Intravenous Drip

by Natasha Waxman

Now, asthma was not the unmitigated drag it might seem: I got plenty of attention, treats, sympathy, and holidays from school that I otherwise wouldn't have gotten. Besides, I was born with it, and I have never known what it is like not to be aware of one's own breathing, or to know that sooner or later, it will be in short supply. Everyone has something.

Every time, I fought going to the hospital like a small panting bulldog. Asthma attacks actually have something of the character of physical fights - you heave for breath, dragging it in like air through a straw; you feel like a bully is sitting on your chest. The insides of your lungs crackle and skreek; they feel scorched. All of the muscles involved in the effort to expand the bellows of your lungs - trapezoids, pectorals, abdominals - ache and ache. And yet, there is such clarity: each moment narrowed to the ember of breath.

It was only after an attack had progressed to the stage where my lips were blue and my fingernails white from lack of oxygen that I would consent to be taken to the emergency room. In other words, when I was too weak to fight anymore. Why did I fight the hospital so hard? Because, as you may already have guessed, I had to pass through the IV. Going to the hospital meant getting deposited in the emergency room on those chlorine-smelling sheets, gasping like a beached fish from the exertion of the trip. It meant case histories being asked of my parents, interminable waits, x-rays, blood work. And it meant the inevitable medical resident saying, "I think we're going to have to put you on an IV, okay, honey?" As if there was a moment's doubt in anybody's mind.

Just in case you haven't had one lately, IV's are used to deliver medication fast, directly into the bloodstream. You have a bag filled with some innocuous solution, usually saline or glucose, attached to flexible plastic tubing which ends in a needle inserted in the vein. The kind of IV I had would be considered old-fashioned, these days. (Now they have those fancy-schmancy computerized pumps that deliver precise amounts of medication and basically take all the fun of human interaction and error out of IV's). On my IV's, there was a little device on the tubing that pinched it to varying degrees, regulating that flow of fluid. This part ended in a needle which dripped into a clear ampoule, so you could see the rate of drip, and then the tubing continued on down toward the vein. Above the regulator there was also a little branch off the main tube capped by a rubber plug. This rubber plug could be pricked repeatedly with injections of medicine without springing leaks.

If I was lucky, the resident called a nurse to put in the IV. It is common knowledge in hospitals that nurses and blood technicians are far more competent than doctors at dealing with needles, and they generally have a far more soothing bedside manner to boot. If you ever need an IV, and sooner or later you probably will, try to politely suggest that a nurse do it. The IV cart would be wheeled in, bristling with clear, jellyish IV bags, tubing and regulators, alcohol swabs and fresh needles encased in plastic. A torturer's arsenal.

My veins were small, even for a child. IV needles are about an inch long, and they are thicker than the little prickers used to draws blood. They have round, open mouths. They must be securely anchored in the vein, a small metal pipe inside the larger, delivering their fluid into the current of the blood. "Are you right handed or left-handed?" they'd ask brightly, once I was old enough to write, and they'd pick the other first.

There was the cooling swab of alcohol, the tapping and smoothing over the back of my hand to find a prominent vein. The imminent foretaste of pain clarifies the mind. I would watch my vein with a detached, clinical interest, my dread giving way to a stoical resolve not to scream. I always watched, no matter how many times I was told it would hurt less if I looked away. There was the needle, approaching my skin. The moment of contact, as the skin gave beneath the needle without breaking. Then - puncture, the stinging blaze of pain as the sharp metal point breached the skin. The nauseating feel of the long needle nosing rigidly inside my soft vein. Sometimes, it slid right in, as though the skin had craved puncturing, as though the vein was grateful. More often, though, it took four or five jabs to get it in properly; often the damn thing would just punch right on through both sides of the vein walls, scattering blood under the skin in purple bruises that took a long time to heal.

I tried to be "good." Weak as I was, shaking with the load of medications I'd already received, I didn't want them to think me craven. What an effort, straining against my own skin, not to cry out! The person putting in the IV and my watching parent would be disappointed if I cried out and I feared that disappointment keenly. I wanted to be the one they talked about in the staff room, the one who didn't make a peep. To moan and cry out in pain means to use up some of the precious emotional currency that is the capital of every sick person, but, as we all learn, it is expendable and finite.

Sometimes, though, I couldn't help making sounds.

What extraordinary people they are, those brave souls who can bear children's cries.

