The Hip Chronicles, Part I: The human pincushion

In my series, the RA Diaries, I’ve tried to write about the weird, the painful and even the comical parts of having a chronic illness. Very recently, I had what for many RA patients is a rite of passage: my first joint replacement. My new right hip, with its festive combination of titanium, cobalt and plastic polymer, is worth five times more than my car. And it will surely be a great source of amusement to TSA scanners worldwide, because on x-rays it looks like I’m packing some major heat.

Now, kind reader, let me tell you exactly how I went about getting my new hip. But be warned. It’s gonna get gross. And graphic. And, maybe once in a while, somewhat amusing. I hope you get something out of it. I’m certainly hoping I will.

For years, I’ve been the scourge of blood extractors everywhere.

I’m what’s known as a “hard stick,” aka someone who is difficult to get blood out of.

I’m not entirely sure why, but I believe it’s a combination of things. I definitely have tiny veins — none of those strong, cord-like veins that twist around the arms and calves of athletes (or Madonna) can be found on me.
Those tiny veins are also shy. They don’t like to show off, so they hide deep under the skin like elusive sea creatures, especially when predatory needles are in sight.

The biggest reason, of course, is the rheumatoid arthritis that has plagued me for 34 years. The first joints to go were my fingers and toes. Then my wrists, then my elbows. I honestly can’t remember the last time I could stretch either elbow completely; maybe in my early teens?

This is a problem, since the favored place for a stick is in the inside part of your elbow. On the normals (and I use that term ironically), that is vein central.

After numerous unsuccessful and painful sessions with lab techs at myriad rheumatologist offices, I decided to try hospital labs, where the professional bloodsuckers — sorry, phlebotomists — congregate.

At these places, an eight-hour shift includes stick after stick after stick; they stick newborns, wriggly toddlers, reluctant elementary schoolers, professionals on their lunch breaks, stoic retired ladies and gentlemen and the really tough cases, like me. They know human veins like a veteran Interstate trucker knows his (or her) highways, and they spent the majority of their lives navigating the circulatory system, looking for a way in.

Like truckers, though, there are good and bad phlebotomists. Getting a bad phlebotomist is not quite as painful as having a truck driver scissor his heavy load right in front of you. But you can get a nice big bruise and a couple of unwanted punctures.

That is why I always warn my possible tormentor about being a hard stick. And I suggest one of my two fall-back veins, which are located on the inner side of each wrist.

Most of the time they are grateful, though hand sticks always require special equipment, and hand veins tend to move, or roll. A hand stick also takes a lot longer to yield blood. Some get huffy; how dare I tell them what to do? This is tricky, since the last person you want to piss off is one wielding a needle.

To be fair, I need to state that, since I have sought out these professionals, just two have let me down. One got huffy with me after my wrist suggestion, tried it without much enthusiasm, struck out, then punished me by digging her needle into the vein on the inside of my wrist. This vein is wrapped in nerves, so apart from the pain of the initial stick, the entire procedure felt like being seared with a hot poker.

The second told me she had just gotten her own RA diagnosis a few months earlier. The sight of my bent wrists, fingers and elbows must have been a painful tableau — her ghost of RA’s future. She stuck me twice, got no blood, then, looking stricken, sent me away.

But let’s not dwell on the failures. As a phlebotomist habitué, I’ve started tagging them for migratory purposes (Will their shift coincide with my stick? Do I have to go to the lab across town?). I’ve also been logging their odds, much like a bookie does, and if there ever was a Secretariat of the phlebotomist world, it would be the man I have dubbed, with a great deal of awe and respect, “RuPaul Phlebotomist.”

Before I continue, let me clear up the RuPaul thing. I know RuPaul is best known for his transvestite persona, and has hosted innumerable gigs in woman’s apparel. RuPaul Phlebotomist does not go about his noble work in drag. No, when I liken him to RuPaul, I do so because he reminds me of the times I have seen RuPaul in his male persona. That RuPaul is a tall, slender, elegant African-American gent with a light timbre and a kick-ass attitude.

RuPaul Phlebotomist fits that description exactly.

Anyway, after greeting me, he ushered me into his lab chair. I gave him my usual spiel, and showed him ol’ trusty. That’s when he told me didn’t like doing hand sticks, but that he would try my arm instead. Since no one had gotten blood from there for at least a decade, I was skeptical.

But he waved off my concern with a shapely hand.
“Honey, it’s okay. I can get blood from a corpse.”

He went on to tell me that there had once been a murder case which hinged on getting blood evidence from the victim. Unfortunately, no one in the Coroner’s office could do it. They called in every other medical professional they could think of, from surgeons to hematologists. No joy. And time was running out — there is only so long blood stays liquid when you’re dead.
But they finally called in this man, and like a one-person phlebotocavalry, he got the needed sample.

I’m always a sucker (yeah, sorry) for a good story, so I let him have at it. And he was true to his word. Not only did my shy veins give up the B negative, it didn’t hurt in the least, and there was no bruise to speak of.

Just last weekend, however, I came across a phlebotomist who could knock off RuPaul’s crown. It was early Saturday morning, the morning after my hip replacement surgery. I was in a bad way.

I hadn’t slept, I was really sore and my right leg felt like it had been removed and replaced with a slab of beef. I couldn’t move either leg, since they had been strapped to a foam pillow to keep me from rolling over or crossing my legs. I had more tubes coming out of me than an English underground station.

I was bug-eyed from the morphine drip, which I kept administering constantly even though I knew the plunger only gave it up every ten minutes. It was a small attempt to regain the control I had lost over my own body less than 24 hours earlier.

Anyone who has ever stayed in a hospital knows it is hardly a restful experience. Just when you finally have the pain under control and feel drowsy enough to sleep, in comes a nurse to check your vitals. Or the doctor needs to talk to you before he or she goes off to the clinic. Or the dietitian needs to make sure you avoid greens, since you’re on blood thinners, or the physical therapist needs to get you on your feet. And so on, and so on.

At 6 a.m. that awful first day after surgery, a young man in light blue scrubs wheeled a cart into my room. He was there to draw my blood.
I sighed heavily. Even if I had had the energy to tell him about being a hard stick, I had no ol’ trusties left. They had all been blown the night before by two anesthesiologists in their quest to place an IV. (Be warned — the anesthesia ratfuck I went through will be getting its own special chronicle.)

I had been stuck five times already, with success rate of 40 percent. And the only reason that rate is so high is that the final stick was administered when I was unconscious.

I managed to convey this to Scrubs Boy, and, mindful of patient rights, he promised not to stick me unless he found a decent vein.

Of course he didn’t, so we called in reinforcements.

That’s when RuPaul Phlebotomist’s competition arrived.

Like my previous champion, this man was also African-American. But the resemblance ended there. He was shorter, stockier, and quite gruff (maybe he’s not a morning person?). But his hands were strong yet gentle, and he homed in on my veins like he was a spy satellite tracking a missile site.

He tried one vein in my arm and failed, but his technique was such (and the morphine was finally working) that I didn’t feel a thing. Then he tried again, succeeded, and within seconds he had drawn my blood. I didn’t feel a thing, and there was no bruise.

Unfortunately, this wondrous blood-sucker had Monday and Tuesday off, so I never saw him again. The phlebotomists that followed (with the exception of Scrubs Boy, who came back to try his luck, failed, and left me with a nasty bruise) were successful. But it took a while, and they did not have his same style.

However, I have his name. I know his schedule. I know his lab. It is likely my veins will meet his needle again.

–This text is copyright of A.K. Whitney, and cannot be used without permission.