It was clear the situation was more serious than another routine incision and drainage: the patient was cold, sweating profusely, and pale as the hospital sheets. I’d thought that now, post-medical school finals, I’d be raring to go in an emergency. But as it turned out, I was terrified.
‘We need access now,’ the registrar barked. ‘Take all the bloods, including a group and save – he’ll be going to theatre.’
The patient let out a groan, and promptly vomited over his pillow.
Panic rising, I gathered my equipment and trembling, fastened the tourniquet around his bicep. But by now the patient was beginning to writhe and groan louder, intermittently flailing his arms, and then vomiting – this time over the registrar’s arm.
She cursed under her breath, and left the cubicle, wrenching the curtain angrily to one side.
I tried to restrain the patient’s jerking limb, and searched desperately for a glimmer of blue. I could do with spotting the houseman’s friendship now. My clammy hands tapped and slapped, but found no reward. In desperation, I plunged in at a bulging length in the antecubital fossa, but the resulting yelp and thrashing arms confirmed my suspicion that this was no vein. And then I felt the sharp thrust of the needle piercing my own finger, and my heart sank. A needlestick – that was all I needed now.
I turned aghast, holding the offending bloodied finger in the air as the registrar returned. She took one look at me.
‘Get out - you’re no help here.’
I scuttled away to the nursing station, but the response there was no warmer. The nurse grimaced at me.
‘You’ll be needing this,’ she announced, slapping a huge incident book onto the counter, covered with tick boxes, short answer forms and multiple-choice questions. Apparently, my assessments for starting work in the world of medicine weren’t yet over after all.
Susanna Mills now an ST1 in public health in Newcastle-upon-Tyne. At the time of the incident, she was a final-year medical student
This is a great blog. I'm a consultant virologist. I'd like to include this account as part of material for teaching medical students on needlesticks, how they happen and what to do about them. I will not make any personal gain from this, simply use it as part of the teaching curriculum. Is the above material copyright? What attributions are required?
Hi - that's good to hear - thanks! Please could you email [email protected]
The attitude from the E.D. registrar is disappointing, but perhaps can be understood given the stress of the situation. However, the lack of support/ empathy from the nurse in question (away from the acutely stressful situation) is appalling. Sadly, this is a situation that I can envisage happening to others too.
There are two learning points:
1) Never put yourself in danger: if a patient is thrashing or unco-operative for whatever reason, then do not partake in a procedure that has the potential for self-injury;
2) If out of your depth, and particularly as a junior, then seek help. This is for your safety, the patient's safety, for the sake of fostering a good working-environment, et.c..
Always assume anything involving a needle has
the potential for a needle stick injury.So be prepared in all situations of this possible outcome.
I guess there's always an easier way ...
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