles. Then, being the old pro that I was in dealing with needlestick injuries, I excused myself from the session, trudged over to the sink to wash the wound with soap and water, and retrieved a band-aid from my purse. I was also shouting a string of obscenities in my mind the entire time, being such a good multitasker and all.

And that is the story of my second needlestick injury. I know that I'm probably expected to have slip-ups like these so early on in my medical training, but this is just getting embarrassing. I mean, I come from a family of people who have displayed insane levels of badassery in the face of injury - my father took a freaking chainsaw to the throat (work-related accident), my brother managed to work out in the gym for 2 weeks before noticing that he had a pneumothorax, and my mother gave birth to both my brother and I without epidurals. And here I am, getting repeatedly jabbed by needles without even a cool backstory to show for it.

Ah, screw it. Stay tuned for my next needlestick injury (you know it's going to happen eventually), same Bat-time, same Bat-channel.

My First Needlestick Injury (Mistake #276 that I've made in med school so far)

Every doctor is guaranteed to get at least one needlestick injury at some point in his or her career. No matter how many precautions you take and protocols you follow, there will come a day when shit will hit the fan and the nasty end of a hypodermic needle will hit you. After listening to a lecture covering some of the occupational hazards that health care workers face, I began wondering what my first needlestick injury would be like. While I fervently prayed that it would be a relatively benign event (i.e., getting stuck with a sterile needle fresh out its packaging rather than getting stuck with a needle fresh out of a patient with an infectious disease), I found myself imagining that it would be like an epic movie scene. In this scene, I would step back from the patient whose life I'd just saved, yank the needle out of my arm, rip off my surgical mask, wipe the sweat off my brow, and look boldly off into the distance. "It had to be done," I would declare. "Damn it all, I'm a doctor. I save lives!"

(As you can see, I clearly have no future writing movie scripts, so let's hope this whole becoming-a-physician thing pans out for me.)

But based on the title of this post, you can hazard the guess that my first needlestick injury categorically did not occur in as awesome and badass a manner as I hoped it would. What actually happened is probably better described with words like "laughable" and "pathetic" and "Oh my God, I cannot believe this girl is going to be allowed to handle sharp objects like scalpels and loaded syringes. Someone take those away from her before she hurts herself!"

Like most things, it started off innocently enough. Our class was expected to attend a special skills session in the anatomy lab where we would practice inserting IVs and performing venipuncture. Excited at the prospect of doing something hands-on, I arrived at the lab early to check out what was set up for us. Laid out on a table were packages of alcohol swabs, tourniquets, IV catheters, tubing, butterfly needles, and two massive mannequin arms connected to bags of what looked like red food coloring. As I looked over all the equipment, a girl from my class joined me by the table and we started making small talk to pass the time. "I'm really excited to try this out," I told her. "Although knowing my luck, I'll probably be the first person in the class to get a needlestick injury doing this." (Hint: this is a little technique that them writer folk like to call foreshadowing.)

She laughed and replied that she was sure I'd be fine (if I'd known what was going to happen, I would've bet money against her wonderfully idealistic prediction). Shortly after, the rest of our classmates in our group started filing into the room, followed by our preceptor, an anesthesiology resident. He went through a handout that we'd been given on IV insertion and venipuncture, then gathered us around the table to demonstrate what we'd be doing. It all seemed simple enough - apply tourniquet to distend vein, disinfect site, insert needle, then either advance catheter and attach tubing (IV insertion) or attach other end of butterfly needle into collection tube (venipuncture). There was no possible way to screw that up, right? (Another bit of foreshadowing: there was totally a way to screw that up, and guess who discovered it?)

We were instructed to take turns practicing inserting an IV and drawing blood (well, red food coloring) from the mannequin arms. When my turn came, I decided to try venipuncture first, since it was the easier of the two techniques. To my credit, I started out like a seasoned veteran. Apply tourniquet? Check. Locate suitable vein? Check. Disinfect area around said vein with alcohol swab? Check. Now for the fun sharp stuff.

I removed a sterile butterfly needle from its packaging and carefully inserted it into one of the mannequin's veins. A moment later I was rewarded with a flashback of red food coloring into the hub of the needle - I was in the vein. As I held the needle in place with my right hand, I ran my left hand down the length of the attached tubing until I reached the second needle at the end of it. Now, this second needle is meant to be inserted into a blood collection tube. Since these tubes are under negative pressure, poking through it with the needle will draw blood out from the patient's vein, through the tubing, and ultimately into the collection tube. I'm sure anyone reading this has probably had blood drawn before and can hopefully visualize what I'm saying, but I included a picture below for reference.



To get back to the story, we're at the part where I'm holding the needle that I'm supposed to insert into the collection tube. And as I looked at the needle, I realized that it was covered with a rubber sheath (which I have marked on the diagram with my piss-poor attempt to draw an angry face using MS Paint - more foreshadowing!). Thinking that the rubber sheath was supposed to be removed prior to inserting the needle into the tube (look at the size of that sheath! Could you blame me for thinking that I wouldn't be able to just ram the whole thing through the top of the tube?), I started tugging at it with my left hand.

