Other Features: Teaching and Learning Moments
It’s normal for a shortstop to get the jitters on opening day playing in front of teammates, onlookers, and the opposition. Despite his (or her) practiced skills, the first ball hit in his direction might take a bad hop or he might simply muff it. After he boots that first ball, he can relax and just do what he is supposed to do.
The first patient on the first day of my pediatric internship, a nine-year-old boy with panhypopituitarism, had been sent to the emergency room by his endocrinologist to obtain blood work. My senior resident asked if I wanted to draw the blood myself. I felt nervous, but I had drawn blood before in medical school, and I said I would do it. I assembled the gear—alcohol swabs, gauze to staunch the bleeding, a band-aid, a butterfly needle, tubes with the appropriate color tops, and a 12-mL syringe. We needed a lot of blood for the esoteric assays that had been requested.
The boy’s mother and grandmother stood by, attentive and protective. Both large women, they put me in mind of opposite-gendered lineman for the 49ers; they couldn’t have been more intimidating. It was clear that they would brook no nonsense from anyone, certainly not a lowly pediatric intern on his first day of internship.
I applied the tourniquet, found the vein in the antecubital fossa, and stuck in the needle. To my relief, and, no doubt, to the relief of all assembled, a snake of blood inched up the tubing to the syringe. I pulled the plunger ever so gingerly and watched as the big 12-mL syringe filled with blood, all the blood necessary to fill the different tubes. And then something happened. Anxiety? Distraction? I don’t know. Before my senior resident, the nine-year-old boy, and his mother and grandmother, I pulled the plunger out of the top of the syringe, spilling all the blood—all two and a half teaspoons—onto the floor. The mother and grandmother looked at me, jaws agape, with a “You moron!” sort of expression on both of their faces. My senior resident just covered his eyes with his hand as he shook his head. I don’t remember the details of what happened after that, but I do know that the patient survived, I survived, and the blood got drawn, though not by me. Eventually, with lots of practice, I became quite comfortable and adept with blood drawing and other invasive procedures in children, a lasting source of pride and feelings of accomplishment.
Now, a quarter century later, I tell that story to brand new pediatric interns anxious lest they should make a mistake. I booted my first ball, I tell them, and everything was okay after that.
Randy Rockney, MD
Dr. Rockney is director of undergraduate medical education in pediatrics, Department of Pediatrics, The Warren Alpert School of Medicine of Brown University, Providence, Rhode Island.