I started to my left and from the first student, there were items missing. The entire class were missing at least one item and one poor soul was missing six. I waited for a few minutes, until I started my second trip. I wanted to give everyone time to get what they thought they were missing. After three trips around the room and several students were still missing one or two items, I asked.

"How many patients were there to collect from and are any identified as children?"

"There are three patients and one with age nine in brackets." answered Andrew.

"Okay, then how many pairs of gloves should you have?

Everyone answered 'three' and the four people with only one pair came up to get what they needed. I was surprised that they answered three but only chose one pair.

"Now, how many tourniquets should you have?"

Surprisingly all but two answered 'one'. The lone wolves were Tom and William and they both held up three fingers.

"Does anyone remember reading that you always use fresh supplies for each client, you never cross contaminate?"

Sheepishly twenty-eight of them came forward for tourniquets.

"Now we have a child to draw from, do you know if they have had blood drawn before? Are they afraid of needles? Is the child big for their age or small? What would you suggest? William?"

"I would suggest a regular vacutainer needle, a smaller size one and a butterfly in case they have tiny veins."

"Good answer, so I would like everyone except William to pick up a butterfly set."

They all got up to collect one.

Tomorrow we will review the steps of a blood draw, for today I will pass around paper towels. Please use one for each set up you have and if you want you can write #1,2,3 on the corner of the towel so you know which set will be used.

One hand went up.

"Yes, Michelle?"

"Does that mean we are going to start drawing blood tomorrow?" Her voice quivering.

"Absolutely. We are limited on the amount of time to get everyone prepared, so we will not waste a minute. How about after our discussion in the morning, you volunteer to be the first person to do a blood draw? I will be right there at your side the entire time. Okay?"

She meekly answered, "If you say so."

Everyone took care of setting up their supplies and left. Well almost everyone. There were three students remaining and from their stance they all wanted time to talk. Michelle was one of them.

"Mrs. Armstrong, I think I need to tell you that I faint at the sight of blood. If I cut myself, my mom takes care of everything while I am passed out." She reported.

"Mmmmm, well we shall just have to make sure you don't faint tomorrow or anytime. It is interesting why you chose this type of career when you knew you would be exposed to blood. Would you like to share your thoughts? And the other two, do you have similar problems?"

The other two almost jointly said that they were afraid of needles and one admitted to fainting.

"Well, we do have a problem. On one hand it will be good for the rest of the class to learn how to deal with fainters because that happens more frequently than you may realize. On the other hand, I do not want to cause you stress and put you in potential danger. Since this course does cover the information needed for both Medical Office Assistants and Laboratory Technicians, I suppose I could just sign you three off for the MOA after I check with the dean. If she permits it then I need to be sure that you all realize that your certificate will be for that position only."

They all stared at me with wide eyes and pale complexions.

"I would though, like to see you all try once to draw blood and have blood drawn. I don't want you to give into your fears. You just might surprise yourself. If you don't mind I would like each of you to talk to me privately about your concerns. Can you do that?"

They all nodded and the other two quietly left the room.

"Okay Michelle, tell me what happened to make you afraid of blood?"

"Well, when I was about four, my mom was pregnant. We were in the kitchen making cookies and she doubled over and there was a big gush of blood. She had shown my older brother and me how to call 911, so I did. The ambulance came and took my mom to the hospital and I had to stay with a neighbor until my dad got home. Mom was in the hospital for a few days, she had lost the baby, it would have been my sister. So, when I see blood I think of that and I think I am going to die." She was crying as she told her story.

"Now I want you to think really hard, okay? Does this happen any time you see blood or just when it is your own blood?"

She thought deeply and then answered, "Only my own blood. I saw my dad cut himself, in fact he cut the end of his finger off. There was blood everywhere."

"And you managed dealing with that accident, right? It must have been rough when you started your period."

"Oh, that part was okay, my mom had talked to me and explained everything, and it wasn't bleeding from a cut."

"I see, so it just your blood and if it is from an accident. Why did you sign up for this course?"

"I thought I might be able to get over my fear, but now I am not so sure."

"Okay you have told me about what happened to your mom, that was traumatic for you. Now you have seen that your mom didn't die and neither did your dad, but you know your sister did. Somewhere along the way, you have developed a fear that if you lose your blood through an accident you will die. Honey that is not going to happen with either drawing blood or having blood drawn. Let's just try that one time. You will be fine drawing blood and I will be holding your hand when you are the patient. I want you to promise that you will look the other way and take slow breaths. You can do this."

"I never thought of it that way. I will try." She smiled as she got up and left.

Henry was the next to come in. I asked him why he was afraid of needles.

"I wasn't afraid of them until I was about fifteen. My grandpa was really sick, so he came to live with us. They had a nurse that came every day, she said he was dying and he wanted to die at home instead of the hospital. At first, he had pain pills but then he couldn't swallow them and when he couldn't swallow the liquid pain medicine, they taught my mom and dad and me how to give him his needles. Sometimes my parents would take a little break and I would be with him since I was the oldest. He would scream at me to give him his damn needle, it would always work. He died one night, I wasn't awake but ever since I don't like needles." He was shaking when he finished.

