Hey, I've got a great idea

While growing up the phrase "Hey, I've got a great idea!" ususually preceded some sort of an adventure. A wide variety of grass stains, hitchhikers on our shoelaces, prickerbush scratches and bruises followed us home. At some times those ideas weren't terribly good ones, (smashing or clapping bees between your two ungloved hands comes to mind, eating unripe crabapples, or even ripe crabapples follows quickly behind), and Friday had a series of events that stemmed from me saying something like: "Hey, I've got a great idea!"

Cue whatever music you might use to underscore comedic chaos: The Benny Hill Show theme, circus music, something having to do with Keystone Cops, The Three Stooges, or even the Bad News Bears.

So . . . they put two IVs in my left arm on Thursday before they pulled out the infected catheter. One, which is still in place, is in the area of my wrist sitting below my thumb. The second was placed neatly where most associate blood draws--right there in the crook of the elbow. All was well, medicines were flowing until I went to sleep Thursday night.

At the risk of providing more information than you'd like to hear, I tend to sleep in various positions through the night but an overriding theme seems to be that my left arm is BENT. The effect of all this bending was that the flexible tip of the IV that sticks into the vein was getting crimped. Unless I could find a way to sleep with my arm straight my pump would issue a shrill rhythmic beep and display a warning: reading something like "Patient Line Occluded".

Of course we didn't figure this out right away and there were several curses hurled in a surprisingly dark hospital room as the nurses tried to find any place at all crimped in my lines. My nurse was about to swap out the pump as defective when a thought came to one of us to look at the needle site itself. When I showed the evening nurse (it was the day nurse who placed the IVs) where it was, she said "Oh, I could imagine that the way your arm bends right there that the flexible end of the needle is crimping."

"Perhaps tomorrow we can think about moving the site" I replied. Maybe I should have gone ahead and said: "Hey, I've got a great idea . . ."

But all of that was between Midnight and 3:30 in the morning. There was still sleep to be had and I was determined to make use of it if I could find a way. And where I had determination, my sleeping body had defiance in its soul. I believe that in the 2 hours to 5:30 I set the alarm off three more times. Each time I would carefully put myself into bed (enough slack in the lines so I don't rip them out?, can the nurses reach the pumps?, its cold, why did they make this bed in such a way that the covers don't go higher than my chest?). I would drift mercifully in to a nice drug-enhanced sleep and start the recharging process. Then, my relaxed and comfortable body would put on an ugly sneer (because it was both a malicious act upon myself and completely out of my control) and gently put that left arm right where it wants to be . . .folded in by my chest. A few seconds later the starved pump clicks fervently away and gets no liquid to be moved. Beep, beep, beep. Russ buzzes nurse, nurse arrives, Russ apologizes profusely, nurse sighs and saves her own ears from the incessant high pitched beeping. Rather, rinse, repeat until you get to your normal 5:30 wakeup time and then punt.

So, I did the sort of things that I typically do in the early mornings. I take a leisurely pace to getting ready and mix that with gathering information that I want or need to start my day. As her duties came to a close the night nurse, experienced, and perhaps a bit portly, who had dealt with the headaches was willing to put all of us out the misery being created by the location of this single IV. She took my suggestion when I reiterated it. She nooded her head eagerly and said that's a great idea. In essence, "I know where there are a lot of bees!"

So she went off and got a small kit for removing IVs--really just a few wipes for removing the glue on tape and a gauze pad--and some surgical tape. In no time the offending IV was no longer attached and was unceremoniously dumped in the unsterile field (I won't be explaining this, ask if you must). This nurse and I were united in our desire to remove and replace but we had to be concerned about the bleeding risk! Ahhhh, don't forget that I am a cancer patient. At any time I may be devoid of platelets. You can't just insert the IV elsewhere anyway. So we slowed it down for full and complete thought.

I pointed at possible locations (meaning veins I could see, disregarding through ignorance whether they could tolerate the punishment or be reached without severing limbs) where the IV might go instead. The nurse grabbed her gauze, placed it carefully over the needle and pulled the needle gently out while applying pressure on the gauze to staunch the bleeding. I offered to take over, the confident sign of an experienced patient and so I held my right finger down tightly on the little spot in my left elbow. The nurse continued to get herself together for an IV placement.

Here's where comedic music of choice much reach its fever pitch.

At an appropriate moment according to her, the Nurse slowly lifted the gauze. She and I both noticed the same three things: 1. there was a big bruise developing under the IV site in my elbow, 2. there was a big pool of blood starting to well around my elbow joint, and 3. the amount of saturation of blood on gauze was enough to tell how much longer this gauze pad had before beyond its useful life.

The now sleepy night nurse and I exchanged glances. She spied another packet of gauze and opened it frantically. I cooly pointed out that I've received larger gauze pads for much smaller issues in the past, so there must be some around somewhere. As she gathered herself for a Paul Revere-like gallop for gauze. I dutifully held pressure down on the wound and waited for the nurse's return.

