Archive for October, 2005

We’ve all been there (at least those of you who are on dialysis have…), a bad or painful stick, a queasy feeling, and then the feeling of dread as you feel your arm "blow" and fill with blood. 
Then for the next few weeks you watch the bruise migrate around your arm, and finally leave after putting up a bit of a fight. 
So I mentioned having a couple of bad sticks last week.  Nothing major, no infiltrations or anything, just some awkward sticks that left a giant knot in the middle of my arm.  Yesterday morning though, a nasty looking bruise just appeared over one of the sticks!  It’s almost black … with a little pink in the middle.  It’s really disgusting.  Imagine my surprise when I woke up yesterday, only to find a shiner in the middle of my arm.
The best part of this is that I do some work in sales.  Now, let me tell you, there’s nothing better than trying to demonstrate the singing capability of a $90,000.00 piano with a Schubert Impromptu and looking over to see that the customer’s eyes are trained on your arm.  Music doesn’t even exist at that point, only the horror they must be experiencing as they notice what looks like a giant snake crawling under the skin on your arm.  What are all those bruises and scars?
I’m sure to most I look like a junkie.  My nieces and nephew think there’s a bug trapped in my arm (it vibrates pretty noticeably you see).  So what do they think it is?  Do they assume the worst?  Do they assume the best?  I’d like to think that it’s a help.  That it builds credibility when they realize I’m not likely to be lying to them, as I have far more pressing concerns in life than whether or not they believe I’m as passionate as I say I am about music.
I fear though that the opposite is most likely true.  In my experience people fear what they don’t understand (cliche, I know…).  Worse than just fearing though, they tend to construct a reality in which their assumptions become not the worst case scenario, but the most likely explanation.  At this point "Occam’s Razor" seems to make sense and I’ve become a questionable character who probably uses drugs and wants to steal their money.   Of course nobody has ever said this or even implied it.  But do they really have to?
At a seminar a few weeks ago I learned that only 10% of communication is verbal.  Ten Percent!  People communicate very clearly with posture, noises, expressions, and so on.  Nobody has to tell me they’re questioning my motives.  It’s apparent in their sudden distancing.
Luckily I don’t have to work tomorrow.  Perhaps the swelling will go down tonight.  And perhaps, I’ll get another bad stick tomorrow at dialysis and my arm will look twice as bad on Tuesday!
One way or the other ‘ya gotta love this life.

…. Because I was so well behaved today, I got 3 sticks!
Ok, not because I was well behaved, but because the first stick was too shallow (eventhough cannulated by an ‘A-list’ tech).  So with the second stick less than desirable (unable to push or pull easily), a third needle was in order.
Should’ve been enough right?  Well, I noticed that my venous pressure kept rising the first few minutes of treatment.  This is why it is SO important for patients to understand the machines, and their accesses.  Noticing that the venous pressure was rising (not good), I called a tech over and asked her to lower my blood flow rate until we could figure out what was wrong. 
When a venous pressure gets too high, the fistula can blow open.  We don’t want that…
Luckily though, we were able to "fix" it.  I recommended that we remove the tape/gauze from the second (bad) stick, as I believed this narrowing on the fistula was causing the higher pressure further down the line (where the third stick was).  Sure enough, removing the tape and then subsequently re-positioning the needle brought the pressure right into range.
Boring I know … but this is the life of a dialysis patient.
If you are a patient, you need to understand how your access works, and how the machine works.  You need to be able to work in concert with your nurses and technicians to observe and correct issues like this before they become serious. 
More observation means fewer problems with these types of things.  This includes problems with infiltration, infection, and a host of other things. 

Almost time for me to head out of here …   more next time I guess.