Saturday, July 5, 2014

Blood sacrifice: or, why I hate going to the clinic



This is still so traumatic that I haven't even been able to write about it in my private journal. I sit here this morning after a lousy night, waking repeatedly and full of anxiety, trying to get through my giant mug of coffee and make sense of it all.




I'm not sure yet if I was the victim of medical mauling, or my own aging physiology. Though the pictures here are trying to help me play this for laughs, it wasn't too goddamn funny.

For medical reasons I won't go into, I need to give blood samples at intervals for analyses of cholesterol, glycogen, that kidney stuff I can't remember - all that shit - so there's no way around this visit to the clinic and the dreaded arm-stick.






Does it make sense to you to say I've never enjoyed this? Eons ago when I was pregnant, we first ran into my little problem: the technician (I think it was a nurse back then, before every medical procedure was farmed out to a different specialist)could not always score a direct hit on a vein. This involved (if they were shitty at it, which most of them were) repeated poking, twisting, trying the other arm, and a growing irritability towards ME for holding things up with my difficult veins.



Back then, if it didn't go well, I'd really hold things up by fainting. By now I've got past all that, but in recent years, after a stretch of relative normalcy (i.e. only five or six tries, leaving a black and blue mark 2 or 3 inches in diameter), things got much worse.




At first it was intermittent: some days the technician (usually one of the more competent ones who show up randomly on good days) seemed to get it bang-on and it would all be over relatively quickly. Sometimes it took forever because the needle was not all the way in or in at an angle, and the slow, painful dripping would go on and on. I needed to fill four or five of those little bottle-y things for some reason, and I wouldn't watch, though the technician acted surprised that I didn't want to eyeball the whole procedure (complete with a needle lifting up the skin in a point as it cranked around and around and around in a futile search for a viable vein). I had learned to cope, and as usual my coping methods were suspect and probably wrong.


There were some highlights, or lowlights to this process. Once a hysterical-looking technician had an anxiety fit and asked me, almost wild-eyed, if I was always like this and what was the matter with me. She had insisted on applying the tourniquet very loosely on top of a thick sweater to avoid bruising, though none of the others ever did this. She seemed to be sweating with dread. It took her a long time, but at least she didn't call in a second technician, something that seemed to be happening with alarming frequency.

To call in a backup is a disgrace because it makes them look incompetent, wastes a lot of time (there are other customers waiting, after all, customers with normal-sized veins),and make no mistake, *I* am the cause of this holdup and making everyone look bad. I'm making it look as if they don't know their stuff!




The fact that every so often someone would show up, touch my arm with a fingertip, aim, shoot, and hit it bang-on with no trouble, drawing the sample in 2 minutes, did make me wonder about competence and dealing with non-standard veins. But in reality, my veins were treated like an aberration, something they had never seen before, as if I had walked in with two heads.

The explanation, if I got one at all, was that my veins were small, deeply set in my arm, and moved around a lot (probably because they were small and deeply set in my arm). Trying to inflate them with a super-tight tourniquet seemed like a good idea to me, but they wouldn't do it because their training told them they weren't supposed to.




The over-the-sweater-sleeve tourniquet technique may be OK for a normie, but for me it's a disaster. But I can't tell them to make it tighter, can I? I will get that "whaaaaaat?" look. And why don't they do that little two-fingered tap-tap on the spot any more? Will it be too traumatic and painful? Will it cause. . .  bruising? But it can't cause the kind of lead-pipe black-and-blue mark I come away with after a typical bloodletting ordeal.

Can I even pick a "worst"? At least up until yesterday's debacle, that would be the young trainee who poked and prodded in the usual way, skidded over my arm which finally began to bleed furiously (though not into the tube), giggled, yanked it out, halfway capped the tube and began shaking it violently. Blood flew through the air and splashed all over the front of my blouse, ruining it. She giggled some more. "Gee! That's never happened to me before!"

Translation: there must be something wrong with YOU. You are a freak. A nineteen-foot-tall Atomic Woman stalking Port Coquitlam. 




When I try to tell this story to anyone with a medical background, they say something like, "Oh, that didn't happen. The cap can't come off like that. You couldn't be sprayed with blood." It's great to be listened to, isn't it? How I wish now that I had immediately complained to the front desk, ripping open my jacket to expose the gobs of gore.

So on it went, every three months forever. The bad episodes were intermittent, and I found tricks that I thought worked, kneading and slapping the crook of my arm, swinging my arm as I walked over to the clinic, pumping gallons of water like someone said I wasn't doing. 

