Saturday, October 10, 2009

Firing your chemo team?

I don't know what to do.

I went to Alta Bates yesterday for my 5th to last Vincristine infusion. After 5 attempts they gave up on starting an IV and sent me home. I'll try again on Tuesday. However, I was there for over 2 hours. I did get a flu shot so it wasn't a complete loss.

The nurses seem convinced that my veins are just too small, and at this point all the good ones have been too fucked up by so many other attempts (and successes). Vincristine will really mess up a good vein--it's nasty stuff. However, this same nursing team also made a few strategic errors in which veins they poked and which IV needles they used. They were unsuccessful at drawing blood from the anacubital (the big veins in your elbow pit) so I'm not sure how much confidence I have in the general skill level.

The thing with really toxic chemo drugs is that you worry about them "leaking" into other tissue if the IV needle has punctured the vein in a few places. As a result, once you hit a vein high up (like in the elbow where they all meet) that arm is done for the day. Also, if you get in, but not good enough, it's too dangerous to infuse. Wrists and elbows, where veins tend to be more visible are too risky for chemo because if it were to leak the damage to the joint could be devastating to utility. This limits where you can get poked. I got poked in all possible places.

It's the little things: refusing to use a pediatric size needle even when I tell them my vein are too small for regular sized needles, the callous IV rip out from last time which resulted in the biggest IV bruise I've ever had, this month's blood draw failure... While everyone is nice, there seems to be a chaotic culture reigning in the treatment room and bad communication everywhere. As a systems observer, I am more appreciative now of how on it the Swedish team is. There is a huge qualitative difference based just on operating practices.

Anyway. I don't know what to do. Obviously try again on Tuesday... but everyone was making noise about having a port put in. I refuse. I am being a good sport about all of this: 2 years of incredibly conservative treatment, subjecting my body to heinous chemicals, but I am not going to have surgery to have PORT put back in my chest. No. 5 IVs.

I think it might be easiest to just start flying back to Seattle. Getting a new treatment team at Stanford or UCSF would be a pain. All the extra appointments... By the time I commute to either of those hospitals and go through all the introductory crap... I'm calling Dr. K on Monday.

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