Is It Live or Is It Mannequin?

I survived the first week of classes, so that's good.

Friday was an on-campus clinical day. We had a lecture in the morning on pediatric patients, nothing specific, just kind of a general introduction. Then we had a quick break, then we spent an hour practicing the handful of skills we would be tested on in the afternoon. (So just know that if I ever have to take care of your tracheostomy-related needs, I am well prepared. And by "well prepared," I mean that, like all the other students who are graduating from the program,  I a) have seen a half-assed demonstration from someone who hasn't been involved in direct patient care for nearly a decade, b) watched an eight-minute youtube video on the subject, and c) had five minutes one-on-one practice with a mannequin. So, rest easy.)

I'm feeling very...cynical about how the labs are run. I mean, most of the experience we get will be in the on-site clinicals, but I am finding that that depends largely on the clinical instructor. I've been lucky to have one (out of three) good clinical instructors. It seems to me that the rest are probably instructors because they want a fairly easy way to earn some extra money.

So we were only tested on one of the five skills we had practiced, and that was done in a completely random manner until everyone in the group had been tested on one skill. By chance, I drew insertion of a Foley catheter on a male patient. (A Foley catheter, in case you don't know, goes up the urethra into the bladder. A small balloon at the end of the catheter is filled with saline to keep it from slipping out. The catheter allows urine to drain from the bladder when the patient is unable to get out of bed for whatever reason, be it surgery or something else.) Sometimes we practice and test on a full-body mannequin and sometimes we practice and test on just the relevant part of a mannequin. Today, for me, the relevant part was a male mannequin from hip to upper thigh.

It's actually better to practice on a full-body mannequin, I think, because you get used to doing things like positioning the legs and working around the thighs or over the knees to reach the urethral opening, all while maintaining sterile conditions. You also have to practice draping the patient so as to preserve some modesty because they're laying there spread-eagle while you insert a long, floppy catheter into them. And sometimes with mannequins you forget that there are things you shouldn't or couldn't do with a live patient, like, when the mannequin is cut off at the hip, you can just push on the flat top of the hip to pull the patient toward you. (Turns out that patients have things like stomachs and pain responses.)

While I was testing, I caught myself doing something that I probably shouldn't do on a live patient (though the instructor watching me--who actually made a phone call on her cell phone while I was starting the procedure and who then texted the rest of the time--didn't notice). Like I said, my fake-patient was male. I started and got up to the point where I had to insert the round-ended catheter into the end of the penis and there I ran into a dilemma. Of course you know that the opening of the penis is more slit-like than round--but the catheter is round (and in this case it was the wrong size, very slightly too big for the mannequin). So The Brain saw this and said: If you put pressure on the pointed ends of the slit, it will probably just kind of pop open and become more round (like one of those coin purses that you squeeze at the ends to open) and that will make it easier to insert the catheter, right? Problem solved.

Only. . . I probably shouldn't try that on a live patient, squeezing the end of his penis to make the slit rounder and therefore more receptive to catheter insertion.

But I got full marks this time. (Here is a very good, very complete explanation of the procedure, complete with a few very short videos on a live patient! The only difference is that this example uses lidocaine instilled in the urethra to anesthetize the area, while we don't do that. We just go for it.)

After everyone had tested, we were let out early and I came home and tried to nap and couldn't. (It's been hell week, sleep-wise, although that's not unusual for me.)

When Dave got home, we ordered a pizza for dinner (the first time we've not cooked in a week--a recent record for us!) and I ate three slices and went straight to bed after.