It was only my first day at clinical placement but I told my supervising nurse I was ready to give the injection – I had been both nervous and excited about it but I wanted to get it over with. I went to the patient and found I had an audience more medical staff watching me. Ignoring them I mentally went through the instructions in my lecture notes – firstly, introduce yourself to the patient.

1) Introduction: I introduced and smiled at the nice happy middle aged man as I snapped on my snazzy latex gloves. Good for me, my first patient ever was very compliant and happy. He looked just like Penguin man from Batman.

2) Professional conduct: I kept to the NHMRC ‘s professional conduct guidelines. Just kidding. Basically the patient asked me if it was my first injection and no one replied him and my buddy nurse said “Don’t know. She won’t tell me”. Everyone around just smiled like Ronald McDonalds throughout the procedure. The patient smiled the widest. I suppose he had little entertainment sitting around the hospital.

3) Antiseptic: Swabbing the man’s well rounded stomach with an alcohol swab. I kept swabbing in circular motions around a large surface area of his stomach, and my embarassed buddy nurse said “that’s enough”.

To be honest, after I swabbed the area and put my swab into the kidney dish, I looked back at his stomach and was not sure where was the area I swabbed. Nevertheless, he did not show any signs of pain after, so I assume I had done an excellent job.

4) Procedure: I then pinched the skin and poked the needle in at 90 degrees. Some say pinch the skin, some say hold it tight. The staff then wanted me to pinch the skin so I did. But make sure the patient has fat to pinch in the first place.

The needle did not go in, and it is supposed to be guided in smoothly and rapidly. I looked at my buddy nurse, puzzled as to why the patient was not as easy to poke needles into as the practice sponges we had used in the university labs. To answer my question, she hit the top of my hand and that rammed the needle in.

5) Finishing up: I pushed the plunger in and then removed the needle. Everyone was beaming. I was sure they would have clapped if the patient in the next bed was not asleep, and I felt as if I had just finished an 8 hour surgical procedure.

Very good, said my buddy nurse. “So why couldn’t I get that needle in?” I asked her. “I gave you a blunt one,” she said. The hospital had run out of smaller, sharper needles. So we had used the needle we had used to draw up medications…

And that was my first experience ever giving a Clexane subcutaneous injection. Penguin man was then wheeled to a day room to get ready to be discharged, and with a beam on the face he then complemented me, to my chagrin, on “such a good job done. And you’re only 18″ too!

The key question I will answer about my experience so far is: Why did I decide to volunteer?

While this is a sensitive topic I believe it should be discussed. To be extremely honest, I have always suffered from a fear of irrational behaviour. At a shopping centre a man (who I now can identify was not mad, but a little hard of hearing) was “shouting” and many people were backing away from his strange demeanour, not realizing he was autistic. When I previously met people suffering from cerebral palsy, I did not understand their condition and ignored them.

I suppose my main reason for volunteering is actually a challenge to myself to confront this fear and dislike, and also because I wished to gain knowledge about intellectual disabilities. No one persuaded or had given me the idea to, I looked up the center on the internet and called them myself. Also, none of the staff at the center actually gave me a lengthy explanation about anything when I showed up. I was just called to imitate them by observation (for instance I observed them wearing thick polo tees).

And there’s the question: Has it been challenging? Will this make a good future career?

When I was first introduced to the clients I was to shake hands with them, but unfortunately on the rare occasion one or two clients are not aware of any appropriate gender protocol and they do abit of touching, (they are actually trying to get your attention), but they can be quite inappropriate! No I was not offended, I am very much aware that many of the clients are not aware of their actions. In fact, from that incident I realized this:

To sum up my entire experience, were the centre clients hard to deal with? Yes, sometimes, when they kick up a childish fit. But then again I very honestly say I prefer any single one of them to the company of some un-handicapped individuals I can name. Though they are not intellectually blessed about all of them are jolly, simple, happy people, childlike. They may throw tantrums but they are unable to plot harm against you – their needs are usually just one more cookie, more time in the toilet, that’s enough said. Would I consider a future career as a handicapped helper? Yes. In fact I found it more spiritually rewarding that any job I have taken in the past (aside from normal nursing practice which is rewarding too).

The clients are picked up by bus every morning and then the center runs activities every weekday from 10 – 3. It reminds me of a neverending youth camp and that is actually alot of fun. My “camp group” is usually excited when I arrive at “work” in the mornings and the girls will throw me hugs. And we get to play games like Boggle and sit around and have milo and cookies and chat about stuff. It’s a great job.

