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Let Me Tell You How It Will Be (Or At Least How It Was)

By Guy Boss | Published 02.16.2012

To explore where I’ve been so I can better decide where to go next, I’ve spent the last day or so re-reading my previous posts. When I got past the more than occasional, awkward sentences, and the frequent inept phrases, what I noticed most was how much was left untold. Much of the silence can be explained. Sometimes the item glossed over is just not important to the story, or it would take the piece in an unwanted direction. Sometimes I don’t remember enough of the details to explain the reference. Sometimes I just don’t want to.

And sometimes, it was just such a part of my everyday life at the time that I forget that the modern reader may not know what I’m talking about. For example, in my second article, “I See Your True Colors,” I talked about how the only place we clotted was in the needle. Nowadays, what with ports and PICC lines and peripheral IVs with heparin locks, it’s very likely that you might not know the joys of an IV with a non-disposable needle, or the almost indescribable joys of a keep open IV.

First, the needle. They were big, and if you were lucky, they had been sharpened in the last couple of weeks. They were about two—maybe two-and-a-half inches—long and were made of thick, stainless steel. And I wasn’t kidding about needing sharpening. Every few weeks, months, or years, they would be sharpened on a schedule known only to two men, one of which had to be dead. You could always tell if your needle had been sharpened recently, because the intern, expecting the usual blunt piece of pipe, would go clear through the vein in the first couple of attempts.

That was one of the other things about those needles. If the intern, or third-year student, missed the vein or went through it, they didn’t automatically put on a new one. Those needles were built to be used and abused, and the intern, or student, was darn well going to use and abuse them.

If those old needles did anything, they made sure I went to college. It wasn’t very often that I was allowed out of bed when I was in the hospital. Once, when I was about 13, I was allowed to go pretty much wherever I wanted, as long as I stayed in a wheelchair and was back in time for treatment. So, of course, I went exploring.

For some reason, where the morgue was located was important to us kids, and I was determined to find it. We were fairly sure it was in one of the basements, so I very methodically made an inspection of the basement, but I didn’t find it. The next day, I tried the sub-basement, and again came up empty. The day after that, I tried the sub-sub-basement.

I never did find the morgue, but rolling along the gloomy corridors of the sub-sub-basement, I came across a room with its door open. It was about 15 square feet, and was dimly lit by a utility light hanging from the center of the ceiling. Along the back of the room was a workbench with a couple more lights brightening up the workspace. Somewhere, there was a radio playing the kind of music my dad liked.

Sitting on a lab stool with his back to me was a man. On his left side was a tray full of needles. In front of him, at about eye level, was a board with a row of wires hanging off of it. He would take a needle out of the tray on his left, see what gauge it was, then pick the appropriate wire and ream out the inside of the needle several times, pushing the larger bits of crud out. When the needle was clean enough, he put it in a tray on his right to be autoclaved. Then he would pick up another needle from the left tray.

I could hear my dad’s voice saying, “This is the kind of job you get if you don’t study.”

One last thing about those old needles: Because they were so unforgiving, they would often tear through a vein they had resided in happily for an hour or a day or two. To combat this tendency, interns and students took pride in their ability to tape your arm down to an armboard so that the arm couldn’t move. Armboards were just that. A board. Usually a piece of quarter-inch plywood, and if you were lucky, a towel had been wrapped around it. The goal in taping your arm was to make it as immobile as possible, and no tape was spared in achieving that goal. Comfort, if considered at all, was way down the list of priorities. And because it was not at all unusual for a whole roll of adhesive tape to be used in achieving immobility, freeing your arm was an adventure best left to the imagination. But then, nurses got to do that dirty work, and interns and students didn’t usually have to see that part of their handiwork.

Keep-open IVs were their own form of irritation or entertainment, depending on your mood. To keep the IV viable between doses of AHG the doctors would write orders to maintain the IV at a “keep open” level. Now, according to the protocols of the hospital at the time, “keep open” meant one drop of the keep-open fluid—in our case it was always saline—per minute. Nurses who had been around for a while knew to ignore that and bump it up to three or four drops a minute. But interns and third-year students, new nurses and senior nursing students, would spend hours getting the IV to run at exactly one drop per minute.

Now, AHG might not have been the most effective coagulant around, and they might not have really figured out how much was an effective dose, but it was a darn good glue. If some of it got spilled on anything, it was best to throw the item out because it would be so sticky as to be unusable. When AHG was injected it would coat the inside of the needle, and if it wasn’t flushed out vigorously, a procedure not often, if ever, done in the 1950s, it would eventually plug the needle.

When that happened, the nurse would first try flushing out the needle to see if it was indeed plugged or if the needle had torn through the vein, which if I remember correctly, was termed infiltrated. That word, “infiltrated,” sounded better than saying it was torn through the vein and sticking in the muscle. If it was infiltrated, the nurse would spend the next half hour removing the tape, and then she would pull the needle. If you were lucky, the intern or student would take a couple hours to get there and restart the IV, giving you a couple hours of relative freedom.

If the needle was plugged, the nurse would try to aspirate it. The plan was to force the plug out using about 20 milliliters of saline. If she was successful, and didn’t blow the vein up, she would make a few comments about interns not knowing anything, and then adjust the flow to something reasonable for AHG. If, as was frequently the case, she couldn’t budge the plug or the vein blew, she would make the comments about interns anyway, and then start taking the tape off.