Washing my hands at a sink near Mrs AW, after discontinuing another patient of mine) I look and say,” Here’s a box of tissue Mrs AW, listen to this… Dialysis isn’t the end of the world, just the end of your world as you once knew it. Even though this disease snuck upon you like a vagabond or like an anvil fell from the sky and landed on your back , I want you to remember this. Dialysis is like an extremely major pothole in your road of life, recovery and success. You can either stand still and just look ahead, you can go around it as a detour towards your destination, either left or right, you can go down in the pothole and climb your way out, or you can build a bridge and overcome it”. The choice is yours and just know that we are here to guide you the whole way.” As she wipes her tears looking at me, she replies “Dwelyn I’m ready . As I go to put on my PPE (personal protective equipment) so we can start Mrs. AW’s Hemodialysis treatment I hear, Mr .T who is in the chair next to her in chair 8 says ,”Hey there ma’am, no need to worry, we are all family here and we take care of each other. You are in good hands!” Mrs. AW smiles and says, ”Thank you sir. I sure hope so,” I Don’t Know About This!”…… Mrs.AW says,” Dwelyn you are wearing a long lab coat, face mask I understand due to COVID-19/ Coronavirus, I see you wear eyeglasses like me and a face shield…!” Do you guys wear this everyday? Why? I replied (laughing),” Yes we must wear this with each of our patients to secure our elite care for you and to protect us all from each other. Nationwide we call this the Universal Precaution. “ Man it looks hot and uncomfortable!” “ Protection from what? As she looked around before I could answer..” Oh!!!!!! There’s a lot of blood lines going and turning in here on these machines and it’s a lot of beeping , oh my!” As I snicker towards her comment,” Indeed there’s a lot of stimulating things happening here, it’s Life In Continuance Production!”… she says’ ‘ Hmm that’s a way of looking at it !” ….. “ Mrs AW , now that we are both ready to start your Hemodialysis treatment, let’s have a conversation about this process……. “First!…… ” Uh Dwelyn , these chairs are quite hard on my bottom and it’s freezing cold in here.” Is the heat working?” Sheesh it’s like a freezer in here! “ ….(INTERMISSION Note: Now anyone who has worked with me throughout my 20 year career, knows I like to have fun and laugh. I tell you Mrs. AW , should be a Stand Up Comedian. From the time I started my introduction of her story with you all, despite her downward spiral and concerning questions, she has always had this humorous demeanor around her. This explains my laughter throughout this story) Ha Ha, yes it is rather cold and our chairs are not the most comfortable in the world , however …… you see those two buttons to your right on the chairs bedside table?” Check this out, as I pushed the one button with the wavy lines, Mrs AW says,” Oh my Dwelyn , this chair has a heater !!!! “ No way!!”, wait there’s more Mrs .AW….. I pushed the button with the zig zag lines and …..” Dwelyn, this chair vibrates too!” she says ….. “ I need this at home !” Mrs. AW now that we went over the controls of your chair , you’re in control of the comfort level of your chair throughout your treatment. Now let’s take a look at the machine, as would say the Hemodialysis Machine, as I turned the machine sideways from her adjacent left side , she looks up towards the machine and says with her eyes as big as Time Square on New Years Eve…” Dwelyn, there’s surely a lot of buttons and lights on there, do you know what you’re doing?” ( INTERMISSION Note: Like I said , comical yet highly concerned) snickering with laughing tears in my eyes,” Yes Mrs.AW , I am well seasoned in my career as a professional Nephrology Clinical Technician/ Hemodialysis Technician, but we all in this life never stop learning and don’t know everything. She says,” Ok !”… We are gonna go from left to right with my demonstration of this machine. We have our Power button to turn the machine On/ Off , we have our mute button to silence any alarm during an interruption, we have our Reset button to widen our alarm limits and to keep the machine going, we have here our arterial chamber ,and….” Dwelyn, I don’t mean to be rude but I don’t have a clue what you’re talking about!” … “ Oops, Sorry we really like the idea of informing our patients about the products we use and the machines that contribute to their care!”