[This post mentions blood and needles. Do not read if you are squeamish.]
On 17Aug2014 after it was determined that Liam had cancer, I was trying to put all of the pieces together. Jenn was working to get herself up to the hospital. I was in the ER room with Liam, staring at a word on a napkin. The word ‘Neuroblastoma’ written in a quick but legible way was a word I had never heard of, but at this point it had at least two reasons to despise it:
- I knew it was cancer.
- I was told not to freak out when I looked it up.
Some people do not like to know what they are dealing with, but I am not one of these people. I reached for my iPhone, and I started to Google it. Right then, the nurse walked in and announced that they needed to start an IV. Another nurse followed behind her.
“OK.” I said.
The nurse grabbed several pieces of equipment from an OmniCell which looked like a vending machine, but had all of the different types of equipment needed for the various procedures that can be performed in that little room. She grabbed several items out of each bin making sure to push a button located on the front of each bin. Each time a button was pressed, a little green light came on for the individual bin. “Clever,” I thought, “That is a neat way of keeping and managing the inventory.” Then I thought about how much each item would cost as it eventually showed itself on a bill from the hospital labeled ‘Services Rendered’. After some quick thinking, I came to the conclusion that it really didn’t matter. These were the things that were needed at that moment, and I was glad they were available. The nurse closed the door to the OmniCell, pushed a master button in the middle that told it she was done, and laid out the various pieces needed to start the IV on the bed. All of the pieces seemed necessary for the insertion of an IV.
The nurse announced that she would be giving Liam a topical anesthetic before the IV was started that should help with the placing the IV. It sort of reminded me of an epi-pen, but it was much smaller in size. The topical made a mark on his skin on the top of his hand. He cried, but I knew it would feel better than the alternative. The nurse grabbed the needle and started going after the vein. As with most things to do with a needle, I looked away. In this case, I looked at Liam’s face. As I watched his contorted face from the painful needle being manipulated under his skin in such a way to find the vein, it was apparent that the topical did not seem to be working very well.
The IV went in, and then it was time to flush it. Which involves pushing fluid back up the IV line.
“It blew.” She said.
“The vein fell apart.” She said “We’ll have to try again on the other side, but this time I don’t think we’ll be able to use the topical. His veins are weakened from his low platelet count, and they are just falling apart. An additional puncture could cause the vein to blow again.”
I remember when I was a kid I had to have an IV put in without anesthetic. It was a pain that was like no other. Unlike giving blood, which is usually done in the crease of your arm where there are much fewer nerves, IVs usually go in your hand so that if they blow out, they can march up the arm and grab another part of the vein. If they started at the top of your arm and it blew out, there would not be any more good tries on that arm.
The nurse returned from the OmniCell with more equipment, and proceeded to try the other hand, this time with no topical anesthetic.
I remember thinking as I watched his face, “Crap, I guess the topical was doing something last time.”
“I think we got it… Almost there… Nope, it blew again.” She said with disdain.
I looked down to see the two large bruises forming on each of his hands.
“We have a special team that I am going to call to put in his IV line that deals with special cases like this. I am going to call them down so that he doesn’t have to endure being poked all day.”
And within 15 minutes or so, a team showed up with an ultrasound machine with a probe head much smaller than I had been used to seeing during all of the pregnancies that we have been through. It was clear that the smaller head was for looking at veins and not babies. I smiled for just a moment as I remembered the last time that an ultrasound had been used on Liam. He was just a baby bump on his mama.
I watched as this special team put in another IV. This time it was further up the arm. It blew.
The fourth attempt made it in, and it seemed to be holding for now. But by the time he had made it upstairs, and before a transfusion could be made along with platelets, that IV had blown too. It was clear that his veins were in pretty bad shape, but the paradox was that he couldn’t get very things that he needed for them to start healing without this line in place.
A fifth attempt was made. It held for a while, but it also blew. By this time, my wife was already there, and we were upstairs in our new room. And I have to admit that even though I am not typically squeamish around needles, the drama and screaming from Liam had pushed me to the point of nausea. I couldn’t stay for this one. I let Jenn take it on. It held for a few hours and into the evening, but failed as the ordered blood made it to the room. The hanging bag of blood sat there unused. It sat there too long. The first bag had to be thrown out.
The order was then placed for a central line to be installed. Which, as it turns out, enters through the upper arm and enters one of the vein in the central [core] body– apparently close to the heart. The nurse said that the order had been placed for the morning because of the lateness of the hour, and yet a moment later, the PIC team showed up to put in the central line. The nurse said, “The order said it was to be placed in the morning?” Which was a statement that had been inflected to act as a question.
The man puffed up his chest with the look of a hero. He said,”Well, I’m here now. Let’s get this thing installed.”