According to Wikipedia, a peripherally inserted central catheter, or PICC, ‘is inserted in a peripheral vein, such as the cephalic vein, basilic vein, or brachial vein and then advanced through increasingly larger veins, toward the heart until the tip rests in the distal superior vena cava or cavoatrial junction’.
And now in English: one day I was told that a two foot long plastic tube was about to be inserted into my left arm. The leading end of this two foot long plastic tube, as it was explained to me, would be fed through my skin and flesh into my body and pushed up, along and down veins until it sat close to my heart. The trailing end would stick out of my upper arm and have a tap on it.
Over the years there have been a lot of things that have sat close to my heart, but a blue plastic tube had never been one of them. I contemplated this. I became anxious, scared. My life had dissolved in a few short weeks. The words "multiple myeloma" had seen to that, once I knew what they meant. And now I was to be turned into a plastic transformer robot as compensation. How grand.
Apparently it was important to get the poison really close to my heart. Right in there, where my blood pump could do its job and spread the carefully chosen toxic chemicals around my body. The plastic tube was the perfect means of getting this sort of action happening. And there was another reason, too. Being toxic, everyone was going to make sure the chemicals wouldn’t be spilled on my skin or small veins in my hand or arm. These toxic chemicals would just burn everything they came into contact with and nobody wanted to see that happening. So the plastic tube had the additional benefit of reducing civilian casualties.
The day after being told all this, when I was still struggling with the concept of a game of snakes and ladders being played inside my body, the two foot long blue plastic worm took up residence. It would be there for six months. I could see it on the x-ray which was taken after the ‘procedure’. A pale, thin line, it traced an exploratory trajectory across the shadowy expanses of my shoulder, chest, lungs and rib cage. The comment on the x-ray confirmed that the plastic worm was happily ‘in situ’.
That’s the way I remember the physics of it. The chemistry is not such a vivid memory, as there really isn’t much to see. The poison is hidden in dark coloured bags because it’s so light sensitive. And everyone who handles the bags wears an outfit designed by NASA and is called Kylie. I do remember that bit.
One day I sat down in my armchair with a book, ready to commence the difficult process of managing my moods over the four days it would take to empty various liquids into the tube in my arm. Four days in a small hospital room, attached to a drip line that divided into three to allow a mixture of saline, steroids and cell killing chemicals to enter my bloodstream.
It takes some patience to get through a four day session of chemotherapy. To occupy myself I often watched the little counter on the blue pump that’s part of the drip arrangement. The counter showed how many millilitres per hour were being pushed into my body. It also calculated how many mils were still to be pumped in. Multiplying the amount per hour by various randomly guessed numbers gave me an idea of how long it would be before the chemicals in the black bag were all gone. No matter what magical arithmetic I performed, at the start of a four day session the hours to go number always worked out at around 100.
On this particular day I sat and stared, drank water and tea and settled in with Bill Bryson’s Life and Times of the Thunderbolt Kid. After a few moments I stopped reading and just stared at the blue pump and listened to its discrete burblings. I looked along the plastic tube until it disappeared under my sleeve. There was a wodge of dressing just above my elbow and the tube disappeared in under all of that. That was fine with me as I never wanted to look closely. It was just too confronting. I could accept it was happening only by avoiding it.
My eyes retreated and followed the plastic tube back down my arm, across the floor and up to the blue pump outfit attached to the drip stand. I glanced at the digital counter on the front panel and did a quick dispiriting calculation. I tracked the tube again and followed its ascension to meet the sombre bag with serial numbers, authority numbers, chemical numbers, warnings and my name printed on it. My name.
Except that Heather Kelly is not my name.
I had never pressed the emergency button beside a hospital bed before. I had wondered what sound it would make, but only idly. Not with any real intent. All that had suddenly changed. I was not Heather Kelly and I did not want her chemicals.
I got my finger to the button just before involuntary shaking overtook me. I had to grip the arms of my chair with both hands to stabilise myself. I held on. I had demanded my own poison like a laboratory mouse nudging an experimental feeder bell.
The noise was horrendous. Everything started to flash and whoop. Footsteps and voices in the corridor stopped and for a split second there was no sound except the shrill of the emergency alarm. Then voices, feet, uniforms and gowns all surged into my room, where I sat and held on to my chair and tried to get out some words.
I pointed but no words came. I shook even harder and pointed again. Eventually I got it out. “That’s _ not _my _ name”. Within seconds the drip was disconnected, charts were flipping around and people began coming and going in numbers. It was extraordinary. I sat back, breathed deeply, realising that every reaction I was observing was extremely well drilled. Faces in front of me were assuring me that it would all be OK.
The pharmacist, who wore a NASA outfit when he brewed everyone’s poison on site, was summoned to my room. He explained that the error was only in applying the wrong sticky name label to the front of the chemo bag. He had my file and showed me all the details. They matched what was listed on the bag. I was actually getting the right poison, he said. As he spoke I sensed that my body was starting to believe him.
I was connected up again. Tap to drip line, to blue pump, out the top to the chemo bag. My name on the bag. I was ready to resume receiving my own poison. I did the sums again. With that much left on the counter, at that flow rate it would take…
I had visits from everyone for a while. Directors, managers, surgeons. Smiling, apologetic, embarrassed and penitent. It was fun. It wasn’t the pharmacist’s error, as it turned out. Somewhere on the ward, someone had printed off a wrong label and attached it to my poison, which had indeed been properly prepared in the pharmacy.
The next day one of the nurses, whom I had established a good banter with, stood in front of me. She said, “I have an apology to make to you”. I reached out and clasped her forearm. I said it was OK, that I’d always felt confident about the procedures and that hadn’t changed. It was nice that she was so straight with me.
I didn’t know what to do with the story for a while. I told my wife, of course. I needed to start laughing about it, to put some distance between me and the sound of that emergency alarm. I’d never been an emergency before. It was hard enough being a cancer patient whose body had suddenly become the very public property of the health industry, without having extra attention drawn to my plight.
So I stared at the counter, read Bill Bryson, drank tea and kept the high moral ground for as long as I could. Eventually the counter ticked over to zero and a meek little ‘you’re finished’ noise emanated from the blue pump. A nurse wandered in and disconnected me. I was glad to get away.
Some weeks later I told the story to the nurse at a pathology unit. I wanted to laugh, to share it with someone who would understand all the elements. I picked the right person to tell. Her response was perfect.
“Well, at least your cervical cancer is cured”, she said.
Cancer Council NSW would like to acknowledge the traditional custodians of the land on which we live and work.We would also like to pay respect to elders past and present and extend that respect to all other Aboriginal people.