Flashbacks

Fun with medical procedures.

Photo by Hiroshi Tsubono on Unsplash

The Irony Machine is Working Overtime

Did you know that when they are trying to start an IV line on a patient, they are looking for a flashback?

An IV line flashback is when blood appears in the chamber of an IV needle or catheter after the needle is inserted into a vein. It's a sign that the needle is in the vein and the catheter can be inserted.

I hadn’t heard the use of that term before in this context—or I blocked it out because my brain can only process so much irony at a time.

In Hard Stick, I wrote about how, because of my disability, (Origin Story) epidermolytic ichthyosis, it is very hard to take blood from me, much less start an IV. I wrote about how that plays out here A Tale of Two Surgeries.

Next Up—A Colonoscopy!

So, with the above background, I tried to get everything in place for my colonoscopy, so that it would play out with as little drama or pain as possible.

1. I exchanged multiple messages with multiple people until I got prescription for Sutab, which is the pill form of the “prep” you have to do before the procedure. You do this prep at home day before and morning of the procedure, to “clean out” your colon so that little camera they stick where the sun don’t shine can see those evil lurking polyps. (The alternative to the pills is a liquid you drink to the same effect, but is the worst thing to drink I have ever tasted.)

2. Multiple messages to ensure that the IV would be set up by an anesthesiologist, who would use a portable ultrasound machine to find a vein.

3. This is in addition to the copious digital records of the IV issue that my medical provider already has.

Day Of

I arrive at the SurgeCenter and check in. I feel really lousy, but “normal” lousy I think, not extra “crip” lousy. I haven’t had any solid food for about 30 hours, no liquids for 3. I am super dehydrated. (I tend to be dehydrated anyway, because of the skin issue, and when I’m not playing colonoscopy, I try to drink a lot of fluids. I don’t really succeed in getting enough, but I am better at it than I used to be.)

When you are dehydrated, it makes harder to find a vein.

They take me back to the prep area and I meet the anesthesiologist, who is woman (I haven’t seen a woman in this capacity for many years.) She is visibly nervous and says things like “I can’t make you any promises,” “I will try my best,” and “let’s start the IV in the OR.” Initially, her lack of bravado was refreshing, but lack of confidence can be contagious and I started to feel uneasy.

The prep nurse sticks leads on you so that they can measure your vitals during the procedure. I told her to please not press them down too hard because I needed to take off after (not them), and they can rip off my top layer of skin.

The nurses that were getting me ready also ran around and made sure that the ultrasound machine was in the room I was scheduled for. The nurses that pushed my bed down the hall and I joked about how I could really go for a milkshake right about now.

When we got to the room, one of the nurses said, “This is your suite.” I said, “If you could fill the ice bucket and close the curtains, and point me to the slot machines.” I got a little chuckle from one of the nurses, and kind of a test pattern from the other.

My anesthesiologist was in that zone where she can’t seem to hear what other people are saying. I asked for lidocaine after the first unsuccessful digging for a vein expedition, and she didn’t even respond. The nurses seemed nervous and did everything she asked them to, but I couldn’t see whether it was helpful or not.

My skin was dry. I hadn’t moisturized my arms because that would increase the likelihood of my skin getting sheared off by their handling of me. They put the tourniquet on so quickly and tightly that I am certain I would lost a lot of skin in that process if my skin had been more soft.

A second anesthesiologist came in (one of the nurses had seen him in the hall and mentioned it my doc.) He was older, ‘60s? He was a pediatric anesthesiologist, and they can be good with hard sticks. I wished that he had given a turn at sticking me, but that didn’t happen. (There is this undercurrent of professional etiquette and weirdness this whole time, between all the medical players. I would have called it out if I had thought it would have served me, but I didn’t think it would.)

Grandpop anesthesiologist started eyeing my feet, lifting up the blanket. Unbidden, I told him what my skin diagnosis is. Then I said, “We are not going to try my feet and ankles. I have agreed to that at least twice in the past, to no good purpose, and we’re not doing that today.” It hurts to take any clothes on and off, and my feet are no exception. There is also more scale and callouses on my feet than anywhere else on my body. He was very disappointed, but dropped it.

Meanwhile, Doctor Insecurity, kept almost getting it, but was not getting any flashback—which is when I learned the term. Eventually, she thought it was in, and we were all staring at the drip chamber, which was starting and stopping. I realized something and I said, “Does it make difference that you haven’t taken off the tourniquet?” I tried to say it in as neutral a tone as possible. After a beat where they all looked at each other, they took off the tourniquet and the IV ran better but not great.

Grandpop brought over a piece of strong looking adhesive to secure the needle, and I said, “No, that will rip my skin later. What about Coban?” (Coban is this cool stuff that wraps like an ace bandage, but is stretchy and sticks to itself when you want it to.) He said, “You don’t want her to have to do it over, do you?” It was all such a slow motion clusterfuck by then that I didn't argue with him.

Ultimately

I was sort of sedated, but I had told them to just go ahead and then felt the discomfort of the camera being threaded into my colon. (Unlike the cataract procedure, there’s no local, so you feel everything.) I even got some nitrous oxide through a mask because how much IV meds I was getting was uncertain.

You don’t feel everything, because I watched the surgeon excise a little polyp, and I couldn’t feel that.

At Home, After

The adhesive patch Doc Grandpop used to secure the needle did take a postage stamp-sized layer of skin in the crook of my elbow. Another, twice as large area was ripped off when a lead had fallen off in the operating suite and they stuck a new one on real good. Those places on my skin just burned for a few hours. The one on my torso got stuck to my T-shirt, so I had to unstick that, again. Sigh.

Flashbacks indeed. I’m not worried about the 3 polyps I had, but I will get the word on them next week. Regardless, it means I should have another colonoscopy in three years.

I know that no matter how meticulously I try to advocate for myself, shit is going to happen, and I will be the one eating the shit sandwich. I knew this before, but I have to believe, as was the case with my ophthalmologist, that occasionally listening and learning happens, and I get to avoid most of the sandwich.

My shit sandwiches always come with a side of flashbacks.

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