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An author of no particular popularity

Jay Lake
Date: 2009-10-22 17:33
Subject: [cancer] The price of a single banana
Security: Public
Tags:calendula, cancer, funny, health
So today's adventure with the Department of Giant Radioactive Spiders (a/k/a Nuclear Medicine) went fairly sideways. I won't have the results til next week, but even getting the test done turned out to be a heck of a challenge.

I was up at 5 am to get ready. Headspace pretty troubled, following my plan for the day. I reviewed the test orders from MyChart, the online patient record system my hospital uses, and it said quite clearly, "Eat light meal before two hours NPO." Meaning, nothing by mouth the last two hours before the tests (scheduled for 8 am), but have something right before that.

This was not how I remembered the PET going last May, as it required fasting. I looked carefully over both sheets of orders, and found nothing contradicting the "eat light meal". So about 5:45 am, I ate a banana.

Fast forward to 7:45 am or so. I am sitting in the waiting room of the Nuclear Medicine unit with calendula_witch and tillyjane when they call me in. The banana is a problem. Why did I eat the banana? I produce my printouts of the orders. The nurse (who was very supportive and understanding) looks at them. "Yes, it does say that right here. It's wrong." To which I point out that these are, indeed, my written orders, straight from their system. Yes, but the test cannot be performed with a banana in my digestive tract.

The reason for this is that the PET scan involves injecting a radioactively tagged glucose analog into the patient's bloodstream, then waiting an hour for the sugar to be metabolized. They want to minimize nonessential metabolic activity to prevent the sugars from being concentrated in areas not otherwise of interest — a lot gets taken up by the brain, the heart, the bladder, etc. Hence the hour in a darkened room with no books, conversation or television. This minimizes brain uptake. Likewise the six-hour fast, to minimize sugar uptake due to digestive action.

Phone calls were made. Doctors were consulted. The test could not be run at 8 am, on account of banana infestation. I wheedle, say I'm available all day for a reschedule, but to come back at a later date would be logistically difficult. I do not mention this will also make me insane with more dreadful anticipation. Rescheduling is a serious issue, because the isotopes involved in the radioactive tagging have a short half-life for safety reasons, and cannot simply be held in readiness for a few extra hours. Somebody down in nuclear pharmaceuticals has to fire up the drug cyclotron or something, and this is a big deal.

We finally decided they can fit me in at 12:30, but I must not eat anything or drink anything other than minimal water. Our helpful nurse does offer to fit the IV now, to expedite matters on my later return.

As TV Guide is wont to say, trouble ensues.

My friendly nurse fetches out the IV kit. I inform her that I am the proverbial "hard stick." This is hard-won knowledge, including a record-breaking 13 jabs to find a live vein one time in a clinic. My circulatory system is laid out rather eccentrically, veins not being where one might expect them. I have a thicker than normal layer of subcutaneous fat, so I show veins about as much as your average basketball does. I have been NPO for some time, so my blood pressure is down and the veins are laying flat. I explain all this. She spends some time studing both my arms, finds a vein she likes in the crook of my left, gets a 20 gauge needle in there, and goes fishing.

Dry hole.

Being a wise nurse, she calls for backup. After a little while, the IV therapist shows up. This lady, very professional and appropriate, was seriously not having any of my sense of humor. She also wasn't pleased when I asked if she was a phlebotomist, as she was an RN. She shortly gets to work, and this is serious business. Hot packs. Dangling arms. Probing of the veins. Lidocaine to numb the site so she can go in without muscle twitching or pain-startles. (I've never in my life had local anaesthetic for a needle stick.) Into the crook of my left arm she finally ventures, and goes fishing.

Dry hole.

Frustration all around. I am informed that my veins are scarred, presumably as a legacy of the last 18 months of medical intervention of various sorts. I invite repeated sharp object penetration of my arms in favor of IV to the hand, which hurts like crazy. The final decision is IV to the right wrist, which apparently annoys the CT team, but they're running out of options. I briefly divert the energy in the room with a question about why the needle gauges are rated as they are, which neither nurse can answer. Meanwhile, calendula_witch, thoroughly distressed by all the sharp pointy bloody bits, has left the room. Eventually, and with more than a little pain (and a second lidocaine injection), I wind up with an IV taped down to my right wrist.

We depart for the cafeteria, so my support team can eat while I look on in idle hunger. At some point, the banana seeks repatriation with the outside world, so I head off for the bathroom. Where I find that my right wrist is bound almost immobile, and certain necessary sanitary functions are improbable unless I plan to return to the Nuclear Medicine unit with feces smeared all over the Coban covering up my IV port.

