Bursting bubbles ~

It does seem to be true, at least in my case, that pride goeth before a fall, although one could predict that due to probability alone. For the past two days I’ve been congratulating myself on learning a new skill: giving subcutaneous injections. Last Friday a nurse came to my sister’s house to give her the first of five injections of an insanely expensive drug that may reduce inflammation, thereby increasing her mobility. (Heartfelt thanks to the Chronic Disease Fund, which paid the $2,000 for 5 milliliters of this medication.)

The remaining four injections would be my responsibility to do, so the nurse walked me through all the steps, which were more numerous than I’d anticipated. Warm the refrigerated vial between your palms for three minutes. Disinfect the rubber top of the vial with an alcohol wipe. Attach an 18-gauge needle to the syringe. (The smaller the number, the bigger the needle, I learned—just like camera apertures.)

Draw back the plunger to the 1 milliliter mark to fill the syringe with air. Twist the protective cap off of the needle. Push the syringe into the vial. Push the plunger to force out the air. Upend the vial and, making sure the tip of the needle is submerged within the liquid, draw back the plunger to the 1 mL mark. (Yes, this is a long and boring explanation, but it’s necessary to the point of the post. Pun intended.)

Then comes the tough part: checking for bubbles. Tiny bubbles are okay, but anything bigger should be dealt with by flicking your finger against the syringe repeatedly until the bubble slides toward the business end of the syringe. Push the plunger a bit to ease the bubble up through the needle. Draw the plunger back down to 1mL and repeat. This process turned out to be both tricky and tedious: there is an area at the end of the syringe where there’s some plastic threading, and it always looks empty, as if there’s a bubble there. Often, though, it’s just an optical illusion.

When you’re satisfied that no substantial bubbles remain, remove the needle from the vial. Put the protective cap back on the needle and twist it off the syringe. Replace it with a smaller gauge needle and take off its protective cap. (These seem to resist removal.) Make sure a tiny droplet of medicine shows at the end of the needle, supposedly indicating there’s no air in the syringe.

Then swab your victim’s thigh (in this case) with an alcohol wipe, pinch a goodly bit of her flesh between thumb and forefinger, and make the stick. The needle should go almost all the way in, but not quite. Turn loose of her flesh and pull the plunger back slightly to make sure no blood enters the syringe, which would indicate that you’ve hit a vein. If everything looks good, inject the liquid, remove the syringe, and slap on a bit of gauze.

Simple, right? The nurse allowed me to do everything except the one thing she could not, because of some financial rule or other, allow me to do: make the stick. Naturally, this was the part of the procedure that scared me the most. As I poised the needle above C.’s thigh on Saturday, I hoped fervently that I would not spear her and produce a bloody mess. I steeled myself to hear howling, and I made the stick. No sound from C. The needle might have gone all the way in, which was wrong, but it turned out beautifully.

I injected the medication, pulled out the needle, and marveled that at first I couldn’t even see where the injection had been. A dot of blood much smaller than a pinhead soon showed itself. No bigger than the nurse’s had been! I did an abbreviated victory dance while C. pressed gauze on the spot, and then a completely unnecessary Band-aid went on. Woohoo!

Things went equally well on Sunday—except that I remembered just after I gave C. the injection that I’d forgotten to pull back the plunger to check for blood. But chance saved me: there was again just a teensy dot showing where the needle had gone in. I was pretty good at this, hey? I could be a sub-Q shot giver, were there such a job. What competence!

Then today rolled around. I drew the medication into the syringe and there appeared to be no major bubbles. This seemed suspiciously lucky, so I flicked my finger against the syringe a few times and tried to determine if a bubble was lurking at the hard-to-see end. After some fiddling around with the plunger, I finally decided that there wasn’t. I switched needles. In the process of struggling to remove the thinner needle’s protective cap, however, I realized that I didn’t have 1mL in the syringe. I had closer to 0.9 mL. The nurse had specifically told me this was NOT okay.

Crap! What to do? With considerable misgivings I decided to switch the needles again and draw more medicine out of the vial. I was pretty sure the nurse would have told me not to do this, but I couldn’t think of an alternative. I also didn’t see how anything would be contaminated, since the first needle had gone back into its protective cap. After making certain I had 1mL, I checked for bubbles again. Flicked again. Switched the needles again and ascertained that a droplet of medicine clung to the tip.

I remembered this time, after making the stick, to check for blood. There wasn’t any. To my consternation, however, when I drew the plunger back slightly, a large, sinister-looking bubble appeared at the needle end and slowly made its way up the syringe.


I had quizzed the nurse extensively about this entire bubble subject, because it worried me so much. “What if I miss a big bubble and inject it into her?” I asked. “Am I going to kill her?”

Undoubtedly the nurse was laughing on the inside, but she kept a straight face. “No,” she said, “but the shot will be more painful. It’s if you have an air bubble inside a vein. Now that’ll get you.”

Frozen in place with the needle in C.’s thigh, I reasoned that since there had been no blood, I could not have hit a vein. I warned C. that this shot might hurt—the others hadn’t—and I pushed down on the plunger. There was a bigger spot of blood this time when I removed the needle, but no spurting—in fact, no Carrie-type scene of any kind. C. hadn’t made a sound.

“Did that hurt?” I asked her anxiously.

“Not really,” she said.

“I don’t think I killed you,” I said with relief.

“Oh well,” she replied. I almost expected her to add, “Nobody’s perfect.”

One more injection to go. Then I should be done with wielding needles for awhile. Maybe forever, if I’m lucky. And if anybody asks me about the experience, I’ll say modestly, “I did reasonably well. We both lived.”

Addendum: After the final injection, I had to revise this post because I still had a step wrong. Perhaps this is why I never taught Technical Writing.


My sister’s feet ~

Carolyn's feet

They are hardly ever still, my sister’s feet. But they don’t let her dance. They don’t even take her places. She is at their mercy. In their pain and urge to move, they flex, twist, and contort, seldom able to rest even a few seconds. So, too, her legs move and thrash, wrapping her up in the bed linens like a winding sheet. The medication she takes for restless leg syndrome has not been helping much.

A severe multiple sclerosis flareup two months ago has left her legs more painful and uncontrollable than ever. Because that flareup also impaired her ability to walk, my sister has been living in the hospital, then on my couch, then in a nursing home, and then back on my couch again.

She is enduring a crippling case of the uncertainty blues. Physical therapists are trying to strengthen and retrain her leg muscles so that she might be able to walk unassisted again and return to her home. She can make it from the couch to the bathroom by using a walker. We are working to get her on a newly approved MS drug. Theoretically, it should reduce the number of brain lesions she’ll suffer in the future—lesions that impair her nervous system’s ability to send and receive the signals that support walking and other body functions. MS has already taken away much of her vision. We don’t want it to take anything more.

Two sisters. I’m the older, and when I look at her feet, her curled toes remind me of the little girl she once was. She may never dance again. She may or may not return to walking unassisted. But we are hoping. Baby steps.