The Sacred Space of Patient Care

One of my hands is soaking in a shallow bowl of soapy water, while a nail technician holds the other, turning it one way, then the next. She files my chipped and broken nurse’s fingernails into a more attractive shape. As she does so, she says “relax” whenever I hold my hand too stiffly for her to manipulate it. This catches my attention, because I had just come from work, where I’d spent the day starting IVs in patients, telling them, “relax,” so the catheter would thread more easily into their veins.

by jparadisi

by jparadisi

I often preface starting an IV with, “I know this is easy for me to say, being I’m not the one getting stuck with the needle, but the more relaxed you are, the easier this will be.”

I realize that a manicure is a much more pleasant experience than having an IV placed. What manicures and IV starts have in common, however, is the need to trust someone, often a stranger, touching your body, and literally putting yourself in their hands.

With this in mind, I’m astounded by the trust patients put in nurses. I mean, think about how we poke them with needles, whether in their chest ports or in peripheral veins, and then infuse chemicals otherwise known as “chemotherapy” into their bloodstream; medications so potent that the patient signs a consent allowing us to do this to them. The chemicals are so powerful, in fact, they can cause other varieties of the very disease (cancer) we administer them to cure.

This is a pretty huge demonstration of trust.

Once a hairstylist stylist told me, “When I cut someone’s hair, I’m in their sacred space.” I’ve kept this statement in mind ever since, whether it was performing a bed bath in the ICU, or now, taking a blood pressure or drawing blood from a vein with a butterfly needle.

No matter how clear our communication with patients, no matter the level of caring we demonstrate, if we forget that we have entered the sacred space of our patient’s body, these administrations will not be received with the intended appreciation.

Developing a soft touch in patient care, whether it’s honoring an adhesive allergy by finding a less irritating occlusive dressing, offering to numb a peripheral IV site or port before inserting a needle into it, or simply placing a hand on the shoulder of a patient who is visibly upset, are ways we tell patients we respect the sacredness of their bodies. We are there to help them relax.

Shift Observations: The End of The Dinosaur

photo: jparadisi 2012

With the care of an archeologist sifting for fossils, I hold his right arm for a second time, turning it to and fro, sliding my fingers up and down searching for a vein suitable to accommodate an IV catheter.  I’ve already looked once, and now return after a fruitless search of his left arm. Decades of chronic illness, medications, and simply old age have done their work, leaving my patient with a spindly network of fragile veins shifting loosely under his skin.

“Everyone should be born with a spigot,” I think silently to myself. “Why doesn’t this patient have a port?” I know the answer without consulting his physician: he is very old, and his illness will likely overcome him. The IV infusion I will eventually administer will not save his life, only limp him along a bit longer.

Outside, cold grey clouds shower a mix of horizontal rain and snow beyond the window of the infusion clinic. An unseasonal storm threatens what promised to be an early spring.

With a slight shiver, my patient asks if I believe in a climate change so powerful it could wipe out life on Earth. Before answering, I take in the wrinkled, reptilian-like skin of his forearm, which I continue to study. Without looking up, I respond to his question, “You mean, like the Ice Age that killed the dinosaurs?” He nods.

Magically, I feel a small, but plump vein. The IV goes in slick as oil on the first stick. I can’t believe our luck. “Yeah, I believe in climate change, but this storm will not be our extinction.”

Shift Observations: That First IV Start After Vacation

photo: jparadisi 2012

Why does that very first IV start on the first shift back from a vacation always cause just a little apprehension?

My patient waits silently while I collect the supplies I need: a sterile IV pack, the angiocath, a normal saline flush. I tear a few small strips of tape and stick them to the edge of the bedside table, easily within reach, ready to secure the IV once it’s in the vein.

How many IV’s have I started over the past twenty-five years? Why does the first one after a vacation always feel like the first one ever?

My gloved fingers palpate the chosen vein one more time before I swab it clean, leaving a glistening sheen and contrasting shadow along its hill, a cairn on his forearm.

Collecting my thoughts, I focus on the vein until they are as sharp as the needle I use to puncture his skin and thread the catheter into the vein. A flash of blood tells me I’m in. Using one of the strips of tape, I secure the IV, then cover the site with a transparent dressing. It flushes easily.

I release my breath, which I realize I was holding.

I’m back.