The first time I took blood from someone it came as a surprise to both of us. All medical students must learn to take blood at some time during their course, but phlebotomy – like other skills requiring the use of sharp instruments – is usually left until the third year. A supplementary class I picked at the very beginning of my studies, however, turned out to include a practical lesson in blood-taking. ‘Next week,’ the lecturer announced, ‘we’ll be giving you a chance to try out venipuncture for yourselves.’ After a short pause, as the meaning of the term ‘venipuncture’ sank in, everyone gazed dully at their desks or out of the classroom window: medical students affecting casualness, a sure sign of overexcitement. The six of us were thrilled. Putting needles into people’s veins falls into the category of ‘real medicine’.
The blood class was held in Brighton’s teaching hospital, the Royal Sussex County. We met in the haematology library, a small room on the sixth floor of a tower block. The window blinds had been pulled shut against the bright South-Coast sunshine; the room was warm, dim and stuffy. A long oval conference table had been laid with lecture notes and a rolled-up tourniquet at each place setting: neat pieces of elastic in jazzy colours like a 1980s duvet cover.
Several people were waiting for us in the room, including a consultant and two specialist phlebotomy nurses. One of the nurses, who was wearing a spotless old-fashioned white uniform with buttons all the way down the front, opened with a talk about Health and Safety. Used needles were to be put in the sharps bin, she said, ‘but don’t ram your needle in on top of an overflowing stack, like junior doctors do.’ And don’t walk about with unsheafed needles or syringes full of blood, ‘like junior doctors do’. In a recent study, a third of American medical students were found to have sustained a ‘sharps injury’ during the course of their clinical training. Most were gored by the little needles used for stitching up wounds in surgery, but a quarter had injured themselves on ‘hollow-bore blood-filled needles’. Eight of the students had amassed ‘two to four’ injuries apiece; they were presumably the type of trainee the phlebotomist was seeing in her mind’s eye at this moment, as she began to shake her head in time with her syringe-waving arm – no, no, no.
The phlebotomists wanted us to be aware of the danger of what the healthcare professions call ‘needlestick injuries’. Each scratch carries a risk of hepatitis, HIV and other blood-borne infections, and though rates of transmission are relatively low – most healthcare workers in the UK are vaccinated against hepatitis B – rates of needlestick injury remain resiliently high. This is despite phlebotomists’ best efforts, and the existence of many training aids, such as the ‘Ten Commandments of Phlebotomy’, a poster issued by the Indiana-based Center for Phlebotomy Education – one of a multitude of organisations devoted to the now little regarded but still essential art of blood-taking – which begins: ‘Thou Shalt Protect Thyself from Injury.’ The seventh commandment is ‘Thou Shalt Label Specimens at the Bedside.’ Labelling is a popular theme throughout medical education, and one with an equally poor profile: in another class the lab technician handed round a collection he’d made of his favourite useless labels, the winner being a bag of human fluids that had arrived for investigation marked ‘jane: female’.