*This entry was originally written over a year ago; the actual date forgotten. This is a revision, but the facts are kept intact.
His delight was palpable, infectious. I cannot help but be cheerful to see this Korean nonagenarian in grand admiration of, to his point of view, a work of art. It was merely a peripheral IV1 I inserted on his left forearm which I, after securing it in place, wrapped with self-adherent bandage2. He glanced once again at his new IV.
‘Engineer!’ again came the admiration followed by a salute this time, his face beaming with joy that filled the room. I reciprocated the gesture and left.
‘Engineer,’ I whispered to myself and smiled. It was a flattering thought, I had to admit. Now I have the vaguest idea of what an engineer does, naturally thus I was at a loss, unable to reconcile the task of inserting an IV to that of engineering work. Howbeit, I was beginning to be convinced that I could’ve been a good one had I pursued that field instead, seeing that not even an hour prior, I succeeded in placing an IV on my other patient, who, returning from a CT scan, had the inexplicable misfortune of it giving out. I noticed the hapless lot when I flushed it.
‘What did they do to you down there? It was perfectly fine before you left!’
‘You need a new one.’
‘I have a good vein here (pointing to her left posterior arm). They used this site when I had my chemo.’
I inspected it, and finding nothing, explained, ‘You know, chemo can cause veins to hide.’
‘Well, I was thinking of putting a 20 gauge, the same size as the one that went bad. I don’t know what else the doctors have in mind as far as exams, but if they do approve of another CT requiring a contrast, at least this should be good enough. But let me put some warm packs on your arms and see if the veins pop out a little. I’ll come back in 10 minutes.’
Fifteen minutes were like a few seconds. Soon, I found myself wrapping her left wrist with self-adherent bandage.
Engineer. I relished the sound of it.
Hours passed and it was fast approaching 5 AM, the appointed time for blood draws. The nurses carry out this task whenever their patients have a central line access; I had two who each had a dual lumen (port) PICC3 line. Having gathered the necessary equipment, I went to one, cleaned the red port of his PICC, flushed it, then drew. Blood trickled sporadically along the line and out to a complete halt. Not … very … good. Seeing the futility of another attempt, I used the other port. Same. Now there are ways to facilitate a good blood flow with PICC lines but they require that a patient be placed in different positions, be it sitting upright, or lying sideways. For this patient however, such techniques hardly were applicable. He was edematousa. He dreaded the slightest movements because of the discomfort they caused. Raising the head of the bed higher hampered his breathing because of his grotesquely distended abdomen. No question about it now; he needed the butterfly4.
I glanced at the clock. The minute hand stationed itself well beyond the fifth hour. There was no point in changing the order for the phlebotomists to come and do the blood draw for me. Bound by their own protocol, they would just set the task for 10 AM. I could’ve left it at that, but all manner of reasons took captive my thoughts intending to bend them to its will:
‘Think of the patient, very sick and could probably be served better if the lab results come early; Think of the residents and how they would answer to their attending physician without a ready bloodwork; What of the morning nurse? You cannot just add to the deluge of tasks he or she has to perform during the day, can you? You don’t have it in you.’
Honorable as these reasons were, there was but one that nudged me to do the task myself. As I stood there staring at the PICC line faced with the pending decision, a feeling of pride arose, then catching my breath, made my stand against the situation presented before me.
‘You wanna play it that way?’ I muttered, ‘Bring it on! After all, you are messing with the engineer.’
I left to do the blood draw on my other patient, then I returned with a few butterflies, a tourniquet, and several tubes. The challenge has just begun. After binding the tourniquet on his left arm, I checked his hand. Feeling a vein through all that swelling was hard but I managed to find one. Bingo! All too easy. I went in for the kill. Blood peeked a little but that was it. [expletive]. I went for the antecubital. Nothing. The right antecubital was just as good as the left.
I finally succeeded on my fourth try, drawing blood from my patient’s right hand. I called for another nurse to come and take away the blood samples so that they can be sent along with the others. After cleaning up the mess I made and making my patient comfortable, I left his room, but then paused, and reclined against the wall just outside his door, exhausted.
‘Engineer.’ I feebly told myself. Then I remembered all the linen and the diaper changes I had to do with this patient all the night long, and how efficient I was at them.
‘Engineer, huh.’ I told myself once more, a cloud of doubt now hovering over me.
‘— Sanitation engineer.’
1short for intravenous, but the acronym is generally understood as the whole intravenous line through which fluids and medications are given.
2The name of the product is Coband.
3acronym that stands for Peripherally-Inserted Central Catheter
4blood-drawing instrument which shape resembles the insect
astate of swelling from excessive accumulation of bodily fluids