Nikhil Joshi, M.D.
Doctor, Author, Leader
Nikhil Joshi is a young physician, writer, and speaker. He is passionate about furthering his ability to touch the lives of people positively.

PICC Lines and Superman

PICC Lines and Superman

I want this fucking thing out of my arm.

I’ve had a PICC line in since September. And it’s been actually amazing. My chemotherapy goes through the line and directly into my deep veins and I’m in no discomfort from the actual giving of the chemo. My veins do not burn as a result of this line, even though the decarbazine is often quite painful for many people. My PICC line has a story. I was recently diagnosed and getting ready for chemo, and handling it with some humour mixed with a bit of vulnerability. Our PICC lines are put in by radiologists and radiology residents in Newfoundland. I was scheduled to get it in, and I was preparing. The nurses were wonderful, and I had to wait for a spot opening which was in about 45 minutes. I told them I’d be back but had to step out for a second.

I walked to the ICU. My friend Kory Turpin was there, intubated and ventilated but still looking oh so good. Kory was being treated for testicular cancer, and he was intubated as he had a combination of bleomycin lung toxicity as well as what was assumed to be a lung met. No one tried harder than Kory to bring hope to others. I remember a story Steph told about him, that once he woke up and she told him “I can’t wait till you can dance” and he bopped his head while intubated and sort of danced around. I mean how fucking badass is that? To be weaned off a powerful sedative, hear the woman you love by your side, and then to do the only thing in your power- which is dance? That’s what inspiration is, that’s what strength is, that fucking guy.

I went to see him because I wanted to talk to him, I wanted to know what this was all like, what it was going to be. But what I wanted more than anything was just for him to be awake and well. And that’s not what happened. But I was lucky to meet Steph and his father there. And we talked and laughed as best we could while Superman was sleeping peacefully thanks to a large amount of sedation. That was the last time I got to see Kory. After that, I started getting chemo and was neutropenic and could never go back into the ICU. I just kept thinking about how we as a group of friends and classmates were just getting the fucking shit knocked out of us. I think there were 7 out of our class of 60 who had cancer. Must have been something we drank.

I returned back to the angio suite, when I see the doctor who’s going to put in my PICC line. He’s tall, well dressed, and my close friend. To see Dr. Chris Nicholas there, was one of the great reliefs of my treatment. Chris and I had gone to high school together, we had worked together often. He was the most pleasant radiology resident I had ever dealt with. He never gave me any shit about any scans I wanted. And I in turn would try to delay any non-life threatening tests so that he could get any sleep, but more often than not, some patient needed them. And that never phased Chris. And you don’t know how nice it is, to have to ask another physician for help and to not be given the fucking run around. We’re bad for that, we’re sometimes bad to each other, especially as residents because we’re so overworked. And the last thing you need on a busy call shift is some asshole who doesn’t want to help- doesn’t matter what service they’re on. We all need help from each other at some point- so why be fucking pricks to each other about it? There are actual human beings we’re trying to look after here- we’re supposed to fucking care about them and each other if humanly possible.

Chris asks if I’m okay with him putting in the PICC instead of a staff radiologist. I’d actually insist that he puts it in. We carry on to the fluoroscopy room, where they expose my arm, drape and prep it appropriately, and I get to watch as they place the line in. I’m transfixed by watching the screen, I see how Chris finds the basilic vein, and places the PICC in. It loses some of its magic as the anesthetic burns, but all in all a pretty pleasant experience. It’s bleeding a bit though, so the nurses have to change the dressing again. They do so without complaint, and continue to laugh and joke with me. There’s so much anesthetic in there that I can’t feel anything. I thank everyone and carry on home happily.

45 minutes to an hour later and the anesthetic has now completely worn off and the damn thing hurts like a sonofabitch. I’m tempted to text Chris to tell him that I feel like he drugged me and left me in a bathtub full of ice and minus an arm. In fact I’m pretty sure I do say something to that effect to him. He laughs- what did I think was going to happen? How many central lines have I placed in people’s necks? You think they never woke up in pain? Well they were usually highly sedated and receiving inotropes to save their lives- so yeah they probably didn’t wake up in pain, but they had a lot of other shit going on.

But I digress. I need this fucking thing out of my arm. The line is infected for what is the second time. The first time cleared up with antibiotics. But it’s really red and painful now, which is different from before. But the real reason I want that out is that whole site is inflamed secondary to a folliculitis (an infection of the hair follicles) and the tegaderm and stat lock adhesive which has been on it constantly for the last two months. It’s red and painful and itchy. In fact it’s the itch that’s the worst thing. Well besides how it all looks.

