Parting Shot

I was on-call the weekend, covering the medical wards. Of course, as soon as I sit down with my cup of coffee the bloody pager goes off. I pick up the phone and call, sigh, another venflon to put in, 'We need it now if you could, her meds are overdue'. I sip at my coffee. It's still too hot to drink. No doubt by the time I get back, it will be cold or some over enthusisatic neat-freak would have poured it down the sink.

So I head over to the ward to find out who the lucky person is. 'You'll have a right job with her doc, we can't get anything into her,' the disgustingly cheerful nurse says to me while nibbling a cookie. I see a steaming cup of tea on the desk in front of her. Sigh.

I walk into the supplies room and gather my things. Tourniquet-check; alcohol swab-check; syringe-check; saline flush-check; micropore tape-check; gauze swabs-check; dressing-check; venflons, venflon, venflons, venflon.... hmmm, we only have these new closed-system venflons here. C'mon, c'mon, where are the good old-fashioned venflons? Darn. None.

So I grab my tray of stuff, a pair of gloves and a sharps bin and head over to the patient. Elderly lady, overweight, oedematous. I shall refrain from using other, more descriptive adjectives. Liver failure, alcohol abuse, self-inflicted. About a million people in the UK fit the description. But this lady, I'll remember her for life.

Now, these closed-system venflons are a new thing. They minimize the chances of you getting a needle stick injury from your own carelessness, but I find them more clumsy to use. Sure, I won't prick myself with the needle, but I may have to poke a patient several more times simply because these things are just a little bit fiddly and harder to maneouvere, especially when the veins are almost thread-like, like in this lady.

So I go through the usual routine and get my stuff out. Tourniquet on the forearm, looking for a vein, looking, looking, looking, looking, and rudely interrupted. "You're rather young for a doctor, have you put many of these in before?" Yes ma'am, although I sure haven't put in as many venflons as you've had tots of whisky, I am pretty good at this. I didn't say this of course. My 'professional-courteous-kind' mask is on. 'Well, I hope you put it in the first time, the last doctor was really experienced but she couldn't get any into me until the third go. I was really hoping she'd be the one to do it today". Yes, well, you're stuck with me unfortunately, and me with you. Looking, looking, looking, found one! Yes!

Swab, wait for it to dry, venflon out, sharp scratch ma'am, "Owwwwww, what ARE you doing, feels like a blade going in," that's because a venflon needle is really a tiny blade with a hole in it, "it didn't hurt this much the last time, Owwwwww...," whatever, flash-back in the venflon, needle out 3 millimetres, advance the cannula, slide needle out and 'click' as the locking mechanism snaps into place and the whole thing should just detach and... WTF? I pull at it a little harder, but the bloody thing refuses to budge. Most unusual. There was definitely a click. I tug at the needle again, keeping a firm hold on the cannula. It still won't budge. C'mon, c'mon. I release the tourniquet with my other hand and keep a firm hold on the cannula while I try to remove the needle and the locking mechanism, won't work, no, this can't be happening, no, no...

"What ARE you doing there young man? Have you got it in or not? If it's in stop fiddling with it! The last doctor didn't fiddle with it! NURSE! NURSE! Come and give this doctor a hand, he's not doing much good!" You fat overweight turd, wtf do you think you're doing shouting your head off like that someone with your vitality shouldn't be in a hospital bed damn venflon why won't you work stupid stupid thing detach I say and let me get away from this...

"Doctor are you ok? Is something wrong? Oh, it's one of those new things isn't it, I hate those, can never get them to work properly. Is it in though? Ah yes you've got it in but what, sorry, you say it won't detach? Let me try, hmm, it seems to be stuck fast, I think you might have to put a new one in, let me try again, hmmm, your call doc," no don't go away, no, help me dammit, sigh. She disappears out of the bay.

No, I refuse to put a new one in. I may not be able to find another vein as good as this one. Point-blank NO. I tug again as hard as I can at the bloody thing and it still won't budge. WTF is wrong with the bloody thing? "WELL? Have you got it or not? If you haven't stop fiddling around down there and get someone who knows what they're doing. My arm's getting stiff." Well fuck your arm and fuck your stiffness and, brainwave hits me, the device is held in place by what appears to be a screw mechanism, I get a good firm hold on the locking mechanism and give it a good twist, and joys, the bastard device finally decides to let go. Note though, that you're not supposed to twist it, the whole thing is supposed to pop off when the needle is locked in the device, i.e. when you hear the 'click'.

Bungs on the venflon ports before they bleed, no such luck, blood flows freely and onto the pillowcase, compress the vein dammit, why won't it stop bleeding, no matter, bungs in place, dressing out, and on the venflon, flush out, and into the cannula, and yes, finally, hurray, hurra-"You've made a right mess haven't you? The last doctor was much better, no fiddling about and certainly no mess like the one you've made, you've gotten blood everywhere, you're certainly, CERTAINLY, not as good as the last doctor."

'Ma'am, I may not have been as neat as the last doctor, I may not be as experienced as the last doctor, but I CERTAINLY, CERTAINLY, ONLY, needed ONE attempt to get the cannula in. As you said, the last doctor, despite her skill and experience, needed three goes before she got one in.'

"Well, you're MUCH ruder than the last doctor as well, she didn't speak to me like that. She was much gentler and nicer, and it didn't hurt as much as when YOU tried...", well go and boil your head you old geezer I didn't have to try, I did it right the first time. I pick up my tray and sharps bin and the assorted pieces of refuse and walk out of the bay as quickly as I can...

"I CERTAINLY HOPE YOU KNOW WHAT TO DO NOW THAT YOU'VE PRACTICED ON ME!"

Stupid, ignorant, illegitimate-daughter-of-a-dece-, nurse walks into the bay to change the pillowcase with blood on it and I hear, "Does that DOCTOR know what he's doing? He seems RATHER young for a doctor, he was fiddling about for a AWFUL long time, and my arm's all sore now..."

And my coffee was cold by the time I got back to the doctors' room on the acute admissions ward.