Tuesday, March 15, 2011

Tuesday's at Chemo

I've posted this on Facebook, but I think it needs to go here.  A friend on www.armedpolitesociety.com asked if we could take pictures of Flat Stanley doing things in our part of the country and e-mail him the pictures.  So I took him to Chemo.

Picture a row of the 13 of the ugly hospital green "designed to be uncomfortable in whatever position they are in; as they are designed by the Marquis De Sade” chairs.   They are the chairs that visitors sleep in when they come to stay with you in your room in the hospital.  Each has one sometimes two IV pumps on each side.  There are little tables attached to each side of the chair that can fold up or down if you know their secret to get them to stay up.  The little tables are about 10" x 15".  There's a short wall on each side of the chair, so you can't turn your head and look directly at the person next to you.  One side has a red sharps box on it.  But each wall only extends to the end of the chair between each position and a there's curtain you can draw from wall to wall, but no one does.  If you recline your chair, your neighbor can see your legs.
There's TV on a swivel arm mounted on the other wall.  It can never be adjusted to the correct viewing angle.  Not many people watch TV, but if you do there’s drawer in desk at the far end of the nurses station with the headphones. Each headphone is in a baggie with your first and last name on it.  They are filed in green hanging file folders, alphabetically by last name.

Many days almost all the chairs are filled and it can be hard to find one.

The nurse’s station sits opposite and behind the nurse station is the chemical or mixing room.  There are six oncology nurses; Patti, Karen, Gwen, Laura, Josie, and Grace.  Normally there are only four or five of the six on duty on any given day.  Patti is in charge and everyone knows it.  The others are a little "relaxed" on the days she's not there.  They all are wonderful nurses and brave human beings.

There are two private rooms one at each end of the row of chairs.  They have the same pump and chair arrangement, but no one requests to go in unless there's a procedure that the rest of the world doesn't need to see or every chair is filled.  There's also a simple straight back chair between each station for those who came with or brought in their loved one to get treatment.  I bet they are more comfortable then what the patients get.

I walk in, but I do so somewhat tentatively.  The place does mostly breast cancer patients, so I'm normally the only guy.  I don't want to embarrass any of the ladies, if there’s “something” going on that I shouldn’t see, as most of them have permanent lines in their chests.

I chat with or sometimes “flirt” with the “single” ladies, meaning that they, like me are there alone.  They are mostly in their late fifties or older.  I make ‘em smile or at least try to.   For some of the regulars, if they’ve brought a family member or friend, I get introduced.  More small talk and I can see the start of the evil eye(s) from the nurses’ station as I need to find my seat and get started.   I always smile at anyone new.

I inquire who my nurse is for the day by asking "Who drew the short straw this morning?"    It always gets a smile from the nurses and a puzzled look from anyone "new".

I fold up the chair arms if need be, put down my Chemo Record/Chart book, a book I brought to read, reading glass case, cell phone and head over to one of the three carts that has all the supplies on it.

Depending on who my nurse is determines what supplies I take.   Grace has a latex allergy so I always make sure that I take the purple nitrile gloves and tourniquet.  Josie likes the large vinyl gloves even though they are really one size to big on her hands.  Patti like to use two 4" pieces of the clear hospital tape torn from one piece long ways placed on the front edge of the table where she can easily reach them after she does the stick.  (I've been known to put a spare pair on the side, just in case she blows out a vein.)  Josie, Laura and Karen like to use the backs of my hand for the IV; Gwen and Patti prefer the inner arm between the wrist and elbow.  I've got the stick kit, plastic adapter for the blood vials, the two blood vials (Purple top and purple/black mixed) for the two labs they do before I get chemo to see if I "can" get it.  Oval shaped IV sticky cover thingy, some gauze, band-aid and an alcohol wipe or two.  Band-aid and gauze are for Matt or Areliea (the techs) to use when it's all done and they pull the IV.  After everything is opened and setup in the proper order on the little shelf table that doesn't have my crap on it, I write my last name, first name on the blood vials, and put them in place.  Then it's back to the cart for the heat pack.  Squish it between my hands so the inner baggie breaks, squeeze it around so it gets good and warm, then head back and grab seat.

This simply shocks most of the new folks, as I’m the only person that gets themselves setup.  One time I had one lady yelling at the nurses "Hey, he's stealing supplies!!!"  They all looked up from the nurses’ station and said damn near in unison "No, that's just Dave. He's fine."   She was stunned.

Here's Flat Stanley Picking out a chair.  Careful Stanley, if you stay there you'll get the Chemo !!

Okay Let's head over the the cart to get the supplies we need to start an IV

I think we've got everything we need.  Josie is our Nurse today, and she likes to wear 2 vinyl gloves.

Let's get everything setup and organized !!

We'll put our book and reading glasses on the other tray (along with the gauze and band-aid for later)

The process it self is pretty boring.  After a while, my nurse will ask if my arm/hand is ready and I'll let 'em know whether I need to cook a few more minutes or "Yep, the turkey is done."  I keep threatening to have one of those red pop-out-turkey-is-done buttons installed.

They go back to mixing room grab a saline pouch, find one of those round seats; the  backless, rolling doctor stools and wheel themselves over to me.  They tap around for a vein in the preferred area and we debate the pros and cons of each one we see/feel.  Finally a swipe or three with an alcohol wipe, another tap or two, and then the "A Poke" announcement generally about two seconds after the stick. If blood fills the clear tubing then no rooting around is needed.  I hate the rooting around, generally it means either the vein will blow and I end up with a large bruise or it will leak because they've punctured the other side and it looks like I've got blood poisoning for the next week or so.  Rooting around generally means a re-stick, in a new vein, sometimes in the opposite hand or arm, so start over with new hot pack, and new IV starter kit.

