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It's about the hands. She pulls back on the
paper peeling to open the tray of surgical instruments while conversing
with 15-year-old patient Kristen Bergh. "Where do you go to school? Do
you have any pets? What are your hobbies? Do you have a boyfriend?" she
asks. I think to myself, "dear god, leave the patient alone. She's suffering
enough. You don't need to ask her all these questions." Then I realize
that the awkward silence and nervousness felt by the patient is diminished
by conversation. It's as if all the years of gossiping had some sort of
benefit--aside from the embarrassing situations in which I caught myself
when I introduced my mother to my friends.
The hands are fifty-two years
old, weary from years of marriage, raising kids, and working. The fine
lines, aged pigmentation, and dullness are clearly visible. It is with
these hands that she gingerly touches Kristen and reassures her that the
catherization procedure will not be painful. Kristen, who likes to fence
and debate, looks into my mother's eyes for some comfort. She is in the
hospital for osteomyletis, a chronic bacterial infection localized in the
bone, and needs to have a Peripherally Inserted Central Catheter (PICC)
line inserted in her arm. According to my
mother, a PICC line is a "type of central line that is inserted into one
of the larger veins of the arm and where it is threaded into the superior
vena cava." The line is then used as an access point for the patient's
medication, including chemotherapy, as well as nutrition, antibiotics and
fluid hydration.
As my mother begins
to stick Kristen, the brown-haired, brown-eyed girl turns her head to look
away. The entire procedure takes only thirty minutes to complete. After
washing her hands, my mother picks up a pen and writes in her chart. She
brings her cart back to the IV office on the 10th floor of the Tower Building
of Fairfax Hospital where she then proceeds to sit down, make notes and
checks her beeper. There are no patients for the time being so she sits
down and eats her an orange for breakfast. She tells me, "sometimes you
don't know what to expect. It can get awfully busy or things can be relatively
slow. How busy I am depends on how many requests I have. If I have a lot
of requests, I am busy. If I don't, I can watch t.v. or read magazines
in the IV office."
My mother, Jeoung
Yoo, is a specialized nurse and works as part of the IV Therapy Team at
Fairfax Hospital. The team consists of a group of people who are skillful
in placing IVs in patients; they are called when difficult cases arrive
or when other nurses have tried unsuccessfully to thread the needle into
the vein. They stick patient one last time with the hope that the patients'
blood supply will soon be able to be accessed with appropriate drugs and
life-sustaining nutrients. When I asked, my mother told me that her job
consists of "putting in PICC lines, repairing central lines, declotting
the catheter, and accessing PORTS." The latter is an alternative device
to the PICC, and consists of a tube underneath the skin. The benefit comes
in that the patient doesn't have to be stuck with needles over and over
again.
Soon her beeper
rings and she is off again. This time the patient is a baby, only 37 days
old. "Children and babies need to be sedated," my mother says, "since they
move too much and do not understand what is going on." The baby's grandmother
brings him into the treatment room, a brightly lit, colorful room especially
designed for the purpose of administering medical procedures to pediatric
patients. The boy is chubby and cute, with light brown hair, blue eyes,
and the softest skin you can imagine. As I bring back some toys from the
"distraction box," I can imagine him starring in a Pampers or Huggies commercial.
My mother examines the baby's legs with her hands for some veins. She takes
off her glasses and peers closely, commenting that the good veins are taken.
After sticking once, twice, and then a third time, my mother shakes her
head. "I can't do it," she says in a frustrated tone of voice. She lets
go of the baby's leg and gives him back to his grandmother. His grandmother
takes him into her arms and thanks my mom for trying. My mother is standing
by the door with her arms crossed against her chest watching the grandmother
take the baby back to his mother in his room. I ask how many times they
fail, meaning the IV team. In "1% of all cases they cannot find the vein,"
she says. It happens "very seldom." In these cases, patients are sent to
the department of intervention radiology, where a mechanical procedure
called fluoroscopy is performed to better visualize the obstructed vein.
The patient is then sent to the operating room and a surgeon puts in the
catheter.
We then head to
the X-ray department, where my mother asks for the film of the first patient.
She takes the film from the technician and holds it against the white lamp
so she can check the proper position of the catheter. It is amazing how
one can see the catheter on the film, a thin wire among all the skeleton
on the x-ray. My mother takes out the measuring tape and with her hands,
checks the distance of the insertion. It is slightly too long, so my mother
must go back and pull some of the tubing from the patient's arm.
The next patient
is an elderly Vietnamese woman with cancer. In contrast to the baby, her
skin is leathery and aged. Laying in bed with various tubes hanging on
the side of her bed, she looks frail and weak. Her right arm is a bit distended
and has a purplish-blue hue. This is because the person who had previously
changed her dressing had not been so careful and had caused the needle
to shift in her arm. My mother is incensed about this and demands that
the nurses on the wing come to the room to see how a dressing is properly
changed. In the process of demonstrating, my mother takes on a serious,
commanding tone of voice. This reminds me of the times when she yells at
me for not picking up after myself after I take a shower and leave the
towels astray all over the bathroom floor.
With all her years
of experience, my mother has seen many things. She tells me about the IV
drug users who tell her what to do. "Put it here, put it there," they say
knowingly from shooting drugs. Like babies, there are adults who cry because
they don't want to be poked or prodded anymore. Some confused patients
will even pull their catheters out. One time a catheter could not be found
anywhere in the patient's room. After extensive searching people came to
the conclusion that the patient had pulled it out, chewed it, and ate it.
At the end of the
day, the hands push the cart back to the IV office and write notes in a
log commenting on the patients that she has treated. After taking care
of some phone calls and wrapping up loose ends, her shift has ended. I
change out of my scrubs and take the elevator to the first floor of the
main lobby of the hospital where I wait for her near the gift shop. We
soon walk out together in the drizzling rain and I hold her hand, the one
that will drive me home.