Nearly every day a stranger’s arm rests on my knee. I roll their sleeve up and strap a tourniquet around their arm just above the elbow. I usually have already eyeballed their hands for veins. Is this going to be an easy stick? Or am I going to work for it?
While their arms rest on my knee, I draw up a saline lock and unwrap a Ven-A-Guard. If I see my vein, I take out the appropriate size catheter; usually an 18 or a 20 along with an alcohol wipe to clean the site. If I don’t see the vein, I will then use my finger tips to hunt for a vein beneath the surface. Today I had a rather large thirty-five year old female with a lot of fat on her arms. I couldn’t see a vein, but I felt the sponginess in the crook of the elbow. I wiped the site down with the prep, and then plunged in a 20. Flashback. All right. It made me think if I was oil driller I would be a rich man – the times I have stuck red gold. You can get on a streak where you can’t miss. You just plunge in and blood fills the chamber. Send me to Texas or Oklahoma. Pay me more – a lot more if you want me to the Middle East. Or maybe I could be a water finder. Send me to the Sudan or Ethiopia. With my water stick, fountains will sprout from the earth where I have plunged it in. Of course there are times when you can’t get anything. You go in and you miss. That’s life.
When I am done with the IV, the lock attached and flushed and taped down, I usually take the person’s arm and move it to their side. But sometimes, particularly for older people, I leave it there if isn’t in my way or doesn’t seem awkward or uncomfortable for them.
Sometimes the IV is never used for drugs or fluid. It is just put in because it is protocol. You have chest pain or shortness of breath or syncope or had a seizure, you get an IV. The IV is there in case you need it, and so you are ready, prepared for if the patient takes a sudden turn for the worst.
I try to talk to my patients. Lately, as I have written, I have been doing it more so. It breaks the tedium, and patients like it, for the most part. They are wondering what lays ahead and maybe sharing that time with another person helps ease that worry.
Yesterday I had a patient who had a syncopal episode when she walked in the door from visiting her sister in Florida. Passed out and smacked her head hard. There was blood all over the foyer and kitchen and bathroom as she wandered in circles, saying “Oh my, oh my, what have I done?”
She was covered in blood – She looked like a Hollywood poster for a horror film. I inspected the wound, a deep lac on her left forehead that was still bleeding. The first responder had wrapped it, but not tight enough to hold pressure. I rewrapped it and then helped get her out of her bloody coat, and get her cleaned up as well as we could. Then we helped her onto the stretcher. She was alert and oriented with no neck or back pain. She just couldn’t remember if she fell because she got dizzy – she had been feeling lightheaded all day -- or whether she tripped over her suitcase.
In the ambulance her arm rested on my knee as I put an IV in her forearm. She commented on how nice my knee was. I’ve actually heard that a number of times. Better than the stretcher side rail isn’t saying much. Her vitals were all good and her 12 lead normal. I told her this as we talked. She thanked me for explaining and said she remembered me from the times I had come to help her husband, who passed away during the winter. I gave her my condolences. She said she had no family in the area anymore.
The hospital we were going to was a fair distance away so we talked quite a bit. I checked on her lac, and it was still bleeding underneath the bandages so I got some more 4X4s and pressed them against her forehead, pressed them hard and held them there. She looked up at me her eyes blinking, and thanked me for taking her to the hospital.
“It’s what we do,” I say.
We rode on through the night, her arm on my knee, my hand pressed to her forehead, talking quietly.
When I checked the head after five minutes, the bleeding had stopped. She seemed pleased when I told her.
“You’ll need some stitches,” I said.
“Its not too bad, is it?”
“You’ll have a scar.”
“It could have been worse, I guess,” she said. “At least I’m alive.”
“You most certainly are.”
When we parked at the ambulance, I moved her arm off my knee, and I bundled her up against the night wind. “It’s cold out there,” I said.
“Thank you,” she said, looking right at me.
When we wheeled her into the crowded ER, a triage nurse, her hands on hers hips, saw her, and exclaimed, “Why who hit you with an ax? Look at that gash!” But then she touched our patient’s arm warmly and looking her in the eyes said, “Don’t worry; we’ll take good care of you.”
