Veins

Treatment begins with a PICC line insertion and first round chemotherapy and I realise how woefully ill prepared for what I'm about to go through, physically and emotionally.

Photo by insung yoon on Unsplash

Sitting in the chemotherapy waiting room, our heads lift each time we hear the squeak of rubber soles above Radio 2’s Ken Bruce. We perch, waiting, anticipating my name being called out any minute to have a PICC line inserted into my left arm before my first round of chemotherapy. We bat away nerves with ‘Fancy a cup of tea?’ and ‘Are you ok?’, ‘Yep, I’m fine, you?’, not wanting conversation, but silence uncomfortable too. We stare at our phones, and I pick up an out-of-date copy of Hello from a neighbouring chair.  

Ken Bruce’s soft-Scottish burr comes through hidden speakers while nurses, doctors, porters and patients glide and scurry past us. That strange hospital stop-start rhythm, the radio news bulletins meaningless time markers. My name is called by a familiar looking nurse, blue scrubs, glasses hanging round her neck. She guides us along a corridor we’ve only glimpsed briefly before during a tour of the unit, before arriving at the treatment room.

I nodded as she talked me through the process a few days earlier, before asking me to sign on the dotted line, but I wasn’t really listening.

If you asked me, I might be able to tell you that the PICC line will go into my left arm to make giving me my chemotherapy drugs easier as well as taking bloods. But do I realise that means I’ll be visiting this waiting room, this corridor once a week for the PICC line to be ‘flushed’? What does ‘flushing’ even mean, or do?

I don’t have a clue and I pause in the doorway staring at the equipment. Ultrasound and scanner and cardiac monitor, the trolley laid out with instruments.

It’s a simple procedure, I’ve been told. No, not simple but straightforward, for the nurses, at least and I don’t doubt the nurses’ confidence, but lying here, now on the couch, I realise I’ve completely underestimated today. I didn’t know how close this PICC line goes to my heart. How getting it wrong can have catastrophic results and how tricky it is to get right.

Later, when my left arm is resting in the nurse’s hands and she’s talking, and chatting, and chatting and talking I just want her to stop. It’s all kind and well-intentioned, possibly wanting to distract me, or maybe she just likes to chat, but I just want her to find my vein and insert the PICC line so that I can get out of here and find the restaurant and cup of tea.

I try to catch Andy’s eyes but he’s playing vein watch too, eyes flicking from the screen to the probe the nurse is slowly moving and angling up and down my arm. I try to angle my head backwards to see out the windows behind me, to see the sky and transport myself onto the moor with Bella. That’s where I want to be and, in the film, playing inside my mind, that’s where we are. Walking up to White Wells as we would any other Monday morning, a quick look across Ilkley’s rooftops to the north before Rocky Valley gives way to moorland and the top of Cow and Calf Rocks. Up there I’m breathing in deep lungful’s of air and my heart is thumping. There’s a smile on my face, I’m all glowing pink cheeks while Bella zigs zags in and out of the moorland. There’s a permanence to this landscape, and while I can’t honestly say I remember it from my countless childhood visits and holidays, deep down I like to think my body recognises this place.

But I’m not on there, I’m here.

‘One day at a time, Harriet.’ I think, hearing mum’s voice,

I turn my head back to the nurse who’s jabbing my arm, thinking I should concentrate on what she’s doing. She’s still hopeful she’ll find a vein and I turn my head to focus on a tiny white spot on a cupboard. I remember this nurse telling us at my consent appointment that if she had her way, she’d spend her time visiting patients at home. Coming round for a chat, a cup of tea and biscuit while talking through the admin. Filling out the consent forms and the form filling part of cancer from the comfort of an armchair, away from the clinical end of illness, visions of an Irish Gladys from Open all hours come to mind.

‘Ouch!’ I yelp.

She’s touched a nerve sending my arm into unpleasant spasms and there’s a pause before she picks up the search again.

