Mike Yee: A new poke

With the tourniquet tied and the antiseptic applied, I wondered dimly whether the target vessel had been scrubbed away entirely in the course of my preparatory cleaning. In its place I could discern only the faintest hint that a vein had ever even existed, a mere discoloration of the skin, a ripple on the surface where once thundered a proud tributary of her heart’s coursing river.

I had placed a few intravenous lines, but only for anesthetized patients in the operating room. Never before had I attempted the same feat under the close scrutiny of the recipient herself. The added pressure left my senses addled; whereas my initial assessment was that of an easy “poke”, now the vessel seemed to shrink before the advancing needle, dwindling in size even as my trembling hand drew close. I had the impossible task of spearing an earthworm with a whaling harpoon.

If my ineptitude distressed my partner, her calm and composed visage did not betray the slightest duress; a casual observer might have mistaken my fumbling with her limb for a manicure rather than a possible tattooing. Unfortunately, I could not lay claim to the same stable stoicism. My viscera ran wild, as if on a caffeine-fueled bender, twisting themselves into shapes unimagined by even the most creative balloon artists. I never perspire, even under exertion, but now Dagobah monsoon season erupted on my brow.

Was I hallucinating, or was her vein actually moving? I shook my head — no, there it was again. It not only moved, it danced, juked like Denard, swayed like Rick’s on St. Patty’s Day. We had been warned of “rolling” veins, but this one rolled like a Del Amitri-Limp Bizkit-Creedence Clearwater Revival mash-up. For a moment I worried that the vessel would rise out of her arm and battle for control of the needle.

Pinning the tail on the evasive donkey was taxing to say the least. I had to solve the Schrödinger equation, calculate probability distribution space, channel my inner Zen. I became one with the beveled edge and guided it not where Heisenberg’s vein was but where it would be. It was all in the wrist, and eventually, so was the needle.

A flash in the line signified that I had struck red gold, that indeed, There Will Be Blood. Quickly, I advanced the catheter into the vessel lumen, threading it over the introductory needle. So proud was I of this momentary accomplishment that I failed to close off the open end of the catheter fast enough, sending a torrent of crimson sloshing across the table.

Though my partner looked unconcerned, I hastened to grab the syringe of intravenous fluid that would occlude the open hub and stem the bleeding, but blood on my glove caused it to elude my grasp and careen out of reach. With the desperation of Mitch McGary diving headlong for an errant fast break pass, I skittered after the syringe, caught it on the first bounce and capped the line. As the fluid flowed into circulation, so too did the tension bleed away from me. Our long search for IV access had ended in vein.

The ordeal replayed at the other tables around us, as pairs of medical students did their bloodiest renditions of Dexter scenes. The number who fainted or passed out left the room less reminiscent of an IV workshop than a mass casualty event. I realized then that the goal of the session was not to make us masters of line placement, but to appreciate the nurses and technicians who routinely establish access even in very difficult patients. For injection drug abusers who had blown all of the usual veins, I had seen nurses and techs who could find viable vessels in all sorts of bizarre locations. The practice I received made me marvel at their artistry that much more.

I was roused from my reverie by motion in my peripheral vision. In one fell swoop, my partner had deftly taken up her own needle and pinioned my arm fast. The slightest suggestion of a vengeful glimmer in her eye seemed to say, “My turn.”

I gulped hard with a mouth gone suddenly dry…

Mike Yee can be reached at mayee@umich.edu.