Chapter 3

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Apartment 19G lived behind a flimsy, badly painted door, almost immediately across the hall from the elevator. Frank's radio crackled as he reached to push open the unlocked door: "Three-Five X., Three Two Boy confirms A and O."

Alert and Oriented, Ian thought. Was he more disappointed or more relieved? He followed Frank to the living room, where Three Two Boy had already placed the patient on oxygen and moved her to a stair chair.

The story, gleaned from Three Two Boy and the patient, was that Mrs. Freed, the patient, was a longtime CHFer who had neglected to take her medication. "Did you not have the money for it?" asked Three Two Boy.

Mrs. Freed shook her head. "I just, forgot," she said.

Frank listened to her lungs, and told Ian to start an IV with a saline lock.

As Ian rifled through their bag for the equipment, Three Two Boy pulled a preassembled kit from one of the side pockets. "First day?" she asked.

Ian nodded.

"It gets better."

Ian dumped out the kit, zeroed in on the 18 gauge catheter (it was wrapped in green) and laid out his equipment. He took the patient's left arm, "you mind if I borrow this?" and tied a tourniquet around its, forcing the blood to back up and dilate the veins. While this was happening he tore open an alcohol prep and wiped down the inside corner of the patient's elbow, and donned a pair of gloves.

The plexus of dilating veins appeared. Ian selected a relatively straight one and uncapped his catheter-needle. "You feel a pinch," he said, as, stabilizing the vein with his left thumb, he slipped the needle in -- except that it skipped along the skin's surface.

Bevel up, he reminded himself, during the needle over so that it pointed into the patient’s vein – it fit more naturally in his hand once it was properly positioned -- and trying again.

The tiny popping sensation and the flash of blood in the chamber told that he was in. Lay it down and advance it slightly, he told himself, now slide off the catheter and thread it into the vein. Blood began to well up in the catheter's hub as he withdrew the needle and dropped into the red sharps container. The blood dripped onto the patient's arm, and he remembered that he should have placed gauze to prevent that. So far, he was batting a thousand.

More importantly, he forgot the prep the saline lock. Doing so would take only 15 or 30 seconds, during which the patient would spill blood out through the catheter, because Ian doubted that he could set up the lock with only one hand.

But just as he recognized his error, he realized that he had been delivered from it. Three Two Boy handed him a prepped saline lock, having made it herself as Ian had concentrated on the needle and catheter. He smiled at her, thoroughly relieved, and attached the lock. A transparent occlusive dressing covered the IV site, and strips of tape, which he had remembered to set up beforehand and had left dangling from the top of a nearby table, secured the lock. And there it was: his first IV, albeit with some help.

He balled up his trash, held it in one hand, and inverted his gloves around it, leaving him with bare hands and is trash wrapped in his gloves. He pulled the tourniquet free and shoved it and the unused equipment back into the cardboard tube from which they had come. Frank gave Lasix through Ian’s saline lock and Three Two Boy wheeled the patient to the front door.

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