Tuesday, June 9, 2015

The Return of Vein Lady

Patrick and I arrived at the Clinical Center at the National Institutes of Health late on a Sunday evening.  Most of the building was dark and empty.  Admissions had a lone worker who arranged for an escort to show us the way to the third floor patient area.  By 10:00 PM I was in my room.  Not a lot of sleeping happened that night.

Early the next morning I donned a hospital gown and robe on the advice of one of the floor nurses.  An escort wheeled me across the vast facility to the apheresis lab, where Vein Lady was expecting us.  I recognized her from my screening appointment a couple of weeks earlier.  The tiny room was packed with equipment.  It contained two stations, each with a bed, a small chair next to that, and a cell-separator against the wall behind each bed.  The cell-separator is a complex machine having all manner of dials and gauges.  It whirrs.  It clicks.  It spins and spins and spins the blood.  It reminded me of Mr. Peabody's Way Back Machine. 

Vein Lady had command of the room.  Nothing happened without her approval.  With one nurse on each side of the bed, I lay there, arms outstretched, palms up.  The nurses discussed the various candidates (veins).  They attached a warm, inflatable cuff on each arm and positioned and re-positioned them until both nurses agreed on the locations for the two required venipunctures--one for “blood out”, and one for “blood return”.  The nurse on my right slipped a gigantic needle into my arm.  Vein Lady put a smaller needle into the back of my left hand.  Blood traveled out the big needle, got mixed with an anticoagulant at a juncture of two catheters, and then made its way through the machine.

My entire blood volume traveled out, through the machine, then back into me a total of five times.  It took five hours.  The first cells to exit and go on their amazing journey returned in about ten minutes.  “Welcome back, guys,” I said to the bright red blood in the tube leading from the machine and back into my left arm, “I missed you!”

The first 4.5 hours were not so horrible, but that last thirty minutes was difficult.  I had to lie so, so still the entire time.  I was allowed to move my left hand a bit, but the machine would sound a dire warning if I bent it too much.  My right arm though, had to remain stationary.  I was given a foam ball to squeeze with my right hand.  I had to be very careful to not move my arm when squeezing the ball.  They covered me with an inflatable, heated-air blanket, and made sure that I stayed warm during the entire process.  My right shoulder and arm ached after the first couple of hours.  I so wanted to bend my arm!

Vein Lady barely left my side during the entire process.  When she did step away, she was never more than five paces from me.  She was insistent that I not fall asleep.  It was difficult to stay awake, because I was sleep-deprived from the previous night.  I spent the majority of the time reading a book, but every hour or so I apparently drifted off.  Vein Lady would lean over the bed and remind me that I must stay awake.

Five hours crept to five-and-a-half hours before I was finished with apheresis.  The machine collected my white blood cells into a blood-bag.  It weighed 460 grams (about a pound).  Vein Lady told me that the cells alone weighed 410 g; the anticoagulating agent accounted for the balance.  The squishy bag contained a translucent fluid that was the color of orange poppies.  I wondered how many cells it took to weigh four hundred ten grams.

Vein Lady left the IV in my hand, covered it with a transparent dressing, then wrapped it with a stretchy, non-adhesive tape called CoBand.  CoBand is everywhere at the Clinical Center.  Instead of using bandaids or cloth tape, they wrap this elastic, usually brightly colored gauze ribbon around your wound.  It applies pressure and keeps the site covered.  I am so fond of CoBand because there is no adhesive involved.  Adhesives and my skin are not friends.

By now it was after 1:00 PM. The apheresis nurses had ordered a bag lunch for me, so when I was nestled safely back into my room, I scarfed the granola bar and the string cheese, giving the rest of the bag's contents to my also-hungry spouse.  I dialed “3” for Food Service, while he escaped to find a cafeteria.

Depending on how far I go in the trial, I may have to undergo this procedure again.  Vein Lady informed me that it would be only "one blood volume" next time.  What a relief.

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