No PICC, no port, no chemo

"Just a procedure," I said in my last post about the PICC line (peripherally inserted central catheter). No, not quite.

Things need to be changed about how procedures are done. What I experienced is probably not uncommon and unfair to the patient.

First, I really wasn't given much understanding of what the procedure would be. I was thinking simple IV, shouldn't take even an hour. No, says the nurse, this is not an easy procedure, and it often takes over 90 minutes. So, I arrive unprepared and am now disconcerted.

Second, they take the opportunity at the point you are sitting in the procedure room to go over all the possible bad things that could happen and now please sign that you want us to go ahead. So, now I have a full understanding that they could put the wire that threads the tube up into my brain, or they could go too far and put it into my heart, or it could puncture the vein wall. Not exactly reassuring, actually rather scary. But by this time you are already in the room, even undressed. They should do that before, maybe when you are taken in for the sign-in process when you first arrive. Oh, but that's right, during the sign-in they are only concerned with how you are going to pay. "Would you like to pay something on this account right now?" No, I'd like to see if I'm alive after the procedure before I pay for it, thanks.

Third, it is apparent from early on that the nurse who is doing this procedure has either never done it before, or at least never done it in this hospital. There is a second nurse and they are discussing everything. "OK, how are you going to make a sterile area?" "First you should do these things before you put on your sterile gloves." "OK, I have to do that for you because remember you are now sterile and can't touch those things."

And fourth, the ultrasound equipment they have to use to guide the large needle into the vein is not working well enough for them to be able to see what they are doing. The image is grainy and dark, only slightly differentiated between flesh and veins. They are complaining about "this old equipment" and how the other one is much better but they don't have that one. Basically, they are doing this vein-threading procedure in the dark. Literally, because they turn off the lights so there is more contrast on the screen.

What does this all add up to? Three hours of me lying awake on a table with my arm outstretched, listening to the nurses' crosstalk: "Where is your needle?" "I don't know, I can't tell." "Are you above the vein or below it?" "I'm not sure. I think above it." "Well, then push it in further." "Still nothing." "OK, maybe you've gone all the way through; pull it out some." "Angle your needle to the right(left/up/down) -- no, the other way." "I think I'm into the vein but I can't extend the wire." "Push harder, but not too hard." "No, can't do it." "I guess you better pull it out and start over."

On and on it goes. Trying other places on the arm. Giving up the sterile environment so they can get the better ultrasound from the Emergency Room and give me a break to get the blood flowing in my arm again. During all this the new nurse is persevering. Valiant of her; extremely hard on her patient. Why don't they let the new person take one crack at it, and if they can't do it right away, then call in the pro? Why didn't they give me free Valium if there was going to be a new nurse who wasn't sure what she was doing? Shouldn't I get a discount, like you do when you go to a barbering college to let the new trainees gain experience on you?

Eventually they decide that my veins are what is really giving them the trouble. Although they can't really see what's going on, they suspect that my veins are closing down as soon as they get the needle into them, so they can't insert the wire that will guide the tube. My whole body is reacting negatively to all the stress they have put me under. I have already noticed the big sighs that I can't control; that I am trying to consciously relax my shoulders and arms but keep finding them tensed up again.

Do I want to give it one last try with the department head who is an expert? No, I wanted him after the first failed attempt -- two hours ago. Now I only want to go home and collapse. I'd drink heavily, but for the Flagyl antibiotic that prevents the body from properly absorbing/breaking down/disposing of the alcohol, creating a reaction that apparently resembles that of Antibuse.

So, now what? I still have an appointment with the medical oncologist to discuss the chemo treatment, examine the breast to see if she thinks I'm physically able to go ahead. Then I will have to either get a port placed under my chest skin by my surgeon (which I am now hoping for) or another try at a PICC line.

I will demand Valium. I will demand the expert.