Notes on Nursing
'I Always Faint When I Get This Done'
How the Big Picture Emerged During a Routine Mantoux Test
One of my favorite nursing blogs is CodeBlog: Tales of a Nurse, which is full of stories submitted by nurses that generally confirm what we already know: Patients can be difficult, supplies hard to find, no one is there when you need them, etc., etc. Last September I read a submission by Michelle about emergency room patients. The takeaway message was “See the big picture.” I became very familiar with this saying during my days of community health nursing when I realized that the patients in my office that I quickly sized up as noncompliant often presented a different and, more often than not, complicated picture in their own home.
For example, a hypertensive who seemed unable to place any dietary restrictions upon himself was found to have a kitchen where the only thing to cook with was a hotplate, and he lived next to a McDonald’s where once a day he ate his “fresh” food. Avoiding salt for him was next to impossible.
This “big picture” idea hit home last week when I was administering a Mantoux test to a student for his hospital internship. We chatted briefly about the difficulties of being a premed student at a major university, and then just as I was about to stab his forearm he said, “I have to tell you, I always faint when I get these done.”
Okay, take a step back.
I have to admit that I hate having someone faint in my office probably about as much as that person hates waking up to a strange pairs of eyes staring down at him. But this gave me an opportunity to explain the complicated process of syncope and how best to avoid it. In preparation we moved him from upright in a chair to lying on an examining table and elevated his feet. I put a cold pack near his neck and crossed my fingers.
Then we talked for a few minutes about control — how it was important for him to be able to feel in control of this situation and how I felt absolutely the same. Voilà! He didn’t faint, and very seriously thanked me — after ginger ale and 20 minutes of observation — for being such a good nurse.
In retrospect we both had control issues. It was important for him to be able to get past this in order to continue on with a medical career, although he did make a feeble joke about being a radiologist. And it was just as important to me to have control over what happens in my office, or at least to be as prepared as possible for when things don’t go the way I’d like.
So for him, coming in to student health for a simple PPD and winding up on the floor could have made him question his entire future. For me it was easier; it would mean that I probably wouldn’t get to lunch on time.
But in the big picture, taking the time to see beyond the now was a win-win for both of us.
CodeBlog: Tales of a Nurse
Christine Contillo, RN, BSN, has worked as a nurse since 1979 and has written extensively for various nursing publications, as well as The New York Times.