.. Moving forward Mrs.AW , you have a lower left fistula access which here is located in your lower left forearm. Do you know what a fistula is? “ blank stare she has, “ Well I guess that’s what I have in my arm!” . Indeed you do. A fistula is your artery tied to your vein by the surgeon. Your surgeon did a remarkable job with your access , if I do say so myself. I can barely see your anastomosis and it has a wonderful thrill and bruit.” “ Dwelyn,.. sir , Anasty what? “ Who is Phil and Brutus? (INTERMISSION Note: It always amazes me as a Hemodialysis Technician how our everyday words or medical language can seem so common and routine to us , but yet intimidating and overwhelming to our patients . The conversations we have are always a two way learning streak )… As I laughed “ Ha Ha , Mrs. Williams I do apologize. All the years in my profession , I have witnessed and encountered many Hemodialysis accesses that were very unique. All unique and different in their own little way. This is what makes our job beyond rewarding and in hopes of making you as one of our patients fulfilled. Your anastomosis is defined as a crossed connection between adjacent channels or in other words, in your case connecting tubes surgically. So if you may recall whenever you decided to have this particular procedure done for placement in your arm, your vascular surgeon planned a very well thought out process to ensure you have the utmost proper surgery to continue your journey . Or as we like to say your quest along Kidney Trails. With that being said , normally with most patients I’ve encountered, their anastomosis or incision site is visible. Yours isn’t. That is what makes it remarkable in my eyes! “… With certainty in her eyes,” Dwelyn I understand a little of what you’re saying and where you’re going with this!” ….. Now let’s talk about the Thrill or as you call it “ Phil”! Lol ,” Your thrill in your access is the vibration that we as clinical staff feel prior to Cannulation, in other words before we stick you with the needle. If this is not detected, then it’s possibly very new and still in the maturing phase, or the access is clotted , or I possibly just can’t feel it. “ Here, take your right hand with your pointer finger and middle finger, place it upon your lower left forearm and just relax them both!”…. she replies ,” It’s Pumping like my heart , I think!” “ Bingo Mrs.AW , now let’s talk about ”Brutus as you recalled, the Bruit. The bruit is the sound of your fistula access and we want it to be loud and clear … as I chuckled …..” Mrs. AW lifts her left forearm up to her left ear and says,” Ehhh, I can barely hear it, let me try my right ear…. Ehhh, a little better , but not too loud!” ….” Mrs AW, you never seemed to amaze me, I have an idea, how about I let you hear your fistula to its fullest capacity?!”” … she replies ,”How can you do that?”, “ Here, let me first wipe down my stethoscope with a bleach rag and wipe off my ear buds with two alcohol swabs each.” Mrs.AW replies,” Dwelyn you think I’m nasty, so that’s why you’re ….. Oh, I remember you said earlier , Universal Precaution,,, Gotcha!”, “ I’m sorry”! “ We must always be clean! “ Mrs AW that is correct!” Once I wiped off my stethoscope, Mrs. AW’s demeanored seemed a bit nervous, yet anxious with curiosity. So as I applied the stethoscope to Mrs.AW’s ears and placed a glove over my bell of my stethoscope and let her put the gloved bell over her access gently, she replies ……. yelling without noticing,” “ “Dwelyn , it’s going Boom Boom BOOM!! “ WOW!! “ I can hear it!” As I gently removed the stethoscope from her ears, she said,” Dwelyn, why is everyone staring at me? “ Could they hear it too, or , Oh My!! ( with embarrassment) “ Was I yelling? Mr. T says with laughter,” Yes ma’am you were , and I’m sure people in the building next door heard you as well, LOL!” Mrs. AW replies with laughter,” I’m so very sorry, this is all so new to me!” Mr. T says “ Like I said earlier, we are family and trust, we all have been through it and have experienced what you are , what you have, and what you will go through!”…. Mrs. Ruth in chair 6 next to Mrs.AW replies with laughter also,” Giiirrrll you were so loud I heard you through my ear plugs, LOL”! “ It’s okay”! By now we are all laughing in the Jamaica Pod. “Now Mrs.AW , since we got past that, and I have already programmed your machine and my Charge Nurse has assessed you, let’s begin with your treatment!” As I prepped Mrs. AW’s bedside table with blue pad barrier, alcohol pads, iodine pads, gauze, band-aids, tape , three syringes, one tourniquet, a hemostat, and two 16g needles…the look on Mrs. AW’s face was undefinable…” Dwelyn are you going to perform surgery on me or something?” No ma’am “ I replied. This is the proper procedure for everyday treatment for any of our patients that involve being cannulated or stuck with a needle. Unless you’re allergic to iodine!” No I’m not , but I have a question Dwelyn, Is that the needle you’re going to stick me with?” Unfortunately/ Fortunately yes !” I replied. “ You’re going to get stuck with both…. one after the other!” Mrs. AW with a look of terror says,” WHAT?” Why two? “ Well one needle will be for your venous placement and the other will be for your arterial placement!” Mrs. AW replies ,” What are you saying?”, you know what let’s just get it over with, I’m ready!””
So after I place Mrs. AW’s arm on her blue pad barrier. Wiped her arm with both alcohol and iodine, tourniquet in place tied tight above her left elbow, with my certain Cannulation sites to be cannulated both one in a half to two inches apart , I say are you ready?” Yes I am “, she replied…… Here we go……!!!!!!!
To Be Continued………….
Kidney Trails 