‘Your veins are being a little tricky, but don’t worry.’ Her eyes peer at me above her glasses.

‘I’m fine.’ I’m not but I don’t know how or what to say. I know if this was a friend, I’d be telling them to ask for a pause, to take a moment but it doesn’t occur to me to give myself the same compassion.

I’m not ready to admit now and won’t be for a long time, that this is more than I can cope with. Breast cancer. I’m constantly forcing down swirling anxiety. I know the statistics. I know so many others have been where I am now, and they’ve managed it, including Ginny so I can’t admit defeat now. I haven’t even started treatment.

Nurses shuffle into the room and stand alongside Andy. One breaks ranks and comes closer, her gaze moving from the ultrasound screen to my arm and back again. After a few minutes and a brief exchange she takes control of the probe but despite her radiating the calm competency I’d been craving all morning; she admits defeat too.

‘Time for a break.’ It’s a voice I haven’t heard before and I lift my head. Standing among the line of faces, there’s a tall woman I think I recognise. A good head and shoulders taller than everyone else, she’s not in scrubs and she’s looking right at me. I’m not sure who she is, or how she fits into the line-up, but whoever she is, I thank her.

I’m helped onto my side and up into a sitting position where rubbing my bruised left arm I cry, she nudges Andy’s towards me, ‘Go give her a hug, I think she needs it.’

I’ve failed. I thought I could do this, and I see how desperately I needed this to go smoothly. I needed today to be proof that I could cope with what Miss Murphy had told me lay ahead but I just feel stupid for underestimating what today would entail. For not taking the time to read the leaflets and pamphlets, for not paying attention, not trying to understand what was being asked of me today. Arrogant to think that the past few years, the grief, the loss, the upheaval was preparation for this. I’d been content to not to ask questions, not wanting to know how close the tube goes to my heart. How a wrong move, the wrong vein can lead to disaster. I’d been happy to leave those inconvenient truths unspoken, unknown.

A tissue appears, ‘Please, don’t worry. It can be tricky inserting a PICC line. We could ask radiology if they can do it. They have bigger, more sophisticated equipment. What do you think? I can go and ask if they can fit you in?’ She heads off to negotiate, warning us as she leaves that we might have to wait.

Andy leans next to me while the first nurse quietly loiters by the scanner. My head is down, hands resting in my lap, and we wait.

‘Radiology can fit you in at 3pm.’

‘3pm? Really?’

‘But it’s only 11 now. What do we do til then? We can’t stay here for four hours?’ I know I can’t leave the hospital now. If I go home, I won’t come back, I feel a thread start to unravel and I need to grab hold of it before loosens any further.  

‘And if I can’t have my PICC line inserted until 3, what about chemotherapy? How can I have chemo today if radiology can’t see me til this afternoon. We’ll run out of time, won’t we?’ My brain is turning, thoughts rotating at speed. What about the children? What happens if I can’t have chemo today? Does that mean I have to come back tomorrow, or next week? But I can’t come back tomorrow; I’d need to arrange cover for the children – again.

‘It’ll be fine, don’t worry about the logistics.’

‘But it’s not fine Andy. None of this is fine.’

‘I know, but you focus on you. I’ll sort out the children. The main thing is that we get you sorted.’

‘But how? I don’t want to have to come back tomorrow.’

‘I’ll go back and ask again, see if they can fit you in any earlier.’ Seeing my deteriorating mood, the nurse disappears back down the corridor.

‘Thank you, I just don’t think we can do later or come back tomorrow.’ As I watch her retreating, I hear a faint, ‘I don’t think you’ll be having chemotherapy today.’ from the other end of the room.

‘Sorry?’ I whip round to face the first nurse, ‘Sorry? Did you say I’m not having chemo today? What do you mean?’

I’m confused. The plan was PICC line followed by chemotherapy. It’s not ideal or how it’s usually done, but we’re working around the May bank holidays. There’s a plan and it’s written on my appointment card in black and white.

