Drawing Blood

Laura Johnsrude

I spent a lot of time thinking about blood during my training years—hoping I could get enough of it, wondering which vein would yield the best supply of it, wishing the patients had more of it, calling the blood bank for a bag of it. I cushioned samples of it in my sweaty palm, palpated arteries for the pulse of it, auscultated hearts for the beat of it.

In medical school in the mid-eighties, I learned to draw blood during my third and fourth years. No need to know during the first two years, since our anatomy cadavers had been relieved of their 1.5 gallons, and their veins and arteries washed clean. The books, of course, were bloodless.

Not until our later clinical years did we touch live people, ones with actual blood pulsing through their bodies—arterial, bright cherry-red; and venous, deep purple like a plum. All their vessels flushed with blood, full of oxygen and immune-fighting cells, delivering medicine and keeping fingers and toes warm. Vessels with volume enough to hold us upright and keep our kidneys perfused so we aren’t poisoned by our own waste. Blood traveling so far north that we are able to compute the numbers on our grocery receipt. All humming along, silently, until something goes wrong—a clot forms to block the path; or a vessel balloons and then ruptures; or a wound diverts the flow; or the bone marrow forgets how to crank out normal cells.

Faced with the urgency of acutely ill children during my first year of pediatric residency, I prayed for the “hallelujah moment” when that surge of blood appeared. Such a relief. I learned how to stick a scalp vein on the soft head of a newborn or an ankle vein in a chubby, wriggling six-month-old. With my bare finger, I’d find the best juicy tributary held in place by connective tissue so that it only rolled a millimeter back and forth under my touch.

My heartbeat quickened. I held my breath, biting the side of my lower lip, while I inserted the needle and, oh, the joy, when I saw the instant flashback of red.

The difficult part was before the needlestick, looking into the mother’s exhausted face while describing how I would be inserting a catheter and covering it with a Styrofoam cup cut in half, taping it to the scalp. Sometimes we had to shave a bit of hair. The mother’s eyes always widened with horror and disbelief. “She’ll be fine,” I always said, firmly but kindly, conveying, “We have to do this,” before I started tearing the tape and sticking it to the side of the crib. I laser-focused on my chosen spot with the soundtrack of a crying baby coughing and hiccuping. I listened to every breath the child was taking. A vigorous, wailing sick baby was good. A limp, silent sick baby was bad.

Children with cancers and tumors and blood disorders were housed on 4-West. They suffered through the rigors of chemotherapy and transfusions and all the side effects of cell death—hair loss, unrelenting nausea, diarrhea of water, mucous, and blood. I say, “housed,” because many of the patients lived there for an extended time. Resident physicians would rotate out to other floors and then, a few months later, rotate back to 4-West on a call night and find some of the same patients—sometimes improved, often not.

One of my patients on 4-West—I’ll call her Lily—was a pale elementary-aged girl with Down syndrome and aplastic anemia. She was going through the one-way-out tunnel of bone marrow transplantation because her body was no longer making new red blood cells on its own. A couple of times a day, I’d enter the antechamber, scrub my arms and hands, and don gown, gloves, and mask before entering the pseudo-sterile environment to examine Lily, who had big eager eyes, silvery curly hair, and pudgy freckled arms.

I was there to watch for early signs of a bad outcome—to feel her skin for clamminess, to scan for mottling, to calculate her input versus her output in case of mismatch, to spot the breathlessness before she crumpled. I exchanged squeaky toys for a glance at her chest wall, watching the rise and fall between her ribs. I laughed at her silly songs in exchange for a peek at her toes, pinching them to see how fast the red blush returned. I coaxed her onto her side to check for bedsores, promising to come back later, to visit again soon.

She must have thought she was in a jail cell and that no one wanted to play with her, our visits being so short and dry and complicated by barriers, material and not. Over a few weeks, Lily withered into a pale poppet, huddled under the sheets and transformed from a lively girl to an indifferent one who wanted to be left alone, no longer expecting any games. Over and over, we’d take tubes of Lily’s anemic blood from her and, ultimately, give her new blood to pink her skin, plump her vessels, prop her up.

I never saw Lily again after my month rotation on her floor but her face remains with me, its expression of confusion and disappointment, like she’d been fooled into staying behind that door. My still-photo memory is of viewing her through the window from the anteroom, alone on her rumbled hospital bed, looking expectantly to see who was coming inside. To me, Lily is forever waiting.

My clearest memory of drawing blood happened on a call night during my second year of residency when I was paged to 3-East to get labs on a young boy who I’ll call Marcus. Marcus had hemophilia. He was at risk of prolonged bleeding with injuries and so received regular transfusions of clotting factors derived from the blood samples of many human donors.

The wards were V-shaped, with nursing stations at the crux, and Marcus’s room was the first on the right. The nurses had already tried to draw Marcus’s blood and had failed. When I entered Marcus’s room, I was likely the third or fourth person who had poked him. Since he was in isolation, I wore a gown and mask that felt bulky and hot.

Marcus sat up when I opened the door, alone and clearly awaiting me, his thin legs tucked under him, like he was nesting. His thick, curly, dark hair and big brown eyes were doll-like, even though he was probably ten years old, and his skin was smooth and unlined. He wore a thin cotton gown with white piping and ties.

I set up my venipuncture kit, pulled on gloves, and started searching for a good vein.

“Here,” he said, pointing out the vein on the back of his hand that he thought would yield results.

He took a sterile four-by-four from my kit and held it in his free hand over my target, while I cleaned the skin and prepared to try.

Marcus’s face contorted, as did mine, as we concentrated and hoped for red gold. The vein was much harder to feel through the gloves. But Marcus encouraged me in a sweet, small voice I’ll never forget, and he promised me that when I took the needle out he’d wipe the spot really quickly so his blood wouldn’t touch me. He wanted me to understand his plan and he held the white square of cotton just above my work area and froze in place, stoic and calm.

Marcus’s room held a golden glow. It must’ve been the way the sun poured through the windows in the early morning or late afternoon. Maybe the walls were yellow or the light bounced off my yellow protective gown. I’m not sure. But whenever I remember being in that room, I see an ethereal light filling the space, as though refracted through stained glass, and I remember the small boy, bowing, offering up his tithe.

Maybe an angel was helping, but I got the stick, despite my gloves, and the blood flowed, pomegranate red, snaking its way past the butterfly wings of the needle, along the flexible curves of the tubing, and filling my syringe with a sanguine pool. Marcus swiftly wiped away the wayward drips on his arm.

But there was no joy to be had with the accomplishment. It did not matter that I was a good stick and could come by, once a day, and draw a bead of blood for testing, because—along with the transfusions of clotting factor that Marcus had been getting—a new, monstrous virus had tagged along and Marcus had AIDS.

I don’t remember Marcus’s real name, or Lily’s real name, and, for that, I am grateful. A few names do haunt me and I avoided them when choosing baby names for my own children. But, the names are unnecessary. All these years later, I still can conjure both the tender and the terrifying—the crusted ulcers, bloated bellies, crowing stridor, creeping purpura, and the gurgling of a baby drowning on his own secretions.

And I can still remember leaving Marcus’s room feeling small and inadequate, heading off down the hall thinking about the red stuff—thankful for the gush of it, wary of the risk of it, careful not to touch it—walking away from the boy on the bed, his blood in my hands.