The Art of the Intramuscular Injection

We had a “farm call” by the local horse veterinarian today – they call it that even if you don’t have a real farm.

Our white Arabian princess suddenly stopped eating this afternoon. She acted distant and uncomfortable, even to the point of lying down in the snow on such a humid and raw day. After she got up again, she just stood still in one corner of her pasture, refusing to come in.

By the time I made it home, the vet was on his way. Between the two of us, my wife and I were able to get the horse inside her stall. The vet arrived and she greeted him with suspicion; the last time he had been here was when we lost Caleb, her stall mate. The vet quickly determined that the horse had a temperature, and we had noticed a yellow nasal discharge. Soon the horse was sedated and the exam continued in more detail.

The decision was made to start her on antibiotics. The veterinarian filled a syringe the size of a regular flashlight with penicillin, which was the color and consistency of heavy cream. He injected it slowly against some apparent tissue resistance into the neck muscles of the still sedated 1000 lb animal.

“You could give her these shots, right?” he said, obviously aware of my profession. He thought for a while, then added: “But she won’t be your friend after a few days of doing that”.

After some more thought, he suggested I give her sulfa orally twice a day instead. I gratefully accepted his second suggestion as I imagined giving 60 ml of penicillin IM several times a day to a crankier and crankier horse.

Suddenly, in my mind I was nine years old again, admitted with pneumonia to the isolation ward at our local hospital in Sweden. I was sick, lonely and afraid, and four times a day one of the nurses would come into my private room and give me a penicillin shot.

The first nurse was soft-spoken, kind and sweet. She hated to cause me pain. She inserted the needle slowly and I screamed inside every time.

The second nurse chewed gum and seemed to have an attitude not quite compatible with consoling frightened nine-year-old sissies. She commanded me to roll over, and by twisting my neck I could see her hold the syringe just like a dart. She pulled her arm back and then almost flung the syringe at my bare bottom. The needle pierced my skin in a fraction of a second and, to my amazement, I didn’t feel a thing. I could feel the tension as the medication entered my muscle, but there was no pain whatsoever.

By the time I got to medical school nobody had to teach me how to give intramuscular injections. I had enough of them myself to know how to give them painlessly. To humans, that is.

3 Responses to “The Art of the Intramuscular Injection”

  1. 1 Steph January 13, 2010 at 10:12 pm

    Do I take it you chew gum as well, when giving injections 😉

    I hope your Arabian princess has responded well to treatment?

    • 2 acountrydoctorwrites January 13, 2010 at 10:59 pm

      I use an imaginary piece of chewing gum when I give IM injections.
      Come to think of it, the vet actually had a small piece of peppermint gum…

  2. 3 WarmSocks February 5, 2010 at 6:12 am

    I hope your horse is doing well now.
    Just wanted to come back and say thanks for this post. I remembered the “like a dart” part, and it helped when I had to start my own (sq) shots. So… Thank you. 🙂

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Osler said “Listen to your patient, he is telling you the diagnosis”. Duvefelt says “Listen to your patient, he is telling you what kind of doctor he needs you to be”.


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