Let's just say my left hand will need occupational therapy, and I used more toilet paper than a carload of teenage girls on a Mountain Dew binge. The curtain of good taste will be drawn over further elucidations of this issue.

We wound up reading our books in a nice lobby by the upper terminal of the funicular, with a spectacular view of the Willamette Valley. Eventually we return to Nuclear Medicine, where things proceed more or less as planned. I drink contrast dye, which makes me queasy. I get shot up with the glowjuice in the tungsten-jacketed syringe taken from the lead box. I spend an hour largely sleeping in the dark. I get strapped to a table for 45 minutes for the PET scan, whilst calendula_witch and tillyjane look on, and my bad shoulder makes itself known. I get shot up with more contrast dye, which makes my face, genitals and anus feel like someone is holding a match to them. I get strapped to the table again for 15 minutes for the CT scan. Finally I am released. We are informed that the problem of the bad orders in MyChart has already been escalated several levels of management, accompanied by "a lot of yelling."

I won't have the results til Monday, but I am a lot more relaxed than I was before the test. The oncology consult is much more the inflection point on all this stress, but it is the test that gets the attention of my lizardbrain. And had we been forced to postpone the test date due to the banana incident, the logistical and emotional disruption would have been incredible. So I'm very glad the OHSU Nuclear Medicine people came through, I'm very sorry I ate the banana, and I've learned my lesson about following written orders.

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calendula_witch: arms
User: calendula_witch
Date: 2009-10-23 00:42 (UTC)
Subject: (no subject)
To be precise, the point at which I had to leave was when the IV therapy nurse said, "Oh, this is very bad." As she was digging around in your arm.
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Sally Cinnamon: bucky writes
User: elizawrites
Date: 2009-10-23 01:00 (UTC)
Subject: (no subject)
Keyword:bucky writes
As a confirmed needle-phobic -- I'm a super hard stick, too, and I always have to have a butterfly needle in the back of my hand and I get that lovely vasovagal reflex that makes me almost but not quite pass out when my precious bodily fluids are stolen -- this entry made my innards crawl.

I'm terribly sorry you had such a hard time, but glad you got the scan over with. And look on the bright side: at least you know your digestive tract is in good spirits. A six hour turnaround isn't bad at all.
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User: jtdiii
Date: 2009-10-23 01:04 (UTC)
Subject: (no subject)
You are a hard stick too?

My condolences for that. Owwwwwww
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User: ygolonac
Date: 2009-10-23 01:08 (UTC)
Subject: (no subject)
I too became a hard stick after lots of chemo and radiation therapy.

For my post op chemo they heated up these pads that were filled with dry rice or something and put those on my arms to get a vein to show better. To this day that smell of burnt rice makes me sick to my stomach.

I found out a short while ago that even my nose is a 'hard stick'. Four tries to get the tube down my nose to my stomach. That sucks more than the arm sticks.
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Jay Lake
User: jaylake
Date: 2009-10-23 03:30 (UTC)
Subject: (no subject)
Oh, yeah, I had violently difficult nostril follies last year...my sympathies.
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The NewroticGirl
User: newroticgirl
Date: 2009-10-23 01:11 (UTC)
Subject: (no subject)
Jeebus, what an "adventure"!! :(
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User: cathshaffer
Date: 2009-10-23 01:12 (UTC)
Subject: (no subject)
Oh, boy, I'll bet there was yelling. See, what they love to do is blame this kind of screw up on the patient. The way the script is supposed to work is you were supposed to have eaten breakfast even though your orders said not to. You would have claimed that a nurse or somebody told you it was all right to have a light meal, and everyone would consult your written orders and see that you were NPO after midnight. Instead, you showed them written orders--PROOF--that it was THEIR screwup and they can't stand it. I love it.

Of course something similar happened to Mom once. Bone marrow biopsy. Except the orders were verbal, and there was much disapproving and condescending noises made and no reschedule.

So glad you got to do it on the same day. The waiting would indeed have been unbearable, and the reschedule likely would have been six weeks out or so.
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User: melissajm
Date: 2009-10-23 01:25 (UTC)
Subject: (no subject)
Oh man. I hope that after all that you get good news.
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Gary Emenitove
User: garyomaha
Date: 2009-10-23 02:01 (UTC)
Subject: (no subject)
>>At some point, the banana seeks repatriation with the outside world<<

Sir, that line belongs in the Jay Lake Humor Hall of Fame (tm).

