My Phreaking Phosphorous

It’s my own fault. I’d been getting cocky, telling anyone who asked how trouble-free my infusions had been, tempting both fate and the Gods of Chemo.

My typical schedule on Chemo Day sends me to the Lab first where they draw blood and access my port. Then, I head upstairs to see Doctor Hu. She usually has the lab results before the end of our appointment. Lastly, it’s to one of two Infusion Centers where I make myself at home for the next 4 ½-hours.

Yesterday, 10 nurses had called out sick, and the Lab was pretty backed up. (There are no phlebotomists at the Levine Cancer Institute. Only RN’s draw blood because of the number of patients with ports.) So, Doctor Hu could see some of the results, but not all before I headed to Infusion. We had already started my Chemo regimen when the Doctor called down to say that my phosphorus was low. Evidently, I had lost my glow.

Now, because I am my father’s son, I immediately did some research to try and assess the culprit. I needed to know what vital phosphorous-rich foodstuff I had neglected to make a regular part of my diet. Must I incorporate more pomegranates, or mustard greens into my diet? Was there some obscure seaweed found off the coast of Prince Edward Island that was an amazing source of phosphorous? Based on my research, here is a short list of victuals that are high in phosphorous: whole wheat, peanut butter, cheese, nuts, poultry, fish, beans, broccoli. In other words, food. Food is a good source of phosphorous. I eat food on the regular. Yet, here we were with my phosphorous wanting.

"Petey the soda jerk" by hyperakt is licensed under CC BY-NC-SA 2.0

My nurse for the day was Rachel, and she explained that Doctor Hu had ordered an additional infusion of Sodium Phosphate for me, but it was incompatible with one of my Chemo drugs. That meant it couldn’t be administered through my port concurrent with Chemo. She also let me know that it would take 4-hours to fully administer. In the 1930’s, I could have walked into any Soda Fountain in the country, ordered and downed a Phosphate Soda in 5-minutes. Now, through meticulous research and innovation, the greatest medical minds in the country had managed to increase that timeframe to 4-hours. Rachel gave me a choice – we could either hang the sodium phosphate after my Chemo and add 4-hours to my day, or start a separate IV to send the “Sodium Phos,” as she called it, through. I chose the IV.

In my experience, starting an IV is a pretty straightforward process. In Rachel’s experience, not so much. She inserted the first needle, which blew out the side of the vein. I pictured a garden hose with a gaping hole in the side spewing water, or in this case blood, everywhere it wasn’t supposed to go. It was an unpleasant picture. She tried a second needle, and though I’m not exactly sure what went wrong, wrong something went. After pushing the needle around internally for what I am sure was several hours, an entirely disagreeable thing to experience, she called another nurse, Paige, over to see if she could adjust it to the point of function. Paige could not.

There’s a rule. Maybe it’s a universal rule, maybe it’s specific to the Levine Cancer Institute Infusion Center, I’m not sure. The rule is that any given nurse gets two attempts to start an IV before having to defer to another. The nurse to whom Rachel wanted to defer to was Gena. Gena was at lunch. We waited for Gena to return, chemo meds still dripping.

You know those World War II movies where some snot-nosed Lieutenant recently graduated from West Point is kept alive by the seasoned First Sergeant? Gena was the nursing equivalent of that First Sergeant. She sat down, looked away from my arm and started feeling my veins, using touch to select the one she wanted to target. She inserted the needle, adjusted it efficiently, and got blood return. Fait accompli.

While Gena and Rachel were working, I asked them how they practice starting IV’s in nursing school. Do they use chicken carcasses? Is there some sort of high-tech simulation robot like on Grey's Anatomy? Their answer, “You don’t.” They practice injections, but not IV’s. Learning how to start an IV is 100% on-the-job training. Rachel had gone from nursing school, to the ICU where IV’s rarely need to be initiated, to the Infusion Center. She was a lovely and capable nurse about whom I have zero complaints other than wishing she had had someone other than me on whom to get her on-the-job training. By the way, that morning in the Lab, when Nurse Hilary was accessing my port to draw blood she hit the side of it the first time and had to take a second stab, so to speak. For those of you keeping score at home, my record for the day was three nurses and five needles for two access points.

With all the mishegas around getting an IV started, my Chemo was well under way before the Sodium Phos, as the cool kids call it, got hung. I arrived at the Cancer Institute at 9:30 in the morning, and walked out at 6:30 in the evening. It was a long, crappy day.

It probably reads like I’m complaining, and I guess on some level I am. As I’ve said before, however, during this entire travail I have not met a single care-giver who was anything less than capable and lovingly supportive, Rachel included. Still, she is newly pregnant and after yesterday, I think the least she can do is name the child after me. And not for nothing, next time someone asks me how my infusions are going, I will continue to tempt fate and answer truthfully, “They’ve been relatively trouble-free. I’ve been pretty lucky.”