My experience so far

On Day 1 I was introduced to the centres’ clients, who are distributed into different groups according to their needs as follows:

I. Autism
II. Down syndrome
III. Cerebral Palsy
IV. Intellectual Disability

So far I have spent the most time with Group II patients.

A typical day at the centre typically consisted of a schedule that ran with:

10am – 11am: Singspiration. Some of the clients are excellent dancers, and being a dance handicap, I can only sit and watch dumbfounded.

11am – 12pm: Some light snacks, and then some classroom activities.

12.15pm: Lunch. Thereafter, most clients are encouraged to wash their own dishes. The autistic clients usually follow a schedule of their own and when told to do the dishes, they may take a long time just to make sure it is clean. But the staff refrains from disturbing them and they happily clean and clean away, ensuring no spot of water or dirt remains on the dishes.

1pm – 3pm: Miscellaneous classroom activities, games etc. Depending on their different needs, some clients may see the physiotherapist for some activities. One lady with cerebral palsy is unable to speak and has twisted joints – she is almost always at the physiotherapist at this time of the day for instance.

One day a group of university volunteers came to visit with some cardboard frames, which the clients and staff got to paint. We did a good job of course, and these frames were given as presents (and as a sort of outreach) to the neighbourhood.

Rat poison, or Warfarin, is used to kill rats of course. (Nowadays, rats are increasingly resistant to the drug). Great caution should be taken – Warfarin deaths are dramatic, poetic, and emo. You could literally bleed to death on an overdose.

Warfarin works as an anticoagulant – anti means “against”, and coagulant means ” causes blood clotting”. Here’s a guide to survive Warfarin:

Blood Test

A blood test is recommended before taking Warfarin to ensure you are not getting too much or too little not taking an anticoagulant.

The PT (Prothrombin time) is a measure of how fast your blood clots. The higher the INR (International normalized ratio) the greater the anticoagulant effect. The target INR differs depending on the reason why warfarin is prescribed; for most conditions, it is between 2.0 to 3.0.

How to take the drug

This excerpt was taking from the patient brochure of Coumadin (a brand name of Warfarin). Other methods of taking Warfarin may vary.

http://www.ahrq.gov/consumer/coumadin.pdf

The above brochure teaches how to take Warfarin orally, but notably it can be given intravenously.

When to call the doctor

Bleeding to death is not cool. You don’t want to die like a rat. The following signs and symptoms following the intake of Warfarin are the body’s way of saying the Warfarin is working all too well. See a doctor if there is:

• Bleeding from cuts that won’t stop after applying pressure for 10 minutes
• Coughing or vomiting blood (which may look like coffee grounds)
• Bleeding from the nose, gums, or ears
• Unusual color of the urine or stool (including dark brown urine, red or black [tarry] stools)
• Bruises on your skin for unknown reasons
• A fever or illness that gets worse
• A serious fall or a blow to the head
• Unusual pain or swelling
• Dizziness
• Difficulty breathing

Warfarin cannots:
Cannot be given to pregnant women.

The patient given warfarin must avoid food with large amounts of Vitamin K (dark green vegetables such as broccoli and spinach, for e.g. Those revolting veggies!)

Many drugs increase anticoagulant effects. One to note especially is Aspirin! Find out more here.

Antigen:

Main role: Antibody generators

Came from the root word “Antibody generation” as they were believed to generate antibodies and cause an immune response.

They are “any substance that causes your immune system to

produce antibodies against it”. They are usually proteins or polysaccharides.

Antibodies: (Immunoglobulins)

Main role: Identify and neutralize foreign bodies

Are like a computer antivirus program. They identify and neutralize foreign objects, such as bacteria and viruses.

The body’s immune system produces antibodies when it detects harmful substances, called antigens. Eg. Of antigens (bacteria, viruses, fungi)

They are produced by a form of white blood cell known as plasma cells.

They are gamma globulin (IgG) proteins found in blood or other bodily fluids.

B cells:

Main role: Antibody

production

They create antibodies which bind to free-floating microbes circulating in the blood so they cannot infect other cells.

After antigen interaction, the activated B cells eventually develop into memory B cells.

T cells:

Main role: Follow receptor control according to their groups

Depending on the receptor bound to them, they have different roles. Helper, Cytotoxic (Killer), Memory, Suppressor.

Natural Killer cells:

Main role: Follow their nature to kill. Like cytotoxic T cells, their role is to destroy infected cells, but they respond to a different receptor to T cells.

Pathogen:

Main role: To cause suffering. “Path” is greek for suffering. Pathogens are agents that cause disease and illness to its host.