Way Down Town in the Antecubital Fossa

Writing this during a glorious, unexpected half-day off. Thank god for scheduling errors, right?

Began the afternoon with a leisurely lunch of Clif Bars and Diet Coke, gonna do a little catching up on the old blog and residency interview arrangements, and then it's Nap Time.

Or, considering that it's two p.m. and I'm not locked in a windowless exam room, attempting to stab an innocent, screaming two-year old with a long vaccination needle, or persuade a resistant lung cancer patient to give up the smokes, maybe I'm already asleep...?

Here's the layout of my fall: eight weeks of working in a very urban clinic owned by my medical college. Sort of a "finishing school" to make sure we can all handle the basics of operating independently before they sign off on us as intern material. In some ways, it's pretty cool--we see patients in our own exam rooms like residents would (although there is still a serious amount of supervision by the attendings). We give vaccinations, draw blood, even do minor procedures like irrigations and drainages. Sometimes the staff even screws up and calls one of us "Doctor" on the overhead pager.

Never in a million years did I imagine I'd get good at drawing blood; in the past I've actually gone to extremes to avoid it. I wasn't afraid of the blood itself--more the idea of sticking another person multiple times and not ever filling up the tube. Which is not fun for anybody involved.

I'm getting to the point where I'm decent at it, even with very large people and little kids. The secret, I think, is to visualize the anatomy inside the antecubital fossa (the fold at the inside of the elbow) and to go in very gently as you picture where the veins should be. While you're doing that, you've got to keep the patient super calm, (or restrained, if neccessary). Since you're never likely to be more than 1/4" from paydirt, if you yourself stay calm, a small adjustment one way or the other usually does the trick.

If all that sounds very competent and professional, honesty demands that I admit this technique was developed at the cost of about six gallons of sweat into the pits of my lab coat for about the first twenty draws I did.

For your entertainment, here's a link to two interesting sites about the history of phlebotomy. http://www.medicalantiques.com/medical/Scarifications_and_Bleeder_Medical_Antiques.htm
http://www.mtn.org/quack/devices/phlebo.htm

So next time you're in the process of being stuck by a bumbling, inept medical student, think about the items on this page (i.e. the "SCARIFICATOR"), how lucky you are not to be having bloodwork done in the sixteenth centry, and maybe it will make you feel better. Or not...