Whistling in the dark. Putting out a forest fire by peeing on it. Peeling a turnip with a stone.




So yesterday it gets bad. WAY bad. I arrived on time, sat dutifully in the waiting room and was able to go in almost right away. I said a little prayer, not so much for my inaccessible veins as for the idiots who couldn't find one and turn on the tap.

This was it, the day it got more than bad. WAY more.




The technician walked in. She was one of the more senior ones and seemed to know what she was doing. But on her first poke, her face fell in that dreaded, all-too-familiar, this-is-going-to-take-up-way-too-much-time way.

"Is the other side any better?" She had done me maybe fourteen times already, but acted as if she had no idea who I was and addressed me as a complete stranger.

"No."

"Let's try it, then."

No dice, just nothing. That little gleaming device was like a drill-bit, twisting around and poking and jabbing. I tried not to wince, but it hurt like hell and I knew it wasn't supposed to.

"Sorry, am I hurting you?"

"Oh, no."

Then came the dreaded "calling in another technician" manoevre.




A younger woman with long dark hair and glasses, very poised, very serious, almost doctor-like in her sense of entitlement, swept in. A resident fulfilling a training requirement, maybe. (She was even holding a clipboard.) There was something Special about her. She was the one they called in for Special Cases, when someone became hysterical, fainted or attacked someone in frustration after being fruitlessly drilled for half an hour.

"Let's see what we have here," she said, crisply and calmly, not making eye contact.






She shook her attractive medical head and began to poke into me again.

"Oh, sorry, no, we can't. . . " Weirdly, the first technician hung around. That had never happened before.

At one point I noticed her pressing on my opposite wrist, which already had a huge, godawful plastic clamp on it that left a red welt.

After ten or fifteen pointless minutes, during which I gabbled on and on in explanation, irritating them as I always do when I try to explain anything I clearly don't understand (though not explaining would be even worse because I was being unco-operative and sullen), they gave up on the traditional method. The two of them were beginning to turn away and whisper to each other. I was alarmed. I heard words like "butterfly" and "back of the hand".

They used the butterfly. I've had the butterfly before, and it's no big deal, just another method of jabbing your flesh to suck up your blood, but the butterfly didn't work this time.

At all.

Not a drop.



Now they were really nonplussed. (Yes, that is correct, so don't correct me! Look it up.) They kept looking at my right hand and pressing down and pumping it. Anything there? You would have thought so: I'm old enough now to have those blue veins you see on little old ladies.

"Will this hurt?" I shouldn't have asked: I'd had the back-of-the-hand treatment before, and I knew it hurt.

"Yes, it hurts most people, but we'll try to be quick."

Quick, like. . . ten more minutes?

I stayed calm, but at a cost. I prayed they would get something, even a little bit. Suddenly I remembered a dreaded word as they stepped away to whisper and natter at each other yet again. 

Cutdown.




I knew that if they couldn't get blood any other way, they just used a scalpel and cut you open. Presumably they tied off the vein after the Niagara Falls of blood gushed across the room.

"Oh, no, that's only in the hospital." The two of them, alarmed, looked at each other uneasily. She was having delusions, wasn't she?

Meanwhile, the hand thing wasn't working at all. I had my eyes closed and willed myself to relax, but the first technician took it as dread and panic and asked me - no, I am not kidding about this, "Would you like me to hold your hand?"

"Oh, wait. I think I see something."

A drop!

"Uh, yes, but. . ."

"It's very, very slow."

Drip.(25 seconds)

Drip. (25 seconds)

Drip. (25 seconds)

Drip. (25 seconds)

It took almost half an hour to partially fill a vial, and they were not at all sure it was enough. I prayed they would put the cap on before they shook it. There came another round of flustered, whispered consultation.

I was a freak, a weirdo, something they had never seen in their lives before.

THEY WERE TRYING TO GET BLOOD FROM A TURNIP.




Then came the reasons why, all having to do with me. "You're dehydrated, dear. You'll have to start drinking water."

I didn't know how to tell her that I always pound back water before a test: it helps my creatinine levels. (THAT'S the shit from my kidneys.)

"Maybe you're a little bit anemic." My hemoglobin was always routinely tested, and it was normal. Had never been abnormal. But they treated me as if they could see through me.




"You do look a little blue," the entitled one said.

I can't imagine why.