Meanwhile, I'm seriously sorry about the ordeal.
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User: mmegaera
Date: 2009-10-23 02:02 (UTC)
Subject: (no subject)
I'm sorry. I couldn't help but laugh at your description of your travails. But you do write so very entertainingly...

Here's hoping that the ratio of test obnoxiousness to bad news is inverse. And that your results are very good indeed.
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scarlettina: Hug 2
User: scarlettina
Date: 2009-10-23 02:08 (UTC)
Subject: (no subject)
Keyword:Hug 2
I keep telling people that bananas are evil but no one believes me! See? See? I knew I was right!

Seriously, sounds like it was a perfectly sucky adventure, but I'm beyond happy that they didn't make you wait again. Your head would have exploded. It would have been messy.

One way or another, I'm going to see you this weekend. Watch e-mail regarding scheduling.
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Be wise. Be brave. Be tricky.: medical
User: slithytove
Date: 2009-10-23 02:37 (UTC)
Subject: (no subject)
For a technology as ubiquitous and necessary as intravenous therapy, getting an IV in a vein is surprisingly problematic, still.

Hot packs, dangling arms, butterfly needles, bags of rice...

Some famous doc -- I forget who, perhaps Osler, he's the 'Ancient Chinese Proverb' of medical sayings -- once said that when every doctor has his own favorite treatment for a disease, you may conclude that NO treatment really works. If there was a treatment that worked, every doctor would only use that one.

There actually is a 'treatment' that works very well for getting difficult IV's. It's ultrasound. The problem is that ultrasound hasn't trickled down to nursing, yet, it's still in the hands of physicians.

Heck, a few years ago, most physicians didn't even have it. Us lowly ER docs were forbidden to use ultrasound by the radiology mullahs. That barrier has since been thrown down, and Joe E.R Doc can use ultrasound to start IVs that his nurses can't get. I probably do this once every week or two.

But why can't the nurses just do it themselves? The technology is simple (from the user's POV) and safe. There's a learning curve, as there is with everything, but it's probably flatter than the learning curve for starting IVs without an ultrasound. Plus, *shhhh*, it's fun. Like flying a subcutaneous spaceship.

Same for pre-hospital paramedics. They're very good with IVs, but why shouldn't they have an ultrasound to help with the hard ones?

Eventually this will happen. But isn't it like this with every new technology? Take computers. In 1950 and 60s, they were vast, mysterious things that lived in refrigerated basements, guarded by a priesthood with the arcane knowledge it took to run them. Then Digital Equipment (remember them? *sniff*) came out with the minicomputer in the 1970s, and every damned office could have one. Then came the Apple and the PC, and every Joe Six-Pack could have one.

New, disruptive technology starts out as wildly expensive, controlled by an elite, available to very few. Gradually, if it proves worthwhile, it gets democratized. Usually this is a good thing. Sometimes it isn't. See: Iran, North Korea, and nukes.
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Lawrence M. Schoen
User: klingonguy
Date: 2009-10-23 11:50 (UTC)
Subject: (no subject)
I want a subcutaneous spaceship! Also a pony (maybe one of Bear's steam-powered, telepathic, two-headed, metal ponies).

Oh, wait, sorry, this is Jay's thread. Damn. So does that mean I don't get the pony? What about the spaceship?
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mcjulie: NoShoes
User: mcjulie
Date: 2009-10-23 02:49 (UTC)
Subject: (no subject)
A big, sympathetic owwwww.
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User: yourbob
Date: 2009-10-23 03:06 (UTC)
Subject: (no subject)
I really do love the yelling bit. There should be.

Appendages crossed. Most of them appropriate.
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User: madrobins
Date: 2009-10-23 03:32 (UTC)
Subject: (no subject)
Oh, man. It's not like the whole process isn't stressful enough. You follow their directions and its still wrong? Pfui.

As a woman with veins that make phlebotomists weep with joy, I wish I could give you a pint of my veins for these situations.
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Lisa Deutsch Harrigan: St Mongos
User: lisa_marli
Date: 2009-10-23 03:45 (UTC)
Subject: (no subject)
Keyword:St Mongos
Oh, boy, My husband is a hard stick.
I don't blame calendula_witch for bugging out. I have too, and I'm the loving wife with first aid training.
In reference to one of the above replies, Yes, they even tried Ultrasound and couldn't find a vein when he was in the hospital for his MRSA infection. We still haven't gotten his veins back from that one.
May the news all be good.
And next time, no bananas after midnight ok?
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