Question: do you look at the needle?  When you have to have blood drawn peripherally or when you need a peripheral IV, do you look at the needle as it goes in?  I suspect that the larger category of us look away.  Is this a fear of the pain or the sight of your own blood?  If you have a central line – a port or Hickman or even a PICC – do you watch when the nurse withdraws blood?  I think that this may be an easier spectacle for us.  For some maybe there is even a fascination with seeing your own blood slide down that clear tubing into the rubber-capped collection tube.

As a nurse I have stuck people countless times (by that I mean thousands), either to start an IV line or to draw blood.  Focused on the site itself, I paid little attention to where my patient’s gaze was focused.  But by the number of times I heard “Do you get it?” or “Is it in yet?”, I surmise that they were looking elsewhere.

Do we imagine that seeing that slim, steel shaft pierce our thin flesh increases our sensation of pain?  I have thought about this because last week I took my 86 year old mother to the outpatient lab to have her blood drawn.  And my mother is not what we nurses call “an easy stick”.  But when she emerged from the lab, she related that the phlebotomist had asked her why my mother had watched as the blood was drawn.  The technician, whose sole job it is to stick people with needles forty hours a week, observed that most people look away.

Return to me, Dennis RN, who so fearlessly stuck people with needles all those many years.  Do I look?  Heck, no!  Go figure…

I had my repeat sinus CT yesterday.  Mostly cleared so no real reason to consider sinus surgery in the near future.  Besides my transplant doc, Luke, says that for an ENT the mere presence of sinuses is reason enough to proceed with a surgery.  I had my blood drawn too (didn’t look).  My counts are back to their low normals.  The spike in my lymphocyte count was probablydue to the infection not to a relapse of my leukemia.  So no need to repeat the flow cytometry.

It was also time to attempt to complete my “childhood” immunizations.  Back into 2006 acute illness and high-dose, long-term steroids preventing us from completing the series.  For some reason this $100 series of injections is a cash-only deal.  I forgot my wallet so the secretary had to call Tish at work to get a credit card number.  Getting a call from the transplant clinic that you husband is at tends to provoke just a little initial anxiety in a spouse.  Anyway I had to get four shots, two in each arm.  And you can bet I didn’t watch.

I got the biopsy results on four sites my dermatologist investigated.  Two are squamous cell carcinomas and need to be excised.  That means cut out, and, no, I won’t be watching this either.  Well, that’s all the medical news that is news.  If you have feelings about needles you would like to share,  just comment to this post.  Take care, Dennis

Nightfall in the Land of Cancer Bitch

We got back late last night, coincidentally from the city of our “Cancer Bitch” author, Chicago.  I had just enough time to write the first part of this post.  But my copy of the book is still packed away and my wife is asleep.  So I will list the discussion questions for next week in tomorrow’s post. In the meantime you can start reading the next 40 pages or so. We were in the Windy City to attend a BMT InfoNet meeting for transplant survivors.  I hope to write more about that in the Tuesday post.

~  Did you find that a sense of humor and irony helped you at times while going through diagnosis and treatment? I think that this kind of attitude can be helpful in leavening an otherwise heavy situation.  Irony struck me in getting to see the first installment of the movie version of “The Lord of the Rings” and wondering if I should have since I might not live for the other two installments.  I also joked about renewing subscriptions for magazines if I might not be around to read them all.  Then there are the jokes about having the opportunity to lose that extra weight.

~ She describes her mastectomy, her followup care, and her experience with drainage tubes and post-surgery camisole.  What were some of your reactions to surgical procedures? to adoption of this new patient culture with special clothes, prostheses, and rituals? I always thought most leukemias were fairly elegant in not requiring any major surgeries.  But few of us can escape the knife with the need for biopsies and central lines.  Having to have an line like a Hickman, triple lumen catheter or a PICC certainly marks one both internally and externally as a patient.  As a nurse I was always on one side of the healthcare equation.  Becoming a patient introduced me to that whole other culture marked by all its customs and rituals – lab draws, side effects, bottles and bottles of pills, routinely submitting to being poked and prodded while wearing the most meager clothing.

~ The author explains her choice of the title “Cancer Bitch” in a little “forward’ . When the term ‘Cancer Bitch” is first used in the journal, did it seem to fit the author’s personality? Since I only read with one eye I may have missed an explanation of the author’s chosen sobriquet.  It seemed like it appeared to suddenly in the text without reference or context.  In the short forward she mentions that “Cancer Vixen” was already taken.  But I would have liked to hear more about why she chose “Cancer Bitch”  What meaning, what power does the phrase have for her?  It’s how she signs her emails.  Perhaps she’ll expound on this for us…

~ When was the first time you used “the cancer card”? (March 12 entry) Use it early and often. I used to mention it in stores and restaurants – “I have cancer”. Maybe it’s because I thought I looked so bad – still had hair but looked gaunt and sallow.  Maybe the burden of what could be a terminal cancer was too much to bear, maybe I wanted to spread that burden around.