I could hear her footfalls and her calling to other nurses as she ran. I heard "What the. . . there isn't a single gauze pad in this cabinet!" and then, to another nurse "Where can I find size __ gauze pads they filled the whole thing up with gloves?!"

This newly enlisted nurse took up with the wrong cause. "I don't know why they do that when putting back gloves?", she said. I quietly coached my nurse from my room: "if she can help us then redirect her quickly, otherwise move on to the next possible location". My nurse instead asked, "yeah, who puts away the gloves when they come in?"

I saw red. I mean I saw red when I looked down at the 'fresh' gauze that would see me through until my nurse returned. It was still a gauze and somehow the accumulated blood was contained. I might have bought more time if I left well enough alone, but what do you do with gauze that is not taped down? Well, of course, you take a peek. I would be foolish not to take a peek, right?

I heard my nurse start galloping off for another unit. I prayed she didn't need the pharmacy's help because they are not Minute-Man worthy, something on the slow side. But not knowing where she went I turned my attention toward my bleeding elbow. It wasn't a small amount of blood. There was a pool of it cupped in my elbow joint and tendrils had overflowed and were dripping down now from the opposite, angled elbow and onto the floor. I stood up and started for the bathroom for . . . papertowels, perhaps? I got a couple of steps until I realizeed that I was still teathered at this point to the pole that contains my meds, etc. It would need to be unplugged and then the operation would need 2 hands. I quickly glanced at the IV and noticed that most of the needle had been removed from site and gently pushed it forward hoping that I had just put the finger back in the dike.

From the hallway outside my room I hear the footsteps of the night nurse, she's returning just as the amount of blood on the floor of my room is enough to be described as disturbing (but not yet grisly). It really isn't a dangerous loss of blood to this point but I'm tiring of using my right hand as a cup for blood to drip in as I hear the night nurse breathlessly telling the nurses at the station just how far she had to run to get the large gauze pads that she now held and was regaling them with how she braved the near-avalanche of gloves at her first stop. I summoned up my best Monty Python-esque downtrodden serf and said, "uhm . . . be careful when you come in (hint, hint), there's a significant amount of blood on the floor.

Cue close on the comedic music. . .

The night nurse finally strode in claiming to have established outposts in many FLAUs (Four Letter Acronym Units). I prompted her non-verbally to view the blood on my arm, elbow, and floor and she cursed again. She quickly opened the gauze and removed it and the needle in one swift motion. She placed a gauze significant enough for the job on the needle site and folded the extra cloth into squares on top of the original corner she used. Initially she and I both pressed on that gauze for a while. I was trying to help and free up the medical prefessional to save me from bleeding out, I think she was trying to prove that I might be the reason I was bleeeding out in the first place. At any rate, we both pressed. After some time passed she got some alcohol wipes and started cleaning up my arm, elbow, and the floor. Only then did she get a new gauze pad and some tape. And we taped that gauze pad down like you wouldn't believe.

I looked at the night nurse and said, "Well after that you are getting to the end of your shift? Would you like to take an attempt at replacing it before you go?" I think her initial acquiessence was ingenuine--she didn't particularly look confident--and in truth I didn't see her again until the day shift nurse, the same from yesterday, and much earlier than ever before began her dealings with me. The process to actually remove and replace the single IV dodged a Spinal Tap and an Echo Cardiogram, and was not actually carried out by the day shift nurse--she stuck me twice with no results to show for it, save more gauze and tape appropriately applied. The day nurse summoned the "guru" on the 5th floor and the guru brought her apprentice (?) and a sonogram machine to locate good veins. The guru studied my arms (I had long since offered to move everything to my dominant hand/arm if they thought it would work) and settled on two different spots one a spot in my triceps area and another a spot in my left hand. These veins did in the expert but the apprentice didn't seemed daunted by the challenge yet.

The apprentice snapped up the sonogram wand, found her target, got the appopriate gauge needle and jabbed it uncomfortably fast and certainly deeper than the expert or the kindly day nurse ever had. She he had bloodflow.

So when I typed the the most recent post it was with the single IV placed down near the thumb, and a big old patch in the middle of my elbow on the same arm--not really an IV, but it was supposed to be one. It would now count one of 6 recently abandoned IV sites in my arms.

Despite that ordeal I am now back to the lines in my neck. I spoke up when it became clear that the central line was going to be the path that we'd take. The doctors did a good job of hearing the complaints and placing the line in a more comfortable and workable spot. The good thing is these lines get to be associated only with the tough times in the hospital as they are not conducive for going home and will be replaced with something more durable and comfortable when the time is right. Thank goodness.

The next round of chemo started yesterday . . . wish me luck.

As always, thanks for reading:

--Russ.