"Wow, that was very hard on you. You were pushed into a position that you were not really old enough for, but your parents needed your help. It sounds like you managed, and you helped keep grandpa's pain controlled. Now I want you to think really hard about this question. Did your grandfather ever tell you that the needle hurt him?"

"No, he would yell and holler that he needed his needle and when he got it, he would calm down and most of the time he would go to sleep. I remember every time he would say thank you."

"So, the needle wasn't hurting him, but it probably hurt you to give it to him, correct? You do know that you have an advantage over everyone else in the class. You know how to handle needles. You will of course be doing something different, but you do have that knowledge. I think your dislike and fear is based on what you went through with your grandfather and your responsibilities at the time. Don't blame yourself for what you did, you kept him comfortable."

He pondered my words, although he remained silent.

"I want you to try tomorrow, Michelle is going to draw blood first and I would like you to go second. If you find you just can't do it, then I will talk to the dean. Fair enough?"

"Okay, I will try, and I will think about what you said. Bye Ma-am. I'll send Fred in."

I nodded, and he left the room and I watch Fred walk in.

"Last but not least. Fred would you please tell me why you are afraid of needles."

Fred had been the quiet one, he was not an outgoing person. He answered when called upon, he knew his stuff and he was very polite, but he was quiet.

"It is hard but not hard to explain, if that makes sense. When I was little, I think about two, my mom got pregnant, so my brother and I got twins. A baby brother and a baby sister. The boy was born first, and he was much bigger than my sister, but she was a fighter. A wee little thing but she fought. They were not very old, maybe three months when my mom noticed that she was gaining weight, but he wasn't, and he might have even lost some. So, when she mentioned this to the doctor he of course ordered lab work. I can't remember what was wrong, but it had something to do with a blood disease."

He paused for a moment, his eyes were misty.

"Anyway, the doctor decided to check everyone's blood. I was the closest match. So, until I was nine, every two weeks I had to go to a special lab where they basically did a sort of dialysis to pull off plasma which were then given to my baby brother. It was our Thursday morning adventure. Some adventure. Just before my ninth birthday, my brother who was now six told me he hated doing this, he hated being stuck all the time, he hated me having to be stuck. I tried to cheer him up by telling him we were a great pair because we had our own plastic tube connecting us. He was really depressed."

He had to stopped for a few minutes, as if he was gathering his thoughts or perhaps sorting his memories.

"He lost his will. We were all worried. Even the doctor was worried. He told my parents that my brother had basically stopped responding to the treatment. He also mentioned that my brother had requested to have them stopped, to leave me alone and to let him die. He was only six, but so grown up and so wise. It was hard for the doctor to have this talk with my parents, but it was so much harder to decide to stop."

He gasped and shuddered as sobs over took him. It was several minutes before he could continue.

"It took him five weeks to die, but he lived those five weeks the best he could. He laughed, he smiled, he joked, he played. Several times when we were alone he would apologize for causing me so much pain. It was almost as if he could feel what I was going through. Every time they stuck me, I would tense up and squeeze my eyes shut, praying for the two hours to be over. I always reassured him that it was okay, and it wasn't really all that bad, but it was. He was tired one day and laid down for a nap and never woke up. He was gone. I think it was after the first three months that I decided I hated needles, that they hurt too much."

I gave him a few minutes to collect himself before I spoke.

"That was indeed a challenge for you, I am not sure if I could have done the same. The sad part is that three adults took the choice and the decision away from you and your brother. They decided and you both just did. And unfortunately, sometimes that is just the way life is. You gave him a wonderful gift, the gift of life. You and he had a special bond, that very few people have."

I gave him time to absorb what I had said.

"Have you had any needle sticks since that time? I suspect you have but tell me about them."

"Yep, I have the flu shot each year, I had some immunization shots and I had labs once."

"So, you can manage being stuck from time to time, but you don't like it, correct."

"Yes, Ma-am. I just tense up really bad, so I had to tell you. There is one nurse that I like to ask for. She always reminds me to breathe and not to hold my breath and she has a funny counting system. She tells me she will stick on three and then she says something like one, two, fifteen and sticks on the fifteen. I know the fifteen throws me off and I am breathing, or at least that's what I think."

"You are absolutely correct, it would be interesting to see if she went to the same nursing school, that I did. We had one professor that taught our class that. She said when someone held their breath it made the muscles tighten so it was like hammering a nail into steel, but if the count threw the persons thought off it was like going through paper. It also works when patients have to be turned, but it is important that if you need a partner that they know the turn will be on the odd number."

He smiled and wiped his eyes.

"Fred, I think you are going to be okay with this. I do want you to try tomorrow, how about having you be the patient for Michelle. You can be the child, so it will be a hand stick and using the tiny butterfly."

"Wow, that soon? Can I think about it?" he asked.

"I would rather you just commit yourself, I promise it will be fine, I will be there for both of you. I know you can both do this."

"Okay then, I am once again, a nine year old." He smiled and stood.

"See you in the morning Fred."

He nodded and left.