~ Many of us lost hair to chemo.  Even though the author does not seem a vain person, the issue of hair is given a lot of space.  What are some of your own issues with alopecia? (you all know what that word means) I think there are some strong gender/culture issues at work here.  Losing my hair during transplant was not such a big deal for me even though I have had long hair.  Very short hair is an accepted, even hip style for men.  Not so for women.  On the other hand losing the beard I wore for 34 years, the beard that had seemed an intimate part of my physical persona, was more difficult.  I though I looked old, misshapen and weary. I thought that I looked too much like, oh my gosh! … a cancer patient!  I would like to hear some thoughts from our female readers!!

** (Apologies to the author.  I misspelled her name in several recent posts.  She is S.L. Wisenberg.  I have made the corrections.)

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Site-news: I have been busy.  I have added about 65 links to the Cancer Resources page and about 20 new links to the Cancer Blog Links page.  I finally published the new Being Cancer Book Club page.  I anticipate amending this as we learn what works and what doesn’t work regarding the book club.  This is the page where you can find out about the current month’s book as well as a list of past books.  I am having technical difficulty making the Amazon link for “The Last Lecture” appear in the margin.  I also started the Cancer Book List page.  I am anxious to hear recommendations from you, especially from those bloggers who have written their own books.  Finally I have added to the About this Site page to include the new posting “schedule” – Monday Book Club, Wednesday Guest Blog, Friday Cancer News Round-up.

Sophia

Missing Nursing

It has been over seven years since I last did “floor nursing”, that is, bedside nursing in a hospital.  I worked on the oncology unit from 1987 to December 4, 2001 – the day I left work to see my regular doctor about the mass I discovered in my lower left abdomen, what the CT scan would reveal as a massively enlarged spleen due to my leukemia.  Except for three years I spent as manager, I always worked at the bedside.

On Sunday night I noticed that my fingers and arm seemed slightly enlarged.  A 250cc antibiotic “piggybacked” into the main line had just finished.  I set my call button and waited for my nurse, Anissa.  When she arrived I showed her my arm and asked her what she thought.  “Looks like it might be starting to infiltrate” (fluids leaking from the vein into the tissue).  We made a joint decision to run the second antibiotic at a slower rate and then reassess the site.  A very simple and, for me, very familar interaction.  I tell her that I miss nursing.

In many ways I was at my best as a human being when I was nursing.  Normally a quiet, somewhat introverted person, in my role as a nurse I seemed to blossom over the years.  I became comfortable in those quiet, personal moments of tragedy and hope.  It is a special privilege to be a nurse, especially an oncology nurse.  You are a lead actor in some of the most dramatic moments in a person’s life.  Some of your most human of memories are those at the bedside.  Snow falling outside, or sunshine.  Late at night or early in the morning.  Alone with your patient or out in the hall with the family.

I miss nursing.  I miss being able to access a port or a peripheral vein on a difficult to access patient.  I miss doing a dressing change on a Hickman or PICC because it gives a patient the opportunity to talk to me about some small fear.  I miss teaching the family, deconstructing the technical explanation that the physician offered before he left the room.  I miss distracting my patient with jokes and small talk as they endure yet another bone marrow biopsy.  I miss creeping into a room at night with a styrofoam cup covering my flashlight so as not to disturb the sleeping patient.  I miss struggling to decipher the doctor’s Progress Notes so that I can put the patient’s orders and history into some meaningful context.  I miss the satisfaction of noticing some early sign of a change in condition or an oncologic emergency, saving the patient from “crashing” later.  I miss being able to touch the shoulder of an unconscious patient.  I miss it when the wife of my patient says “because I know you’ll be taking care of him on Saturday, I will go ahead and take the kids out of town to King’s Island like I promised.”  I miss being stopped in the hospital cafeteria by a person I don’t recognize because now they have hair and have gained weight and are in a solid remission.  I miss being the only one my patient will let me see without her wig.  I miss passing popsickles out to my patient’s young children.  I miss drawing little pictures on the edge of the Port dressing.  I miss visiting a patient in the ICU after I kept them from nearly ‘coding’ on the oncology floor.  I miss helping a man celebrate his daughter’s wedding in his isolation room.  I miss being there on the day of discharge when my leukemic patient has been there for over a month and has gone through some close calls and now is going home to his family with a “clean” marrow.  These were all good times to be a nurse.

I miss sitting in the room of my patient who just died.  I have cleaned up the body, removed the oxygen mask and IV line, put on a new gown, changed to top linens and made sure that his arms are arranged naturally and outside the linens so that the family can hold his hand when they arrive.  I sit in a chair at the end of the bed to catch up on my charting.  It is as quiet and as peaceful as a church.  This was a “good death”.  This also was a good time to be a nurse.

My day nurse is named Alyssa.  She is new, less than six months on the floor.  I quiz her throughout the morning as I always did with new nurses.  Gentle teaching.  I miss nursing.  When Tish arrives to pick me up, I ask Alyssa how many patients she has.  “Four” she replies.  No, I said, how many in this room.  She looks back at me questioningly.  “One?”  No, I say looking at Tish, you have two.  The family is always your other patient.  Her eyes widen a bit and she nods.  She pushes me in a wheelchair down to the car.  At curbside she tells me she is glad that she had me as a patient.  And I tell her she will be a good nurse.  It was a good day to be a nurse, even a retired one.

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