Here's Josie, our nurse today !!

Our first stick, I think Flat Stanley got a little wobblely there.

Oh No !!  The vein blew out !! Flat Stanley had trouble watching the needle go in.

Stick #2  He's up and doing better this time.

Hmmm, not getting any blood in the line, so we're rooting around to try to find the vein.

Sorry Josie, but two sticks and your out.  Patti (the head nurse) comes to try a third stick. (Patti is camera shy.)

Success !!!  We fill the first blood vial.

And now the second vial.

Hooking up the saline solution

Once they get good blood flow into the tubing, pull out the needle by pulling the cap at the end of the tubing.  Cap with needle safely contained goes into the Sharps box on the wall. Twist off the little plastic cap at the end of the tubing (which they hand me to drop in the sharps box hanging on the wall.  Then Twist on the round plastic vial filling adapter.  (BTW, they are called VAC-U-TAINER's and are made by B-D.  The Styrofoam trays that they are shipped in make great metallic cartridge reloading trays, so if you get in tight with the Pete the Lab guy, he’ll save them for you).

Fill each tube to about half to three quarters full.  Tourniquet comes off and twist off the Blood vial adapter and attach the line to start the saline drip.  Chemo drugs will later get attached to the saline line as the saline is used to rinse the line and make sure that all the Chemo drugs go in, YEA!!!  We drop the rest of the non-bio hazard trash in trash can next to each chair.  If I forgot to grab a juice box or three, some cookies, crackers or a warm blanket, now is the best time to ask.  After the blood vials go into the lab/mixing room, the goodies get delivered with a smile.

I don't start my own IV's anymore, as Patti threatened to just watch me bleed out if I screwed it up.  I'm not sure she wasn't entirely serious.  Karen said it was because that REALLY scared the crap out of all the other patients.  As in there was NO WAY they were going to do it.  So I acquiesced.  I'm a firm believer in not pissing off the nice ladies with the needles.

 Yep, Saline. We use this to give us a constant line.

Josie is busy at her computer, Laura is asking her to double check the chemo drugs for another patient.

Here's the IV pump set-up and running.

And here I am with Flat Stanley, all hooked up and waiting for the blood test results.

I pass the blood tests, so here's the anti-nausea drug.

Here's the Aranesp, my Hemoglobin was a little low this time.  (9.6)

The Cytoxan arrives.

We double check to make sure it's our name on the bag.

And up it goes !!

Ooops, we fell asleep and missed the changeover to Velcade !!

She takes the Chemo Chart/Lab book back to her station and does whatever computer/paperwork that nurses do.  I start to read what I brought. I don’t make it very far, as I've generally fallen asleep when the chemo drugs are delivered.  Sometimes the nurses arrive in what looks like full-on Tyvex Hazmat suits, complete with face shield and other times, they just have on plain lab coats and hang the bag and hook it up to the saline line and through the pump, no muss, no fuss.  I'm not sure how many bags of crap they hook up and take down, because I mostly sleep through it.  I sometimes only wake up when the pump alarm goes off, meaning that bag is empty and they can hang the next one.  This goes one until I've emptied all the bags for the day, and takes anywhere from 4 to 6 hours depending.  Then one of the techs will pull the IV.  I hold pressure on the gauze, and get a bandaid.  The last baggie gets dumped with the rest in through the hole in the lid of the yellow CHEMO ONLY plastic tote by the nurses' station.  I quickly say goodbye to everyone and head out.  I go straight home most times.  Sometimes, I get a Buck Double at the Burger King that's on the way.  For the next day the only way to sleep is sitting up.  Apparently the combo platter of chemo drugs I get gives you hiccups if you lay down anytime in the first ~12-20 hours afterwards.  I mean 2-4 hours of hiccups, the kind where just when you think they're gone, you get one.  I sleep sitting up in a chair to avoid them.

We get a new saline bag, to dilute the Velcade and flush the line.

Everything is empty so it's time to pull the IV.

Some direct pressure for a minute or so, then gauze and bandaid.

 Where I'd rather be.

I got to know Al and Mary pretty well. They were in their late sixties or early seventies.  Al was a big guy, as in built like what you’d expect a former NFL middle linebacker would look like at that age.  She normally had a chair across from the Nurses’ Station.  Al had been a member of the Aurora Sportsmen’s Club for many years, up until Mary got sick.  Then she became his life.  Most times, Mary was too weak to speak, but I could always get some smiles out her. Mostly though, she slept.  Al and I traded ASC and hunting stories, when I wasn’t sleeping.   We liked to watch the nurses work “harder” on their computer so they wouldn’t have to listen to us.  One time Al and Mary weren’t there, so I asked Karen, who was my nurse that day, were Mary was.  “They have another doctor appointment so they were coming in later in the afternoon.” was the answer.

Then I made the mistake once of asking, “Where’s Bernice been?  I haven’t seen her is a couple of weeks.”  I was very sharply told by Patti that they are not allowed to discuss other patients.  All the other nurses just looked down or away.    My eyeballs kinda clicked together as I now knew that she wasn’t coming back.

 I haven’t seen Al or Mary in four months.   I haven’t asked, but I heard through folks at ASC that knew Al, who told me that Mary had passed.  I sent a condolence card to the address I found.  I hope he got it.

Edith normally has first chair.  Best way to describe is that she’s a mountain of a woman.  As she could easily kick my ass and give Chuck Norris a good fight, but that would have been before.  I haven’t seen her in four weeks now.

I hate making new friends at Chemo. 

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