“That clerk”

You never want to be “that clerk.”  And yet sometimes you do…

Do you know what I mean?

“That clerk.”  The person who did either stupid thing x and is now famous for it.  It can also be the person who did ingenious thing y and is now known for it.  But really, 9 times out of 10 it is stupid thing x.

I had a “that clerk” moment today.  Not quite a world-renowned “that clerk” moment, but enough to be famed about the internal medicine wards in the particular hospital where I reside.

The story that makes me “that clerk.”  Patient with acute renal failure has a central line.  This is his second in the last week and it seems to be bleeding and there is nothing to draw back.  Perhaps it is coming out a bit, but the site was just redressed, so maybe check the ports.  Solution, send clerk and doctor to go check it out… Clerk cannot draw back from first port… Or second… Oh wait, they are clamped.  Point: clerk!  First line, no flashback, but no backpressure, second line, no flashback, but no backpressure.  Third port… Patient bellows. While concentrating on unclamping port, I somehow (unsure exactly how) both sprayed him in the eye with saline and a good bit of the dressing at the line was also soaked.  After profuse apologizing, I check the third port… I get flashback and flush, but then I look at the site more closely now that I adequately salined the entire area (whoops)… Turns out the entire line appears to be pulled out more than it should be.  Had I not soaked him with saline and needed to change the gauze dressing, we may not have noticed as quickly.  A chest x-ray shows that the line is displaced quite high in his jugular.  In my defense, I did not do that… The line is sutured in and it was out below the suture line.  We need a new line.  Again.  Ugh.

So, I am “that clerk.”  The clerk who attacked a patient with saline in the eye, yet discovered an incorrectly positioned port that we otherwise may have said was okay.  A mix of good “that clerk” and bad “that clerk.”

As a clinical clerk, you develop a bit of a complex at times, when people say something about “the clerk.”  Probably because a good chunk of the time, it is not good… Incorrect orders, a problem or just more work to do.  That is the beauty of being a learner.

One of my favorite “that clerk” stories involves one of my friends.  Her first rotation was general surgery and she was ridiculously excited.  They were in the OR and the attending she was with was using the hand sanitizer type scrub solution.  There is a foot pedal to press to have this administered.  Her attending told her that if she put her hands under and said “Abracadabra” that solution would come out.  She didn’t believe him, but played along and it worked!  So, he strung her along like this all day.  And the resident perpetuated it more the following day.  Finally, they didn’t hit the pedal when she said “Abracadabra”.  She was confused.  They had to break it to her.  Needless to say surgeons all over town joke now by saying “Abracadabra” when getting the scrub solution.  Someone went on an elective elsewhere and the surgeons there knew.  Word travels fast.

One of the attendings tells us the story of how he was “that clerk” because he didn’t know how to work the Dictaphones properly and spent his entire first clerkship rotation dictating what he thought was correctly.  Then, he got an angry call from his attending a week or two after his rotation ended to say that none of his dictations were completed.  Turned out he wasn’t hitting the complete dictation button.  He had to re-dictate everything.

A good “that clerk” story is one of a clerk who, when asked to do an ECG on an elderly patient with chest pain noticed a palpable lump in the patient’s breast.  With further assessment, the patient was diagnosed with breast cancer and required further management.  The lady had been ignoring the lump as “nothing.”

The good thing about “that clerk” stories is that you learn.  You learn to check for things before you act.  You learn to not believe everything people tell you.   You learn to be on your toes and be observant and keen.  You learn how to not be “that clerk” and to be “that clerk” and to laugh at yourself when you have “that clerk” moments.  It is through these moments that you grow into a doctor.  Somehow.  At some point.  And even then, you still have moments.

But, life lesson… Don’t shoot people in the eyes with normal saline.  Especially when they didn’t like you that much in the first place.  Even if most other people found the whole thing a little funny.

Have you had a “that clerk” type moment before?

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