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JAN 29, 2006
TPN: TORTUROUS
PESKY
NUISANCE
“You might want to look away; it’s kind of gross,” said the nurse.
When such words are uttered by someone in the medical profession, I
tend to comply.
I squeezed my eyes shut with such force that I almost expected my
eyelids to fuse together, and suppressed a scream. It would have
been, had it escaped from my lips, the hyper, terrified squeal of a
young child faced, suddenly, with his or her worst fear, a
high-pitched, urgent appeal to make
it go away or I might die right now!
“Eeeeee!”
But I managed to keep the yelp of horror from escaping, and after a
brief, odd sensation coursed through my arm, the nurse said, with a
smirk, “It’s over now. You can open your eyes.”
In her hand was a piece of limp plastic tubing that she had just pulled
from my body. It was incredibly skinny and shockingly long, like
the world’s lengthiest strand of vermicelli. After the few
moments it took me to get over the initial shock of the size of this
thing that had been inside of me for three months, I repositioned my
jaw, made sure my heart was beating again, and breathed the most
profound sigh of relief I have ever experienced.
The tube was gone. I was wireless, cordless, 100 percent human,
zero percent robot. Free at last, free at last.
When prisoners go on hunger strikes, I’ve heard, they are sometimes
given nutrition by force, intravenously. A solution very much
like extra-strength Gatorade is put into the drip; the liquid is called
Total Parenteral Nutrition, a.k.a. TPN. It’s powerful stuff, and
while it may prevent the public relations disaster of inmates dying,
those who are not convicts but must receive TPN regularly can feel like
they’re prisoners.
TPN gives you calories when you desperately need them, when your colon
cannot handle the massive amounts of food that would be necessary to
add bulk and nutrients to a body in decline.
It’s also, however, a tremendous nuisance, even when you aren’t hooked
up to the IV.
First and foremost, there’s this piece of blue spaghetti dangling out
of your arm (the internal end of which is somewhere near your
heart). Let’s say it’s summer, which it was when I served as host
for this mostly non-parasitic parasite, and you live in Minnesota,
which I do. In Minnesota, it gets hot and humid in the
summer. The natural human desire, therefore, is to wear
short-sleeved shirts. This is particularly true if you are an
individual who sweat glands have a little party and go wild when the
temperature goes above 85 degrees or so. Short-sleeved shirts are
practical.
But not if you have an IV drooping from your arm, a flaccid piece of
plastic that waves languorously to passersby.
“Hello,” it says. “This person is sick. He is part
robot. He cannot eat for himself.”
Or: “I had a horrible knitting accident with a really sharp needle and
a piece of thin blue yarn . . . but I haven’t noticed it yet.”
Or: “Pull this cord and I say one of three humorous phrases!”
It says none of these things in real life, of course, but only because
you silence it with a cotton band. Said cotton band will be
“flesh” colored, and labeled as such, in that really offensive way that
assumes that everyone’s skin is sort of a peach tone, a hue that is
found on perhaps one individual on earth. You coil the tubing and
push it snugly under the elasticized band, where no one will ever see
it except for the people who look at you for more than half a
second. These savvy folks will, if you are wearing a
short-sleeved shirt, easily spot the bandage-like thing wrapped tightly
around your upper — but not “upper” enough — arm. They will
stare, and then they will see the outlines of something beneath the
band.
The band prevents the tube from dangling, which is good – no one wants
to be on the bus when it rounds a tight corner, everything slides
suddenly to the right, and “Whoops, sorry, ma’am, I seem to have caught
my IV line on your purse. . . .”
But it doesn’t really hide anything, because it is thin and tight and,
well, there’s a lot of line under there, an amount not too easily
obscured. The band is basically a wink woven in cotton, a
not-so-sly way of saying, “There’s something under here, but not really.” It certainly
takes up enough real estate, at least if you have, as I do, arms that
are relatively small in both the length and circumference
departments.
Each night, for three long months, I had to connect this albatross —
er, IV line — to a bag of supercharged, nutrient-rich salt water, the
TPN. This was a relatively simple and painless process. And
then there was the pump, a oversized PDA-like device with a small
computer screen, a hodgepodge of buttons, and a couple of clamps by
which you connected the IV tube to the actual pumping mechanism.