Once the needle was in place, all that remained was to tape it down on my hand and attach it to the tubing that led to the IV bag, and then to tape my whole hand and forearm to a small, fabric-covered board which kept the whole arrangement stable, since children have a tendency to thrash around and pull out the needle. A few tugs on the plastic seal, a flick of the regulator, and the liquid started flowing.

The trial was over. The needle was inside my dark vein, whispering its little pearls of liquid into my blood. I knew that the medications dripping into my vein would shortly begin to work, the relief I had fought so hard against was on the way. For a week or more, I'd been making the gigantic effort of breathing, dragging in the thin, reluctant air. The last reserves of my strength had gone into fighting the IV, and now, when I had reached the furthest edge of exhaustion, the axis of things tilted. From the sparse, rasping ache each moment had been a few moments ago, time welled outward, became silken as I sank into my exhaustion.

The first nights were always bad. No matter how late my parents stayed, there was always the moment when they had to go home. Aside from my terror of abandonment, there was this alien attached to me, its clear bag gleaming coldly above my head. Waking in the night, there would be the sudden vertigo of feeling my body different; in the split second before consciousness, an instant of revulsion, the strong urge to throw off the thing on my arm.

The stylized roosters on the curtains by my bed were positively sinister at night. In the corridor beyond my room, the nurses went back and forth on brisk rubber soles. There were the muffled or piercing cries of other children on the ward, babies usually. A quick slash of light as a nurse opened the door, and I would lie there pretending to sleep as she changed the bag. Together, the IV and I kept vigil. Even during sleep I was connected and at some level conscious of it, since I slept favoring the immobilized hand. I only pulled it out once, in all those times.

By day, however, the IV was a different story. For one thing, it looked important. There was no mistaking who was the patient around here. For another, it was attached, a new limb. It was like having an important friend, someone only you knew, like a foreign cousin everyone wanted to talk to. It impressed the hell out of my brothers when they came to visit.

Hospital staff would come and check on the IV. They always checked it first, before me. They would squeeze the bag, see how much solution was left, check the rate of drip, inject meds into the rubber plug. How I loved to watch those painless injections! The nurses would always flick the syringe lightly and squeeze out a few beads of liquid first, to get rid of air bubbles. It was such a lovely, precise movement. Many times I begged them to let me do it, but I don't remember any of them ever letting me. A few times, when a nurse was very cursory about it, I would endure silent terror at the thought of an air bubble traveling through the tube, which I knew could be fatal. Trying to fall asleep with the clumsy thing in my bed, I often would envision a crazed nurse giving the IV an injection of pure air as I slept. Given the gothic nightly scene on the wards — the unending crying of small children, the clattering of the night cleaners, the hoarse laughter of the night nurses — such morbid imaginings were not as neurotic as they may sound.

I have said that the staff always looked at the IV first; I didn't resent this. It somehow put some of the responsibility for getting well onto the IV, rather than me. I watched it quite a bit myself. It kept me company on the interminable, lonely waits for visitors. I loved the regulator, and the oval vial below it, inside which fluid dropped from a needle. I could watch the drip tirelessly, especially when I was dull and shaking from medications. I even played with the regulator myself, feeling very medical-professional, adjusting the little plastic knob to slow or speed the rate of drip. If I increased it, I felt a slight sensation of coldness in my hand as more fluid hit my vein. This little game of mine sometimes caused consternation, as when it was discovered that I had absorbed all of the medication meant for eight hours in thirty minutes and lay in a groggy fog, flopping like a beached sunfish. I listened guiltily as a doctor reprimanded a nurse outside the door of my room. Nobody ever suspected me.

The IV was an external stomach I could watch. And such clear, pure nourishment flowed from it. I liked the fact that it was not mere water, but sustenance. I wondered how long one might live, detached from the need to eat solid, heavy things. I wondered how my veins could hold all the extra fluid coming in. Actually, sometimes things didn't go in only one direction; sometimes blood seeped back. The first few times it happened, I screamed blue murder for the nurse, who came and simply opened the clamp, increasing the flow and flushing the blood back into the vein in a wonderfully cold ripply gush. It was a horrible and intoxicating feeling. When I realized it wasn't dangerous, I would wait and wait to call the nurse, watching the blood creeping up the line. My own blood, crawling away from me.

