When Needles Hurt

"Ray, don't be afraid." She would say.  "The needles don't hurt as much as you think.  Just take your time and imagine what the vein looks like under my skin.  There, you've done just fine and the needles are in.  Tape them down and we're ready to start."

The blood pump is slowly turned on.  Gradually a pint of her blood loops through the artificial surfaces of tubing and a filter to wash and then return to her free of toxins.   She spoke to me as if she was my big sister, and in many ways she was.  Her name was Toni, we were both nurses; and the year was 1971.

She was dying; a dreadful disease taking from her, youth.  She knew how to help people in our profession of nursing, and did so with expertise and care; but now she is the patient, resting with her eyes closed.  She is perfectly still with her jet-black hair quiescent upon her pillow, her son resting at her shoulder and we are connected, not by ‘six degrees of separation', but rather friendship in the first degree. 

At first it was simply my job to administer to her, a treatment.  She knew of all the things that could go wrong.  She knew I was still learning about dialysis procedures, yet she reached out to help me. 

          It was a monster machine she depended upon.  Oh yes this machine saved lives, but what she had to go through in order to survive was enormous in those earlier years when this therapy was more an experiment than it was a treatment and names were chosen out of hat to see who would live, as the chosen would allow themselves to be experimented upon. 

The operative word, what was it?  Was it fear?  Was it courage? Was it hope?  It was all these words and more.  Yes, more.  Words that have not yet been thought of to describe fully the fear, the courage and the hope by many in those earlier years, and in spite of all the breakthroughs it continues today. 

          Then one day, the Transplant Surgeon stood at her bedside offering a hope that Toni embraced with anticipation.  Her choice would allow for another to use her machine.  Her blood type, rare, made the availability of a kidney for transplant in her case, a miracle in this year of 1971.  She was readied, and the transplant was performed.  She went back to work to her patients who she loved, as we ourselves cherished her.  Often we would all gather at lunch to celebrate this wondrous thing we call life, filled with all of its hopes and miracles, and then one day the miracle came to an end, or so it seemed.

          It was "clinic day" and Toni already knew there was trouble.  Upon awakening, her skin had turned yellow.  There was an inflammation of her liver with two immediate plausible causes.  Perhaps the medicines she's had been taking as prescribed to fight rejection of her transplanted kidney may have caused a chemical inflammation of her liver or perhaps one of her needed blood transfusions months earlier inoculated her with hepatitis. The answer could only be found by the performance of a needle biopsy.   These were some of the challenges faced by kidney patients in 1971.

          A needle biopsy, this meant a sterile procedure of a large needle plunged deeply into her liver in order to capture a tiny piece of it for microscopic examination.  This would tell us if the liver inflammation was chemical or viral.  The medicines arresting rejection would have to be adjusted or stopped; all of this in an effort to save her life in this year of 1971.  In either case her transplanted kidney was now in jeopardy.  The major risk of this diagnostic procedure was for an artery to be serrated causing major internal bleeding, and therefore for this procedure the one Doctor who had performed hundreds of biopsies and had never nicked an artery was chosen to perform this course of action. 

          Toni, ambivalent, tried to decide whether or not to have the biopsy; as she would reflect, "everything always seems to happen to me."

          The Biopsy was done.  All seemed to be well, and then her blood pressure began to drop as her pulse rate increased and became weak.  A large artery had been incised and Toni was bleeding internally.

          A huge total body pressure bag was applied for compression to slow the internal bleeding while, with Toni, the decision was made to operate.  The Doctor knew that anesthesia with a compromised liver was akin to a death sentence, but he could not just stand by and watch her bleed to death.

          Toni miraculously survived the surgery.  A week went by as the bleeding continued and could not be stopped.  I sat and visited with her not as her nurse, but as her friend.  She slipped into a coma as she fought for her life.

Most Americans do not know that 51% of all Medicare dollars are spent for kidney failure diseases and their treatment; or that the growth of patients undergoing treatments has grown from 40,000 nationally in 1971 to over 350,000 in 2005.  Longevity for patients undergoing dialysis has increased from three to five years, in 1971, to a normal life span for the patients who do not have compromising secondary diseases.  Vast improvements have been realized in kidney transplant medicines and tissue matching procedures, as well as controlling of anemia, a life threatening condition for kidney patients.   Nor do most Americans realize that the projected growth of patients in need of dialysis will grow to 2.1 million by the year 2026.  This is because what is needed is not a focus to treatment only, but a meaningful effort in research to cure as therapies are improved.

It is a strange thing, this thing of getting older.  The eyes worsen, as your vision gets better.  For me 34 years of service for 5000 patients seeing 99% of them never realizing a cure for their disease, has me believing that the best way to focus on a cure is to imagine a life when it has been lost, as I do when I remember Toni as she says to me "Ray, don't be afraid.  The needles don't hurt as much as you think."