A nurse came to my house to demonstrate how to use the pump and to
present me with an alarming pamphlet detailing what to do in worst case
scenario sorts of events. The headlines were frightening,
the line drawings worse. What To Do If The Line Breaks Inside
Your Body. Um, panic? Scream? No, lie on your side,
remain calm, call 911. (Isn’t this what you’re supposed to do for
rather a lot of major medical crises? I seem to recall these
three steps appearing a lot in my CPR textbook in 10th grade health
class.) The last part, calling 911, sort of goes without saying,
I’d think.
Trust me, if I ever feel a snapping sensation inside my chest, I’m not
going to order a pizza or finish watching my phone conversation with a
friend. (“Well, I should be going, I guess. I felt a horrible pop
in my chest about half an hour ago. . . .”) I may not be a
complete hypochondriac, but I like to think that I’d notice it if a
plastic tube broke while inside by body, and that I’d be more than a
bit concerned by this occurrence.
After assuring that I would spend the next three months of my life in a
state of heightened paranoia and awareness regarding any remotely odd
or painful feelings in my arm or chest, the nurse calmly moved on to
the operation of the pump. The crucial step, it turned out,
involved closing the clamp by turning a particular dial with the help
of . . . a penny. You had to find a small coin — other ones would
work, I discovered, and it even took Canadian currency — and thrust it
into the slot, push down, and turn. I looked through the
informational pamphlet, certain that it would mention some special
tool, or an alternate method, that would be the real way to turn the
dial. Nope. Use a penny.
So. You mix the Gatorade, you hook it up to the pump, you get out
your coin of choice and get the pump all set up, you prime the pump,
you uncurl your line from its super-secret hiding spot, you swab the
end with an alcohol wipe, you hook everything up so that the
elixir-o-life will flow into your body, and you press “on.” In my
case, it was set up to drip slowly, over the course of 10
hours.
At some point, someone suggested that I could administer the TPN during
the day, while I worked. Right. I can think of about a thousand
different reasons why this is a very, very bad idea, ranging from
genuine safety concerns to the fact that it would be dangerously
awkward. Also, I don’t think an IV bag would be considered an
appropriate “business casual” accessory, even by the loosest
interpretation of that rather meaningless term. No, no, no.
Far better to do it at night, even if the pump would emit a contented whirwhirwhir every couple of
minutes, so that each night, just as I was about to drift off to — whirwhirwhir. I would
silently curse the dratted machine, then lose myself in various
thoughts and start to get drowsy and feel my mind finally, finally
shutting down, and then whirwhirwhir.
As mentioned, I was paranoid. I worried about riding the
bus. I worried about moving at a speed faster than a brisk
walk. I worried about people slapping my back, shaking my hand
too vigorously, or handing me large parcels to carry. I wasn’t
supposed to lift anything heavier than 10 pounds, or play contact
sports, or do anything that might cause undue strain on the area
spanned by the line, which ran from my arm to the heart, or at least
very close to that crucial organ. And so, of course, I wanted
nothing more than to play soccer or ultimate frisbee, to go to the gym,
to help little old ladies carry massive bags of kitty litter to the
checkout at the grocery store.
After I finally bulked up — thanks to the TPN and the Revolutionary™ New
Milkshake and Doughnut Diet — and the line came out, I noticed that
the
way I carried myself, the way I move, suddenly changed. Without
even realizing it, I had been restricting the movement of my right
arm. When I walked, it barely swung; in conversation, my gestures
were a one-handed affair; when I was seated and not typing, I hugged my
bicep to my chest, protecting the line from whatever evils might be
lurking.
The final plucking of the line was an event I’d been looking forward to
since, well, the day it went in. Having it removed would be a signal
that I was on my way back to the Land of the Healthy. It would
erase the paranoia, the coiling miasma of fear, that had haunted me
every minute of every day. Though I dreaded the horrible sight of
the too-many-inches of plastic removed from my body, and the sensation
of it tickling my veins as it passed through on its way out, I knew
that once this tiny, lightweight foreign object was gone, a tremendous
burden would be lifted.
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