Port Insertion

A slight change of plans. Instead of getting the port inserted on Friday, then heading straight over for chemo, Dr. Wendy wants a little more time for everyone to figure out how to use this new drug.

Am I willing to get my port inserted on Thursday morning, then start chemo on Friday first thing in the morning? Sure. I'm flexible at this point, as long as we're moving forward.

So, Miriam and I head over to the Physicians Plaza in front of Timpanogos Regional Hospital on Thursday morning around 7:30. They want me there by 8 so the insertion can start at 9 a.m. I don't know why they want me there so early, but I'll comply.

This time is weird though. No call to let me know where to go or how to prepare (no eating or drinking after midnight kinds of information). Luckily (or is that unluckily?), this is the third time I'll have a port inserted so I pretty much know what to do.

We arrive at the heart cath lab, and it's pretty obvious that they've never dealt with someone like me before and are not used to inserting ports.

They want three vials of blood and to start an IV before the procedure. Pretty standard practice, but not for me anymore. It took BMT six pokes to draw two vials of blood, but they were used to chemo veins.

It takes over an hour, seven sticks, an ultrasound machine, and two different "expert" phlebotomists to FINALLY start an IV. The whole time I'm saying "You don't really need an IV. I'm not going to have any sedation. And I just had labs drawn at Dr. Wendy's office on July 31." That's not good enough. Hospital protocol says I have to have an IV and labs drawn within 7 days of the procedure.

During all the pokes and digging into my arms, I did have a unique experience to add to my repertoire. While fishing for a deep vein in my right arm that showed on ultrasound, an intense electrical shock traveled down my arm and zinged hard into my right ring finger. Never had that happen before. It's intensity surprised me so much that I jerked my entire hand in a involuntary reflex sort of way. I knew as soon as I felt it that the tech. had hit a nerve, but what a strange feeling!

By the time they finally insert the IV into one of my wrist veins (ouch again!), they've all given up on the hope of drawing any blood from me. ("That IV is so tenuous at best, that I'm not risking it by trying to draw blood from it first.)

Can you see why I asked for and need the port people? If you absolutely need the blood, wait until the port is inserted and then draw from it.

A port insertion is supposed to be fairly easy and fast, so I mistakenly and somewhat brazenly tell Miriam we'll be out of the hospital by 11. Huh! Not so fast, Trish.

First the whole IV fiasco puts us behind by an hour. Then, Timp. isn't used to doing port insertions so it takes about 90 minutes, instead of the usual 30 or 45. Then, they want to keep me afterward for observation for two hours.

What's the deal? I didn't have any sedation. I was absolutely fine and walked out of the procedure room on my own two legs. I guess the nurses at the front desk were really in shock over seeing me walk out. They'd never had that happen before.

They just want to observe me and ensure that the port site isn't going to bleed because they were unable to draw their labs beforehand. Fine, but will you please pull the stupid IV. It's burning and stinging worse than my neck and chest are. Nope. Hospital policy is to leave it in until you're discharged.

Crud! Another hour and a half of more waiting time just got added to my schedule.

In the meantime, can I get some Ibuprofen or something for pain? The IV in my wrist, another attempted IV site that blew, and my neck are all stinging and burning.

"Oh, we're not used to dispensing medications and don't have any here. We'll have to call the doctor to get approval, then order the medication from the hospital pharmacy next door, and then go pick it up." We might be able to have something to you in about twenty minutes. Lovely! This place sucks for port insertions!

And they don't listen to their patients very well. I told them that AF found it most helpful to have me partially sitting up. That position assists gravity in pulling my chest away from my neck and giving the radiologist the most room to work with (because there's about 1.5" total anyway between my neck and the start of my chest). Also, I'm allergic to tegraderm (those clear plastic bandages that doctors like to cover surgical sites with) and don't need the port for anything else today so don't leave it accessed. AND I have tachycardia (fast heart rate), so don't expect my heart rate to ever be under 100 bpm unless I'm asleep. (The doctor wanted to be called any time my heart rate was over 100--ha!)

They didn't listen or weren't prepared to deal with any of those things, so I suffered through it as best as possible.

Then, when I was being discharged, the papers are obviously the standard for a heart cath. patient. Mine read, "If you were told that you have heart failure today. . ." What the! There's nothing on the papers about keeping the incision site in my neck and chest clean and dry for X number of days or anything related to a port insertion, but now I know what to do if my heart is in failure. Very helpful. . .NOT!

And no prescription for pain pills. What? Let me stuff a 1.5" cubed piece of plastic into your chest and dig a tunnel for the connecting sheath from the plastic to attach to your neck vein and then into your heart with several internal and external sutures and tell me you don't need pain meds. Can I please have just three: one to help me sleep tonight, one for tomorrow because day after is usually a little worse, and one for tomorrow night for sleep? No. We don't do that. You might want to contact your oncologist because she knows you better and can judge that better.

Look! I just walked out of the procedure room by myself, after having no sedation. Clearly, I'm pretty tolerant of pain. If I'm telling you that I want three pills, is that really too much to ask? Apparently, for them, it is.

Luckily, when I checked our medicine cabinet at home, I still had three pills left over from the port insertion that was done just about a year ago.

Poor Miriam. What was supposed to be an easy, 1.5 hour hospital in-and-stay ended up being a 6 hour torture fest. She did hear two of the staff, including the doctor talking in the hallway after the procedure. Apparently, they think I'm the perfect person to have with them if they were ever in a bar fight--because I'm so tough. Hilarious!

Whew! I didn't realize that today was going to be such a fight just to get a port inserted for chemo!