The fact that the sheath was tightly wrapped around the needle and difficult to remove should have led me to the very sensible conclusion that maybe it wasn't supposed to be removed at all. Unfortunately, brawn won out over brains, and I gave the sheath one last, forceful yank. What happened next was a bit of a blur since it all took place in the space of about a second, but I'll outline it as best I can.

The sheath snapped off and the now uncovered needle shot toward me like a rubber band. I reflexively jerked my head back to avoid getting hit in the face, but the rest of my body didn't respond as quickly. I felt something stab into the index finger of my left hand, and I looked down in time to see giant drops of blood fall from my fingertip onto the table, mixing in with some red food coloring that the mannequin arm had leaked out during another student's failed attempt at inserting an IV.

"Son of a bitch!" I snapped under my breath, as I frantically tried to think of what to do next. My right hand was still holding the opposite end of the butterfly needle in the mannequin's vein, so I yanked it out and chucked the whole thing into the sharps container. I then walked up to the anesthesiology resident, who was fiddling with his pager in the corner of the room, showed him my finger, and said, "I had a bit of an accident while trying to do a venipuncture." Completely unsupervised by you, I wanted to add, but I figured that I should probably first address the issue of how I was technically turning the lab into a biohazard by dripping blood onto the floor.

His reaction pissed me off. His eyes widened as he took a step back (what, did he think I was planning on bleeding onto his expensive-looking shoes?) and said, "Oh. Wow. That's not good. Um. Wow. You need to, uh, wash that out. Yeah, go wash it with soap and water."

Okay, so cleaning the wound was good advice, but this guy made no attempt to try to find a first aid kit, glance at the injury for more than 2 seconds, or even ask how exactly I'd gotten hurt. Realizing that I wasn't going to get any help from him whatsoever, I stalked out of the room to find the sink near the entrance to the anatomy lab, trying to ignore the stares of my classmates who had clued in to what had happened.

Once at the sink, I pumped a crapload of soap onto my hands and started rinsing the blood off my finger. It hurt like hell but I was still able to move it normally, so I figured that the needle hadn't jabbed in deep enough to do any major damage. As I left my hand under the running water for a minute, I glanced around at what everyone else was doing, wondering if anyone would come over and ask what was I was up to. I freely admit that I can be a mass of contradictions - while I didn't want to call attention to the fact that I'd been the class idiot and gotten stuck with a needle, it would've been nice to have someone show an iota of concern. Especially the tall, muscular, and incredibly sexy guy in my class that I'd been sneaking looks at during lecture for the past few weeks.

I ended up getting my wish in some sort of fashion, or at least I thought so at the time. As I was drying my hands and wrapping a paper towel around my finger to stop the bleeding (still no first aid kit in sight - shouldn't a medical school be rolling in enough money to have these on hand in rooms containing sharp objects?), I heard someone come up behind me and ask, "Hey, you still bleeding?"

I turned and saw one of the students from my group, a guy wearing a hoodie with a baseball cap pulled down almost entirely over his eyes. Figuring that the resident had sent him to check on me and pleased at the fact that at least one person was thinking of my well-being, I replied, "Well, just a little. I don't think the needle went in that deep. Did the resident ask you to see how I was doing?"

"Anesthesia Guy? No, he didn't say anything," the student said. "In fact, I'm just on my out to use the bathroom. Oh man, the lunch I had today - I really gotta take a dump. Never should've had that second enchilada."

I forced myself to smile politely and repress the I-cannot-believe-we-are-having-this-conversation look that was dying to replace my benign expression. As the guy gave me a parting nod and walked out of the anatomy lab to presumably face the wrath of those enchiladas, I went back to rejoin the group and finish the session with whatever dignity I could scrape together. I hadn't tried inserting an IV yet, and I was required to make at least a halfhearted attempt to do so in order to get full marks for the session.

I won't bother going into the details of how the IV insertion went. One point to the good was that I didn't stick myself with the stylet, thus leaving open the possibility that my second needlestick injury may be totally epic and badass. One point to the bad, however, was that the stylet actually ended up ripping through the mannequin's fake vein and overlying skin, which I could only imagine would've been incredibly painful had I been practicing on a real patient (thank God I wasn't). So I have quite a ways to go when it comes to learning how to properly insert IVs and draw blood from patients without a) stabbing myself with the tools of the trade and b) looking like a moron.

So there you have it - my first needlestick injury. All in all, things could've been a lot worse. For example, the offending needle could've come straight out of a patient infected with HIV or Hepatitis C, which I'm sure has happened to at least a few unfortunate health care workers in the past. However, I can also see how things could've gone a lot better. Namely I could've gotten jabbed in my middle finger instead of my index finger, thus giving me an excuse to flip people off for the rest of the day, under the guise of "Hey, look what happened to me at school today!"

...I'll have to keep that idea on the back burner.


(Pictured: Another idea I am keeping on the back burner. 3 cheers for wasting health care resources!)