No one apologized, but there was a funny feeling *I* should have, for taking up 40 minutes for what should have been a 3-minute procedure. At least there was no indelible gore-splatter down the front of my blouse.

I decided then and there to change clinics, but what good would it do? If I started fresh and just told them nothing, might they just score first try? Bingo?




Of course I had to look all this up on the internet, and two seconds later I hit pay dirt. It was a forum about donating blood, and one woman recounted in frustration being turned away because she had "bad veins".

"My veins are small and deep and they slip around and they can't seem to get into them at all. The butterfly doesn't work, the back of the hand doesn't work. Nothing works."

Another post: "Why are my veins so hard to access? The technicians are getting really annoyed with me. The veins are small and deep and they slip around and they can't seem to. . . "

Fifty thousand entries later, all of them virtually identical, a picture was emerging.




SURPRISE. Some people's veins are not very accessible because they are . . . you get the picture. But at the clinic, they were anxious, astonished and even irritated to find that they just couldn't get me to act like a stuck pig, no matter what they tried. In fact they behaved as if they had never seen anything like this in thirty years of experience.

I have often had the experience, when trying to explain something to a medical person, that they think I'm  making up stories. At very least, it's hypochondria, being dramatic and inflating my symptoms out of sheer narcissism. Was my body lying to them this time, I wonder? Being narcissistic, or deliberately making a fool of them? Apparently.




Almost worse is something I hear often when I make the mistake of "sharing" my experiences with anyone. The listener's eyes fly open and they say, "Oh, that's never happened to ME!" This is called "empathy" and is more common than you might think.

Though such people always advise you (right after telling you to throw away those pills and take milk thistle) to make medical people do what you want, it's a great way to attract the hostile stare. And whatever you do, do not ever, ever, EVER mention the internet to a doctor, or their eyes will glaze over. "Don't go on the internet," I've been told, how many times? Medicine hates the information age because it penetrates the hallowed brotherhood that began eons ago with the local shaman.

I didn't cry or whimper or faint, though many people routinely cry and whimper and faint even when their blood-draw is quick and painless. But I don't look forward to going through this every three months. Hell, the back-of-the-hand thing is foolproof, it HAS to work!

I can't go back there because, against reason, *I* am embarrassed. I will try another place. But if they come at me with a scalpel, I am out of there.





Post-blog observations. It's been a while since I originally posted this, and yes, I DID find another lab. I didn't say a thing about my "little problem" because I wanted to see what would happen if they didn't know about it.

The technician, a brisk, no-nonsense lady with a Germanic accent, whisked into my vein and out again in about 30 seconds: no poking, no pain, just a direct stab and a steady flow of blood.

Miracle of miracles! But it HAD to be a fluke. I went back in three months, got a different technician, but exactly the same results.

This was a magic place!

And it went on for, oh, a year and a half at least. Pay dirt every time. Every three months, no matter who did the procedure, they always struck oil. And then. . . "something" happened.




I think it was a trainee or something, and she had some problems with me. She asked me all the usual questions: "Has this happened before? Does this always happen?" After all the usual drilling and twisting and pain, some blood came out. Slowly.

The next time wasn't much better. It was more difficult, time-consuming, clumsier, with more of those strange, uncomfortable "looks". This wasn't a new set of technicians. Some of them I'd already had before, with no problems.

Yesterday, it collapsed. The whole structure of hope and freedom from the sickening, accusing questions came crashing down on me. They couldn't get blood. "Does this. . . you know. . . has this. . ." The consternation, the projected shame at feeling incompetent which was somehow meant to be absorbed by the patient.

I have no idea what I'm doing: sucking my veins in, then letting them out again? I always drink water, etc., blather blather blather, and stand upside down and shake myself like a ketchup bottle for an hour before the drilling. No dice. Nevertheless, they always mention something I "should" be doing, some vital preparation no one told me about before, to avoid holding up the whole enterprise.

Last night I got a call from the lab. That's right. From the lab. There was something wrong with the sample they had finally, laboriously drawn. It had clots in it, making me think it had come out too slowly or had been contaminated in some way. So on a Saturday morning, because they close at noon, I have to go back in and go through the whole ordeal again, likely sitting for an hour in a patient-crammed waiting room full of whining toddlers, non-bathers and people clearing their throats every 30 seconds.

And when it's finally my turn to be stuck, being asked, in puzzled half-contemptuous amazement, "Has this ever happened to you before?"




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