Journal: January 2002
My nurse for the day is friendly and cheerful. I get the impression that she might be a head nurse. We get a copy of my labs. My white cell count is still high – 17,300 mostly defective lymphocytes. My hemoglobin is normal. My platelets are back up to 95,000, closer to normal. We have a blue folder to keep track of my labs.
I am considered pretty good at starting IV’s. On weekends at my hospital when there are no IV team nurses, I am regularly called upon to try to start difficult IV’s, those belonging to cancer and renal patients whose chronic illnesses have long ago deteriorated their accessible veins. Starting IV’s is the sort of thing that, if you do it well, you feel really good about yourself. It is an admired skill among nurses. You don’t have to have been a nurse very long before you realize that one of the first things you notice when meeting new people, even if they are attractive and of the opposite sex, are the veins on the back of their hands and on their forearms. A nurse with exceptional veins will sometimes offer her arms to new nurses in order to practice IV’s.
On the other hand if you have difficulty sticking the vein, if it takes a long time and a bit of probing, and especially if you don’t succeed even after trying with two separate needles, then you feel very, very bad. You feel bad for the patient who had to endure the procedure. You feel embarrassed in front of the family members (this may be why some nurses ask family members to step out of the room while they work). And your own self-esteem is knocked down a notch.
I generally allow anyone in the room who is brave enough to stay for the procedure. I believe in distraction as remedy for anxiety and pain associated with someone preparing to stick a needle in your hand or arm. I talk to the patient and family during the whole procedure, stopping only as I push the needle hesitantly in those first few millimeters. Especially if this is not my patient, I ask why they are in the hospital, the name of their disease, how long since diagnosis, which doctor, what do you do for a living, or maybe talk about the movie or sports event on the TV – anything to keep their mind off what I am doing. I also want to convey that while I may be only in the room to do this one task, I am interested in them and why they are here. This also means that I know a little bit more about what is occurring with the rest of the patient population on our unit. And when I see the families in the kitchen or at the nurses’ station, or see the patient in the hall on a stretcher or wheelchair, I can ask how things are going.
Sometimes I tell people that they can close their eyes when I stick the needle in because that’s what I will be doing, closing my eyes. Other times I ask if it is okay for our new student nurse to start their IV. She is blind, I explain, and needs to work on her confidence as well as her skill. Sometimes I can tell by the look on their faces that they are not sure if I am joking.
So I am good with IV’s. I am comfortable with IV’s. It is one of the skills by which others and I define myself as a good nurse. But the reason that I have provided this background is so that readers of this journal will appreciate it when I reveal what I was not intimately familiar with about IV’s. I was not prepared for the discomfort, no, the pain of having an IV put in my vein. I don’t scream or faint. I have always thought I had a high tolerance for pain. But I do find myself tensing up. I do look away. And I do ask my nurses to cry, “Got it!” when they have a blood return and the catheter is threaded.
An IV catheter is really just that, a short, narrow plastic catheter. That’s all that stays in your arm or hand. But to get it into your vein, the nurse starts out with a very sharp needle that travels snugly down the center of the catheter. Once the vein is successfully pierced, the nurse will try to advance the catheter into the length of the vein, hoping not to bump into a valve (in which case it will not thread any further) or worse yet not to pierce through the opposite side of the vein (in which case it’s “blown” and the blood will leak out the second hole). If the “start” is a success, the nurse will withdraw the metal needle back out of the catheter and attach IV tubing to the hub attached to the catheter. The other problem is that sometimes you cannot find or “hit” the vein with the needle.
Almost every time the clinic nurses have succeeded on the first try. I ask for a 22-gauge needle, relatively small and my needle of choice when I am working. But it is still a tender process. And the knowledge that sometimes the nurse may not succeed increases the anxiety level. I am getting blood drawn three times a week at the lab (a cinch by comparison) and a new IV stick at least three times a week at the clinic also. A minimum of six stabs with sharp objects every week. For cancer patients it is the little things that grate us sometimes, the little pricks, pains and insults that form a panorama of frank physical, emotional and psychological suffering. Little efforts at comfort, like using adhesive remover to dislodge the tenuous silk tape, are readily appreciated.
On that first day my nurse succeeds with one attempt. But even after I know that the needle has been withdrawn, I am aware of the plastic catheter pushing its full 5/8” length down my vein. She hangs my Zofran (anti-nausea) and Benadryl (anti-chills) in a bag above my head. It drips in slowly. And slowly that familiar wave of weightless floating envelops me. Next comes the Demerol. We bring our own, from a prescription from the oncologist, so that the clinic will not have to stock narcotics and thus become a target for thieves who like the stuff. By the time the Demerol infuses I am pretty well sedated. There is a point just before this moment when I will learn to take off my glasses, elevate the footrest, and push the recliner back. I announce to my nurse and caregiver “If you have anything important to say then say it now or forever hold your peace.”
I am aware that, as in the hospital, although I cannot talk very well or even hold my eyes open for long, I can hear every word. This is not sleep but stupor. My recollection of the rest of that day is hazy at best. I do sense Tish’s presence in the chair next to me. I hear the nurses talk on the phone with my oncologist about how I am doing with the infusion. I hear my nurse tell Tish that she has to go to the other nearby clinic to work.
Then I feel the equally familiar but dreaded electrical rush through my torso and then out to my limbs. “It’s starting,” I moan. Tish gets up to tell the remaining nurse that I am starting to react. This nurse is not familiar with CamPath and asks Tish to run out to the lobby and call back my original nurse. Tish catches her, but is told to tell the other nurse. Tish explains impatiently that it was the other nurse that sent Tish out to the lobby
I am shaking away by the time they return. Tish gets me a second blanket from the cabinet. My original nurse injects additional Benadryl and Demerol into a small bag above my head. The CamPath infusion is interrupted for the time being. I notice what I had noticed in the hospital – that the familiar wave of stupor flows over me first, the slight, burning sting of the Benadryl traveling up my arm, only later does the chilling and rigors subside. On this first day it seems that the medicines are dripping in more slowly than necessary. In the hospital we would shoot them in slowly with a syringe rather than waiting for the bag to drip the medications in.
I remember next being awakened by Tish and the nurse. My infusion is complete, as is my liter of saline for hydration. I feel very lethargic and want to go back to sleep. The IV is taken out of my hand. Tish takes my blankets off and I try to sit upright in my recliner. I start to shake again, not as intensely, but a steady disconcerting shaking just the same. The nurse calls the oncologist and relays the message that this could continue for hours. She suggests that Tish give me Benadryl tablets when we get home. Tish is frightened. She is thinking that if I was hospitalized because of the possibility of rigors, then why am I so readily being sent home now.