Letters to Mom 018: Coping With My First Infiltration

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I’m crying right now as I write this. I feel like I need to admit to that.

There was a comment from a reader on my last post, linking to another post about a woman who also lost her mom and how “she’s still her mother’s daughter”.

At one point she says, “I still need you.”

I’m not the only one who thinks that; who feels that and I don’t know why but it makes it feel like things are ok. I’m not weak or “holding on” or whatever other stupid things I tell myself.

It’s ok to still need you, mom.

I needed you yesterday.

I infiltrated my first patient. In a year and a half, I’ve never infiltrated. I’ve missed. I’ve had the fistula and graphs roll on me like normal veins. I’ve had to restick patients… But I’ve never infiltrated and I’ve never caused a patient to not be able to run their treatment.

Until yesterday.

My patient came in like he always does. I wasn’t able to call him in early. He used to run on first shift, but with having to close the clinic down to three days a week with an ISO patient, he had to be moved to second shift because he is (un)lucky enough to be immune.

He hates running on second shift. His lunch is cold by the time he gets home. It messes his morning up. He’s one of the nicest, quietest people I have ever met and it hurts to know that I can’t make the situation better for him. Whenever there’s an open chair in the morning he’s the first person I call.

Me: *teasing voice* There’s an open chair for you if you happen to feel like coming in early.
Him: I’ll be right there!

It always makes my day to greet him, to spread out his blanket after his treatment is initiated, to help carry his bag to the scale as he’s leaving and saying our farewells.

Yesterday there wasn’t an open chair so I couldn’t call him in early. We flipped the station as quickly as we could. We got everything set up. I smiled a warm and genuine smile when he came into the clinic. We exchanged small talk as I took his standing blood pressure.

I can tell his smiles are real now. They’re different than the ones in the beginning when we were both still strangers. After being there for almost four months I think we both are getting used to each other. I’m not a random stranger stabbing needles into his arm. I’m his tech and he’s my patient and I actually do care about what he’s doing in his garden and what are you talking about? The weather is amazing. I’m from Florida. 100 degrees is basking temperature. You guys are the ones who are weird for thinking it’s too hot.

We moved through all of the different stages of the pre-treatment process. I cannulated his arterial needle fine. I cannulated his venous needle and… hesitated. It didn’t… feel? right…

There was flashback… I pulled the needle back a little… I wasn’t against the wall of the vessel or anything… There was no resistance on the advancement of the needle… But I couldn’t shake the feeling of “wrongness”.

I drew labs from the arterial needle. No resistance. Everything was fine there. I administered his prescribed heparin through the venous needle. Again, no resistance. When I asked if the needle felt ok he said yes.

Ok… Maybe it’s just me…

I connected the bloodlines to the needle lines and initiated his treatment. I watched the machine as the pump started. The needle pressures were within normal ranges. I still wasn’t sold on the whole, “everything’s ok” thing.

I turned the pump up to the prescribed flow. Still ok on pressures…

If nothing is wrong then why do I feel like something is wrong?

With no answer to that question, I reluctantly secured my patient’s lines. I put his feet up and spread his blanket out like normal. I asked if he needed anything else.

Me: Anything else I can do for right now?
Him: Nope. I think that will do.
Me: Arighty. If that changes you let us know.
Him: Will do.

I took my gloves off, rubbing hand sanitizer over them before I began to chart on the computer next to his machine.

That’s when the machine’s alarm went off. Venous pressure had reached not ok levels and the machine automatically shut the pump off. I looked at the machine, reading the alarm message it was giving. I immediately looked at my patient’s arm dread already making my stomach turn to ice. My patient’s arm was so swollen at the venous needle sight, so “not right” that all I could do for the first half a second was stare unbelieving at what I was looking at.

Irrational Right Brain: … But… But everything had been fine…

My next thought was a mild freak out of, “omg is he in pain?”

I asked him if his arm hurt. He said it had for a little bit but it felt fine now.

Irrational Right Brain:  Your arm is not fine. I let this happen. I cannulated you. I did this to you. I hurt you. This is my fault.

Rational Left Brain: It doesn’t matter if it is or isn’t your fault. You’re patient needs you to keep your shit together and not have a fucking meltdown right now. You can do that on break. Right now you need a nurse. You’re not a nurse. Get the nurse.

I called the nurse over. She confirmed it was an infiltration and that his blood could not be rinsed back and he could not run his treatment.

I can’t express the soul-crushing feeling I felt at hearing her words. I hadn’t felt emotions like that since I first started training and would have to be reminded to increase the blood pump speed or hearing the words that I had messed up stringing a machine or being told I had left the saline clamps open… again…

I haven’t felt those feelings of absolute failure since my RN mentor would point out all of the things I was doing wrong, in front of the patients, while I’m trying to already not fall apart because I fucked something up with the last patient I was with, too, and I can’t do anything right and this was totally the wrong choice and why did I think I could ever do anything medical related. I’m just a total failure at life and all of these “wrongs” prove it. I’m a fuck up and I’m sorry and I can’t seem to get it right, just once. I’m sorry I’m a failure.

Those.

Those feelings…

I got through them somehow in the beginning. I had long talks with my coworkers on break. I had my patients thank me at the end of their treatment and tell me that I was doing well. I had several nights of crying in my car after work and talking to Jon. I had all of these moments that helped me get through and fight back that voice in my head that cried out “failure” over every mess up. And eventually, I messed up less. I learned. I got better. I got faster. I got more confident and familiar with the totally new work world I had thrown myself into.

