A Person of Presence

“I was hoping you’d say that,” said the F1, after I’d bravely volunteered myself to cannulate his patient. I say bravely, but in truth the other doctors had moved on in their ward round, paying as much attention to me as they would to their shadow. There I stood ready to impress. Yes the seniors had moved on, but I wanted to show this junior doctor that I had value.

So off I went to gather all the necessary things for cannulation. These were kept in the prep room, a clinical space off to one side of the ward. Fumbling like a stranger in a friend’s kitchen I collected the appropriate equipment: a sharps box, gloves, needle, flush, alcohol wipes and the cannula itself.  I stopped by the F1, speechless as he glanced over my tray of excessively packaged plastic utensils, before exchanging words of encouragement authorising me to approach the patient.

The perpetual rush of the hospital ward washed over me as I coasted out of the harbour that was the nurse’s station and into the tide. I joined the frantic many hurrying around performing this job and that job. Hospitals have undercurrents that can rip you out into the deep. Exhausted by the torrent, there is rarely even chance to break and gasp for air. I let this energy add to mine, each fueling the other.

The hospital ward was split into 4 bays and as I turned the corner into C, a rectangular bay of 8 beds, I felt the eyes of those awake in the room focus on me. If I had been a shadow behind the consultants, it was cast by the attentions of the patients, each of whom were all too aware of what the little white tray heralded. The rows of symmetrical beds created a corridor of access in and out the room. This thoroughfare was cluttered with portable tables and patient belongings, all ready to be relocated at a moment’s notice, much like the patient’s themselves. I arrived at the foot of my patient’s bed and introduced myself.

I had seen the man being attended to during ward round and he had fallen instantly into the category of patients that you like. The group of persons you would willingly go the extra mile to help. He had been intelligent in his enquiries and mindful of his condition, yet frail. He was an elderly Turkish man with a greying beard and white hair combed over in a tidy fashion. Diminished of his physical strength, he retained his virtue: a person of presence whom desired no celebration.  It is only human nature to succumb to such natural hierarchies. There I stood, a boy a third his age, and there he lay with at least thrice my wisdom. Gentle in his manner and assurances, he welcomed my approach, giving no sign of caution at the mention of my student status. Calmed by his reaction I set about preparing for the procedure by drawing the hospital curtain around his bed. It was a token act of privacy that shielded me, more than my patient, from those in the surrounding beds. The F1 promptly reappeared inside the curtain, finding space in his busy schedule, should I need help completing the one task on mine.

Without interruption from the F1 or the patient I arrived at the moment where the cannula must pierce the back of his hand. I ran my fingers over the raised veins spaced between his elegantly thin skin, skin much more delicate than the rough and worn underside that I held steady. My sense of touch was interrupted by an impersonal latex glove, smothering my judgement, making it difficult to choose one vein over another.

As I unsheathed the needle I checked and re-checked my chosen site, conscious to avoid the mistakes I had made whilst practicing the skill on plastic model arms. “Look for flash back, don’t advance too far” I recited to myself.

As the moments passed, doubts scrambled my thoughts, flushing my face hot in an expression that could only reveal  realisation of my failure.

I had advanced too far, piercing needlessly into his hand for no benefit. Flustered by my failure, guilt and shame came rushing up at once as I removed the needle from the puncture site and pressed down with a cotton wool bud.  Dark maroon spread up, just as I looked up to my patient’s reaction.

“Relax” he peacefully breathed out in his native Turkish accent.
My eyes met his and my embarrassment dispersed. I became all too aware of his presence once again.
“Don’t worry, please, don’t worry” he repeated as I arrived at apology number 3.
“Let us try again.”

 

 

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A Person of Presence

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