Let It Bleed

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I’m on the operating table at the Rhode Island Vascular Institute, getting a Peripherally Inserted Central Catheter (“PICC line” to its friends), installed in my left arm. It’s a quick procedure, done under local anesthesia, and Dr. A chats reassuringly as he works. I need reassuring. I’m a queasy wimp around needles and flesh. Especially my flesh.

I’m doing pretty well, though, until Dr. A says, “This vein isn’t cooperating. I’m going to have to go in again.”

“Okay,” I agree. As if I have a choice.

“Getting tense?” he asks.

“A little.”

“Do you want to talk?”

“Okay.”

“What do you want to talk about?”

“I don’t know.”

“Do you want to talk about Boston?”

“Okay.”

It’s Friday morning, April 19. By “Boston,” Dr. A doesn’t mean Red Sox or Sam Adams or Faneuil Hall. He means the surreal situation unfolding as we speak—the whole area under lockdown as police search for the surviving suspect of the Boston Marathon bombing, a man described as, “armed and dangerous.”

“My daughter lives in Cambridge,” I say.

Sophie and her husband Henry are graduate students at MIT. The security guard shot dead last night died outside Sophie’s building. On the phone this morning, she sounded rattled and exhausted. She and Henry had been up until three.

“Crazy stuff,” the nurse says.

“Really crazy,” says Dr A.

And the procedure is over.

I’m here because I have polycythemia vera—my body produces too many red cells. (I wrote about it here.) Standard treatment is to withdraw a pint of blood once or twice a week until the blood count reaches the right level, and then continue to phlebotomize several times a year for the rest of your life.

“You’re a textbook case,” my hematologist said when she diagnosed me, ten days ago. I felt reassured.

The following Tuesday, I had my first phlebotomy.

“I’ll be your nurse every time,” Nurse B reassured me as she led me to my room in the infusion center. “I’m the only one here who does these.” One quick stick and 20 minutes later, she had collected her pint.

I felt the difference right away—less itchy after my shower, not as flushed in the face, fewer of those weird pulsing sensations rippling through my body as I lay awake at night.

Round Two, that Friday, took two sticks and 40 minutes. But that was okay. Nurse B and I discussed local restaurants. My hematologist dropped by, brought me more water, and hung around chatting until I was done.

I felt washed out for a few days. But my symptoms continued to improve.

Round Three got postponed from Tuesday to Wednesday, because Nurse B was sick. When I showed up on Wednesday, she was still out.

“I’ve done this before,” Nurse R reassured me as she settled me into my chair.

I was not reassured—and rightfully so. Three sticks and one hour later, Nurse R apologized profusely and sent me on my way. Both my arms were bruised, and she had extracted less than a tablespoon.

Driving home, I could already feel my face getting flushed. That night, the pulsing was worse than ever, compounded by heart palpations.

“It could just be panic,” David reassured me, and the palpations gradually diminished.

On Thursday, my hematologist called. “Your blood is so thick,” she said. “It’s really hard to get it out. The only thing I can think of is to put in a PICC line.”

Installing it would be no big deal, she said. They would simply thread a tiny tube through my vein. A cap on my arm would keep my vein permanently accessible. And once we’d gotten my blood count down, they would just pull the thing out. No more getting stuck! No more failed phlebotomies! From now on, I thought, blood-letting would be as easy as charging a laptop.

“What are the drawbacks?” I thought to ask.

“You can’t swim while it’s in,” she said.

Or shower, says the nurse at RIVI—unless I cover it with a special rubber sleeve or Saran Wrap, say, or the wrapper from the Providence Journal and Scotch tape. I absolutely do not want to get the bandages wet, because moisture breeds bacteria, and the catheter goes straight to my heart. Call the office if there’s swelling, she instructs, measuring my arm’s circumference just above the bandage. Call if the wound keeps bleeding. Call if it still hurts after a week. A nurse will come to my home tomorrow to change the dressing and teach me how to flush the line. She gives me a stretchy fishnet cuff to hold the cap (which turns out to be a two-inch nozzle) snuggled in place.

This PICC Line is a bigger deal more than I expected. But it’s worth it, because from now on, my phlebotomies will be a breeze.

The TV in the waiting room is tuned to Fox News. “Let’s see how those gun control people feel after this bombing,” someone in saying. I collect David and we drive around the corner to the hematologist’s office, where the TV is tuned to NBC. “They have defamed the entire Chechen ethnicity!” the Tsarnaev brothers’ uncle is telling reporters.

We watch that same footage over and over again as we wait for my name to be called. When someone finally comes to fetch me, it’s Nurse R again.

“B is still out?” I ask.

She smiles apologetically. “I’m trying to reach someone who can tell me how to draw blood through the PICC line,” she says. “I didn’t want you think we’d forgotten you.”

I have a roommate today, a woman young enough to be my daughter. She has the TV tuned to MSNBC, but has turned off the sound. The screen shows the face of Dzhokhar Tsarnaev—disturbingly young and surreally innocent.

“Good looking kid,” I say.

“This whole thing is so crazy,” says my roommate.

She tells us about her illness and her job. Today is her second-to-last treatment, and a steady stream of well-wishers come to see her. The snack lady brings around juice, sandwiches and chips. More visitors crowd into the tiny room. I’m still waiting for my phlebotomy. Every now and then, Nurse R stops by and says, “Still working on it.”

My hematologist arrives. “I’ve got some calls out,” she tells me.

A second hematologist comes in. He shakes his head.

The problem has to do with vacuums. Standard phlebotomy needles have them, and that’s what starts the blood off. What we need is a plumber. Or a syringe, my hematologist suggests.

Nurse R is dubious. “We’d have to constantly pull on it,” she says.

“I’ll do it,” my hematologist tells her.

And she does. For the greater part of an hour she sits beside me, slowly drawing back on the plunger of one after another 65-cc syringe, and tossing the filled syringes into the trash can labeled “Blood Products.” We talk about our children. David’s work. The viscosity of my blood. The beautiful cakes Nurse R bakes for my hematologist’s sons’ birthdays. When Nurse R takes a turn, we talk about batter and frosting. “It’s a labor of love,” she says—meaning baking fancy cakes.

It’s almost 3:30 when we finally get home. My hematologist talked about giving me two phlebotomies next week, but I don’t have even one appointment. The scheduling nurse will call, I’m told. We turn on the radio to hear the latest on the manhunt in Boston. We turn it off again when it becomes clear that announcers are just filling air time as they wait for something to happen.

We call Sophie, who’s still on lockdown.

“My apartment is as clean as it has ever been,” she says.

Before the day ends, lockdown will be lifted and Dzhokhar Tsarnaev will be arrested. Before the week ends, I will have returned to RIVI three times – first to have them check on the bleeding, and then on what I will think is swelling, and then to see how soon they can take the PICC line out. By the time I make that last visit, I will have a new hematologist, with a crew of nurses who have lots of experience phlebotomizing people like me.

But none of that has happened yet. Right now, on Friday afternoon, April 19, everything is on hold, waiting to resume its normal flow.

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3 Responses to “Let It Bleed”

  1. R.L. Saunders Says:

    Oh man. I certainly hope things get smoother over time. I feel guilty for loving this writing so much because of what it’s about.

  2. Nursing My Diagnosis | Giving Up The Ghost Says:

    […] Pictures worth half a thousand words « Let It Bleed […]

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