From The First Touch

The nurses are haphazard. They are fast. Most importantly to them, they are efficient. After all, they have other patients to see. Not unlike the nurses, I have additional patient’s to see as well, yet I prefer to take my time.

With my left hand, I gently elevate the patient’s left shoulder while I softly encourage elbow extension with my right hand. After resting the patient’s now straight left arm on my adjacent knee or the arm of the chair, I carefully and snugly velcro the cuff around their arm. Then, supporting their left elbow with my left hand and crossing my right forearm beneath their wrist to fully support the patient’s arm, I slowly begin to pump up the cuff. I listen carefully for their pulse. As I see their pulse begin to resonate on the dial, I slowly pump the cuff once with each beat of the patient’s heart until I can no longer hear the patient’s pulse through my stethoscope. I am careful to never inflate the cuff anymore than I have to for an accurate measure. Then, very slowly, I deflate the cuff and obtain the patient’s blood pressure. When I am completed with my task, I again slowly (and carefully) return the patient’s arm to my thigh or the arm the chair and gently and purposefully remove the cuff before assisting the patient’s arm back to their side.

A skilled nurse can obtain a patient’s blood pressure is less than 15 seconds. It takes me an extra 30 seconds to complete the same task. I may not be as efficient, but I understand that this is the first time every day that I am going to touch this patient and that each patient is going to remember the quality of my touch.

Each patient will remember that this is how I began my care.


One thought on “From The First Touch

  1. Hi Keith, In “The making of a surgeon” Nolan writes of how one of his partners always took the blood pressure himself. Your wonderful essay reminded me of that.


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