But yesterday… Yesterday I failed.

I failed my patient.

It was so hard to not cry as I explained to him we wouldn’t be able to run his treatment.

Him: Well… It happens.

Irrational Right Brain: NO GODDAMMIT! It doesn’t “happen”. Be angry at me. Be mean to me. I hurt you. I don’t deserve your kindness. I don’t deserve your understanding. I hurt you and I’m so sorry and there’s no way to make it right and I’m so so sorry.

I had to go into the back hallway and cry for a few seconds alone before pulling my shit together to get through the rest of change over. I didn’t have time to feel like a failure. I had other patients who needed me to be there for them and in a way that helped. I had to cannulate three other people and all of those cannulations were flawless.

It helped quite the voice inside of my head saying I should rethink my entire career choice and that I was a horrible fuck up.

After my break, after talking to my brother, I talked to my FA about the incident.

Me: Have you ever infiltrated anyone?
Her: Oh god, yes. That’s part of the job. It happens.
Me: That was the first time it happened to me.
Her: Really? If I had known that I would have been more compassionate. Are you saying in a year you’ve never infiltrated anyone?
Me: No. I haven’t. Which is why I’m having such a hard time right now. I’m trying to complete the NFACT “expert cannulator” thing and yet I infiltrate this patient and have been having a hard time with another patient’s access. It’s hard to not feel like I’m doing a bad job or that I shouldn’t pursue it further.
Her: If you were doing a bad job I would have told you long before this.

I felt better as our conversation continued and she shared her own experiences with me. It reminded me of when I was in Orlando and my trainers would caution me, “You’re going to infiltrate. Everyone does and it’s ok.”

I had accepted, back then, back there, that I would, eventually, one day, infiltrate a patient. And I guess in the year and a half or so since I’ve been working, to only have one on my record is pretty unheard of. I had accepted with phlebotomy that sometimes you miss. It’s not that you’re a bad phlebotomist. Some days are better than others. Some patients are easier to stick than others. The same goes for cannulating a dialysis patient.

Missing doesn’t automatically mean you’re bad. Infiltrating, also, doesn’t automatically mean you’re bad. And that’s something I’m having to work through. I’m not bad at my job. But yesterday I felt like it.

Yesterday I started questioning pretty much everything. I need titles and labels and to understand my roll in all of the dynamics I have; in all of the spots I fill in Life.

Who am I? What am I? What am I working towards? What’s important to me? Why do I wake up in the morning? What’s the point of getting out of bed? What’s the driving force behind doing anything, achieving anything, caring about anything?

Those were the questions going through my head last night.

Everything felt so nebulous and tentative and ready to shatter around me and I don’t know why.

I had already accepted that this incident was not a direct reflection of my skill. Hell, it could have been something as simple as my patient moved his arm while shifting in his chair and the point of the needle infiltrated on its own.

The important thing was I reacted professionally. I made sure the situation was controlled and that my patient was safe and gave the proper instructions for the care of his infiltration while he was between treatments.

Yet, there I was at home, questioning who I am. What I am.

It reminded me of what it was like when you first died, mom. I was no longer a teacher. I was no longer a student. I was no longer an employed member of society. I was no longer anything…

Currently, I’m not a mother but I have an eight-year-old who thinks she’s my daughter. I have a significant other but I’m not a wife or a girlfriend. I’m a nebulous in between. I’m not a nurse but that’s the easiest way to explain things to people because Patient Care Technician is long and confusing and you can see their eyes glaze over with that “not processing” look.

I’m “not” so many things, but then what am I if I’m not those things? What are the constants in my life that I can cling to when everything feels unstable? What are the cornerstones I found for myself during your death that have pulled me through all of the hard times where I wanted to give up?

That’s when I started remembering them…

I AM your daughter. You ARE my mother. I AM a warrior. I AM an earth dragon. And Life can go fuck itself if it thinks I’m going to give up.

It doesn’t matter what other titles I have. It doesn’t matter what other people think I am or am not. I AM your daughter and that is one thing that WILL NEVER change.

I don’t know what else to write, mom. Things aside from the craptastic day of yesterday are going well. I made my first rattan sword this past Saturday and it was awesome. I’m down seven pounds as of today and up one pound of muscle. We’re supposed to be starting serious work in the addition this weekend. The new countertops for the kitchen got installed and they’re pretty awesome. I figured out why I haven’t been back paid for my certification from March. I’m level 20 something in Final Fantasy 14 and I’m still having fun with the game. Jon and I are making solid plans for visiting Jason.

Things are still going really well overall. I feel like I should say sorry for letting this one event shake me so hard, but I’m not sorry so I can’t say it. I can say I will try not to let it eat away at me. I will try not to let it cloud my perception of myself and make me question my self-worth or skill.

But I know myself. This is still an unclosed loop in my head because I have not atoned for the wrong I feel I have committed. I need to figure out something to bring closure to this for me. Maybe writing… Maybe a post for my patient, similar to the posts I make for you, or for the people I can’t say things to…

Maybe saying all the words I wish I could say to him would help me move past this so I can still be the confident, competent patient care technician that I am and that he needs me to be.

I don’t know… But I promise I’ll figure it out, mom.

I love you. And I still need you. And you’re still here even if it’s not the same as it was and I think after reading the post shared with me by my reader that I’m getting better about accepting that.

Thanks, mom, for listening. For everything. I love you. Forever and for always.

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