I just want it out of my arm. I’m grateful it was there. I’d love Chris to put another one in, or maybe I’ll try just have an IV and seeing what happens with the dacarbazine. I just want that arm to be free, and clean and not so fucking red and hot and infected. I just want it out. I don’t know why, I don’t care why, I just want this fucking foreign object out of my arm. I used to be so annoyed when patients pulled out IV’s- well you know what? I just don’t want the fucking thing in me anymore. That’s my explanation. That’s all. That’s it. I’ve become the people I hated. But part of becoming them has helped me understand them. I know what it’s like to just not want something, irrationally. Sure the PICC does lots of great things for me, I haven’t been poked for blood work for a long time now because of the PICC. But I just don’t care anymore. I’ll take the pain of the blood work, and the pain of the decarbazine over the itchiness, infection, and general appearance of having the PICC. It’s a constant fucking reminder that I have cancer, this line with two IV ports. I just don’t want it in my arm anymore, I’m done, I’ve had enough of it. I need to start having endings now, I just need to start having endings in this cancer journey. Last blank. Last time I’ll need a CAT scan, last PET scan, last bloodwork, last chemo, last visit to the fucking clinic. Last last last last I want to have my goddamn lasts.

But getting my PICC was the last day I got to see Kory. Maybe I shouldn’t want for any lasts, any more lasts because maybe they all fucking come together as one shitty mixed package.

I realized today as I drove past Atlantica (the restaurant where Kory and I originally met which he had owned with his wonderful family) that I’m not done mourning Kory. And I don’t know why I’m not done with it- I don’t know why I want to keep feeling shitty about it instead of moving on and trying to celebrate his memory. I’m just not ready to move on. And that’s not a good thing, it’s not a loyal thing, it’s not a smart thing, and it’s certainly not what Kory would want. He would want me to do the best I can getting my treatment and to make the best decisions possible- but he would understand that even though I irrationally want this thing out of my arm as it does far more good than bad, I still need it out and he would understand that. He would understand what it’s like to make decisions not based on reason but based on the needs of your heart. And right now my heart is saying I need this fucking thing out and I miss my friend tonight.

Peace and Love

P.S. PICC fell out in the shower.

4 Responses to “PICC Lines and Superman”

  1. Pat Rodgers

    Well Nick my IV at the end of my post partum Pit drip, accidently fell out too. Lol. But I understand the unreasonable desire to pull that bloody thing out. That IV was the source of the Pit that they chose to run overs hours instead of giving me a bolus. I was having contractions that doubled me over after my delivery. WTF.
    We as health care professionals lose sight of our patients- that means us and Kory too- and the pain, anxiety and anguish we go through as human beings and furthermore don’t really care. And the Families. They just interfere with what we as doctors and nurses want to do– have to do.
    My Mother died in ICU when I was in nursing school. I did her pre-op care. She died from Cardiac complications post op. I waited for 3 hrs to see her post op. I went in, she was intubated, ventilated, brown from bridine and still paralyzed. That was the Practise. I was there for 10 min. No one spoke to me except Dr Heughan outside the ICU 3 hrs before. She died in the middle if the night.
    I guess my point is– like you Nick who is a patient of the system, we all need to put ourselves in our patients and families shoes. Patients need our kindness and support and most of all our smile . We have to put Our best foot forward to make our patients feel safe and can trust us.
    One more thing. If a nurse is worried about a patient or wants more pain relief for her/his pt, listen. It could be all of us one of these days.
    Keep on truckin there Dr. Nick! Tell us where we go wrong and help us fix it. Some of us still care and will be your advocate. Tell us when we do right as well. Positive feedback is so important too.
    I love your blogs.
    I did not know your friend Kory but I could see the love for him from others. He had something that made people want to be with him. That’s what life should be. Caring about each other. Not being mean and nasty and jealous! I did get the honor to know Korys fiancée Stephanie. What Stephanie and Kory had was what my parents had. A once in a decade true love for each other, right down to their toes. Stephanie is a beautiful person who will do the Medical Profession proud. Caring has to begin to play some role in Medicine. We care for human beings not objects.
    Bet it felt some good when that PICC accidentally Lol fell out!! You can see why N/G are pulled out.

  2. Aviva Rubin

    Great piece. But maybe I shouldn’t have read it 2 weeks before I get my PICC line put in. I’ll put PICC line post-insertion pain, potential infection, and chance of falling out, on the waiting list for my things to worry about, which is currently quite full. I also have Lymphoma. Stage 4. Marginal Zone. Pretty recently diagnosed. I have been blogging like crazy. It keeps me grounded. Would love if you’d check it out.

  3. Gang Su

    Fight on my friend.

  4. Patrick Furlong

    Two years ago I spent months in the hospital from pancreatitis and a pancreatic pseudocyst. After my arms refused any more IVs, they placed a PICC in my arm. I had that red, itchy, burning sensation as well. The nurses thought it was dry skin, but I learned after it was removed that it was a burn from the antiseptic they were wiping my arm with. It needs to dry completely before the new Statlock and Tegaderm get put on. As bad as it was, this was the only way to feed me, and getting my blood out of it every day became frustrating for all concerned, but it was better than the alternative.

    I’ve loved reading your articles on CBC, and now that I know you have a blog I expect to read regularly.

    Best of luck for a return to health.

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