There were several types of IVs, even back then. Some kids had IV's with electronic medication pumps which were less common then than now, some had double-bag IVs with thick, vividly yellow medication in one bag. We kids defined one another by our equipment. We compared our treatments and paraphernalia in the matter-of-fact way kids do. Sometimes, I saw other kids getting transfusions, and shivered at the look of that dark, alien blood flowing into them. I recall feeling an obscure jealousy at their infinitely more serious communion.

Medical devices are a wonderful distraction, for staff and patients alike. If there is a heart monitor in the room, there is a real tendency to watch it rather than the patient. The devices are concrete representations of the fact that something is being done about the mysterious chaos inside the body. I loved to play with my IV because it gave me a sense of helping things along. I think it was reassuring to the doctors and nurses in a similar way. Even a vial of pills by the bedside can do this, don't you think? It says: things are being taken in hand.

When I got strong enough to move around a bit, I had to take my IV with me, on a wheeled IV pole. This included going to the bathroom. Not an easy thing to negotiate, especially when you're already unsteady on your feet, and the bathrooms are small. You're always bumping into the things, and the swing of the tubing causes little horripilations in your arm. Yet, like most patients, I insisted if at all possible on going to the bathroom myself, no matter what effort it took. Getting dressed with an IV proved to be a skill that took practice and a certain amount of abstracct figuring. It's no use putting your good arm into your shirt-sleeve first. The trick is, you need to unhook the IV bag from the pole, then push the bag and the tubing through the sleeve, with your arm following last. Then you can put your good arm in.

The IV pole could also be fun. I remember poling around the wards with a cystic fibrosis patient named Karen. Our stays coincided on a number of occasions, and we became pretty good hospital-friends. She was cool, a real hellion. Despite her incredible thinness, her constant coughing, and the handfuls of green pills she had to swallow with each meal, she gave all the nurses a run for their money. We'd stand on our IV poles' splayed metal feet and coast, propelling ourselves along with one foot. We ran IV races, having to pick up various trinkets like towels or nurses' paperwork along the course, before anyone caught up. It is strange to think that Karen, and all the other cystics I knew back then, are all almost certainly dead now. Cystic fibrosis, unlike asthma, is inevitably a fatal disease.

The duration of my stays in hospital varied, but they usually lasted about a week or ten days. By the third or fourth day, I was trying to convince the daily troupe of doctors and residents that I was well enough to go home, or at least to have the IV taken out. Every day that they said, Just a day or two longer, felt like such a defeat. Once the crisis is over, one longs for a return to the active world of the healthy. By this time you have sucked most of the juice out of the experience of illness, and the patience required for full recovery is trying. The real sick can never come back completely, and the endurance required of them is truly staggering. Imagine knowing you would never free yourself from the IV, the respirator, the dialysis machine.

Eventually, the day of emancipation always came. The removal of the IV was pretty much the antithesis of getting one. It was always daytime, I was fully conscious, anticipating my freedom joyfully. I would joke around with the nurse, as she cut the adhesive tapes holding my arm to the little board and yanked it off. This pain, and that of the needle's removal, was hardly worth bothering about. I knew now I was on my way back. Clamped to the board, my hand had become damply swollen and white, and with wonder I flexed its stiffness, sniffed its strange odor. A small prim hole in my hand and a big green bruise were my only lasting mementos. The bag and tubing stood disconnected and deflated by the bed, leaking a little, until the nurse took them away, and by now it was almost impossible to believe that this flaccid and abandoned thing had been my companion for so many days.

Going home, there was the raucous intensity of street sounds and exhaust fumes, the bitter cold and snow or the sweet green yammering of spring jamming themselves up against my pale, anemic consciousness. The air against my cheek, after the unchanging staleness of hospital air. So this was what the world was like! Hello lightpoles! Buses snorting along, full of indifferent people! This was the rarest moment. You must have felt it, haven't you? The communion, the moment of appreciation before you sink back into the everyday rush of things. For a moment, you are still outside it all, your family and friends have no idea of where you have really been. I had passed through the tunnel of pain and illness, with all its delights and miseries. I had undergone the IV trial, an explorer returned to my native land, fully conscious that the sights I had seen were incommunicable. Moving around without my IV was wonderful, heady ecstasy, and yet as I walked back into the world, I often found myself feeling I'd forgotten something, as I cast backward for the phantom pole.

Natasha Waxman has published a number of stories in various magazines and anthologies, including Scribner's Best of the Fiction Workshops 1998 and Zoetrope. She lives in Austin, Texas, where she is working on a novel.