Monday, August 21, 2006

Body Confidence: How Mutinous Bodies Influence Our Instincts

To be fair, I had warned the nurse trying to insert an IV into my arm that I was a “bad stick.” While that is the understatement of the year, I hoped it would let her know that the problem wasn’t her, it was me. Or, as I liked to say, my wily, conniving veins. I needed an ACTH stimulation test to check my adrenal glands. It should have been a simple procedure—draw blood, insert medicine via IV infusion, re-test blood one hour later.

Looks like I may have jinxed all of us that day.

One hour and 45 minutes, 14 sticks, eight blown veins, several hematomas, multiple heating packs, a couple of additional phlebotomists, and much teeth-gritting later, the nurse wouldn’t even come back into the room and I still didn’t have an IV line started. At first, I tried to crack jokes and smile a lot so the nurse—I’ll call her Tammy—wouldn’t think she was hurting me. I have a pretty high pain tolerance (I get my cavities filled without Novocain), but even I will admit that it did hurt.

“No really, it’s okay, you can keep going,” I told her when the needle went into yet another vein and no blood came back out. She’d push and prod until the vein blew or else swelled up to the size of a golfball. After a few tries, she called in the phlebotomist, and an interesting turf battle transpired in terms of tactical approaches. After awhile, Tammy got even more rattled watching over her colleague’s shoulder, and she left the room altogether.

“I don’t understand. I do these all the time, but now I’ve lost my confidence. I don’t want to go near you, and I don’t want to hurt you,” she said as she left. She was practically in tears.

I never got my IV. They had to push the medication in all at once with a syringe and then re-stick me for the second blood draw an hour later. I left with 15 band-aids, several very sore and swollen patches on my arms, and a few instant heat packs to tape around my arms later in the day.

I looked like a disaster, but I honestly think Tammy came out of the experience more troubled by it. “I just don’t have any more confidence in my ability to put in an IV,” she said as she gave me my parting instructions. I was struck by how the balance of power had been disrupted by some tiny, stubborn, and scarred veins. I tried to comfort her with assurances that everyone struggles with my veins, but it didn’t help.

Being the patient trying to console and bolster my healthcare provider was an odd role reversal, but one I’d experienced before. Whenever my body doesn’t act the way it needs to, I feel responsible to remedy the discomfort it causes, like it’s somehow my fault that people lost confidence in their skills when left alone in an exam room with my complicated medical history and my uncooperative body.

But I could relate much more to Tammy than I’d have guessed. I am used to temporarily losing confidence in my own body and in my own skills as a result of my various conditions. It’s the worst when I am returning back to a more “normal” schedule after a prolonged absence or exacerbation. I begin to doubt what I can do, question my stamina level, and hesitate in making plans or commitments because I am not sure I can trust my body the way I once did. Eventually I get there, but while it happens, it is a terrible feeling to question my own instincts, the same instincts that have proved so wise in the past.

I see now why that IV scenario was so precarious for both us. Tammy and I each have our expertise—hers as a nurse, mine as a patient—and yet my body managed to make our knowledge backfire for both us that day. Goes to show that no matter how much you think you know, illness is always an equalizer.


Kj said...

Hey Laurie
Here I am again.
Its becoming a habit.

I agree with the mutinous body theory.
I have the ‘pleasure’ of being the patient and the nurse.

I was, in my real life BS (before sickness), a nurse and I was a pretty good one… I had been a patient for my entire teen years living in ward 2 for 3 years so I knew what it was to be on the other side.

Miraculously I got well and we all thought it was for ever ( the fickleness of youth) and so I made the biggest leap of my life and trained as a nurse. I had 3 great years working in the same general medical ward I had lived in.

And sickness kicked back….and here I am, back on the other side….as the patient.

In some ways it great because I know the routine, I know the terminology (you soon pick that up as the patient anyway) and, because I have a pretty rare combination of goodies, I know more about most of the disease processes than the doctors who are treating me. I know what combinations of drugs titrated to what levels have the desired effect. I know how to best make myself comfortable, how best to rest, and the list goes on….. and it makes my nurses job easier, but they are still my nurses and I have to remind myself to take a step back and allow them to do their job.
That’s something I find hard to do.
And when I’m in hospital and have one of the girls I trained with nursing me I have to remember that she is the nurse and although I know as much as her, more on topics of individual problems, she is the one who is answerable to the medical team at the end of the day….and she is the one who will probably save my life by being in the right place at the right time doing the job that makes my ongoing living possible.
I also know how heart breaking it is for someone you know well to do the crap jobs, the needle sticks that have to go in the top of my feet because all my veins are buggered and a central line isn’t possible, the job of rolling me in the night (which even at home never goes too well), and the jobs that rob dignity form the patient….bed baths, bed pans, catheters, drains, all the fun stuff…. I know form my experience as a nurse that sometimes it’s better to be nursing someone you don’t know. … then its not as personal when you have to intrude on their more-than-personal space.

“‘I don’t understand. I do these all the time, but now I’ve lost my confidence. I don’t want to go near you, and I don’t want to hurt you,’ she said as she left. She was practically in tears.”

I know how she feels.
I know how you feel.
It sucks.

There’s no other way to say it.
Its sucks!
She feels like shit and her confidence is crushed. For the next ten patients she will baulk at putting in lines. She will use less pressure to touch patients. She will hold their arm more gently as she helps them to the loo…and she will go home at night and lie awake wondering if following in the footsteps of Florence Nightingale was really the best choice for a career after all….but then she will have some positive experiences, she’ll have a few patients tell her that they didn’t feel a thing when she puts up a line, and they’ll mean it and then “Tammy” will realise she still has ……..IT…. that she’s not a failure and that she isn’t the menace to patients she had painted herself as last week or last month.

And we as patients will have this experience over and over again…
We get to be in the position of nursing the nurses.
We get pretty good at saying….no, really that wasn’t that bad, it didn’t hurt a bit…and then crawling into the bathroom to cry after they have left the room because of the agony they have inflicted on us.

I feel for the nurse.
I feel for the patient.
I am the nurse, and I am the patient.

Its just how the cookie crumbles

Cheers for the rant

Kim said...

Ummm....perhaps Tammy was a newer nurse.

I'm really excellent with IVs but there are times when I just have to step back and turn it over to someone else.

It isn't your fault that your veins may be a challenge to cannulate, your veins are what they are!

I will tell you, though, sometimes you need to find the nurse/phebotomist with the right "touch" for you that day.

If I'm not the one with "the touch" you need that day, then I'll get another nurse to work with you.

I would't be in tears, my confidence wouldn't be shot and you would not be feeling the need to apologize for your veins and comforting the health care staff.

I guess I'm just an old dinosaur with lots of years under my belt.

Your story was very sweet and your compassion for Tammy was nice to see, but you need to know that presenting as a challenging patient is not something you ever need apologize for. : )

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