The anxiety, frustration and anger I’ve been dampening down all morning is partially released and is heading towards the nurse.

‘But we talked about this when we met the other week? I came in on Friday and had my bloods taken so we could do it all today. I haven’t made that up, have I? This is what we planned. PICC line this morning. Chemotherapy this afternoon. It’s written on my appointment card. We’ve been here for ages, why are you only mentioning this now?’ Fat tears drop onto my cheeks.

I don’t like getting cross, and I’m cross that I’m cross, I’m frustrated that tears are flowing, but I realise all I can cope with, is what’s written in the diary today. Not tomorrow. I hadn’t even got as far as this evening. I hadn’t thought any further than finding a parking space in the hospital car park.

What I don’t understand – yet – is that to get through the next nine months I have to surrender control to the NHS. That there’s an invisible contract lying on top of the consent forms and leaflets. A contract no one tells you about that says you’ll turn up for appointments on time but that there are zero guarantees anything will happen when or how you think it might.

‘It’s sorted.’ She’s back with a victorious smile, ‘They’re fitting you in in an hour. It took some persuading, but I explained you were booked in for chemotherapy this afternoon.’

‘So I am having chemotherapy today?’

She looks between us and the other nurse whilst saying ‘Yes, of course. We’ll be ready for you when you get back from radiology. Your blood tests are back, your medication is sorted. I sorted all that out earlier.’

‘But I thought…’ the other nurse starts to say.

‘No, it’s all sorted.’ Turning back to us, ‘Why don’t you go to the restaurant, get a drink and something to eat. Take a bleeper and we’ll message you when it’s time to come back.’

‘Tea?’

‘Yes, and flapjack’. I’m so predictable.

I look around, clocking the navy walls. I’ve always loved navy. Navy clothes, navy and white stripes. Navy accessories and now navy walls. After the anonymous pastel corridors with their unmistakable scent of illness, people and disinfectant, it’s a joy, especially against the spring light coming in through the floor to ceiling windows and smells of cooked breakfast and lunch being prepared.

It feels like we’ve walked into a completely different space, only the odd scrub-wearing person a reminder of where we are, finding a table that hours later will be heaving with people lingering over drinks, others shovelling quick sandwiches down their throats. It feels wrong that two of us are taking up all this space and I picture a wave of doctors, nurses and visitors flooding in any minute, washing us away.

But for now, it’s quiet and the navy walls trigger thoughts of the house we’re trying to buy. I pull up images of the rooms from the online details and the two viewings from my brain. I try to picture the living room freshly painted in navy with our furniture in it, but our furniture has been hidden in storage units for months while we’ve been living in our temporary home, and the images are out of reach.

‘God, that was a nightmare. What was she going on about – me not having chemotherapy.’

Silence.

‘Andy?

‘What?’

‘This morning. A nightmare, she just kept talking and jabbing my arm.’

‘Yeah, I don’t know what she was talking about.’

Pause.

‘Have you seen the navy walls in here? I was just looking at them and wondering if navy would work in the new house.’

‘You’re asking me about paint colours?’ He shrugs and half smiles.

‘True. Have they given us their solicitor’s details yet.’

‘I don’t know. I haven’t checked messages today, but I don’t think so.’

‘What are they playing at? I don’t understand. Do you think they really do want to move?’

It’s not fair on him, but I need clear, definitive answers to my questions. I don’t know why or how I expect him to know the answers, I just need reassurance and he’s my go-to when I have doubts that need extinguishing. His certainty in opposition to my doubt and hesitancy, but not today. We sit in silence, checking our phones, sighing, drinking our tea until the bleeper goes off. I let him lead me to radiotherapy, passing the turning for the chemotherapy unit where a nurse smiling, all warm confidence, is waiting for me.

‘I’ll take you now; we’ll be just round the corner. Why don’t you wait here. We won’t be long.’

‘That’s what the last nurse said,’ he mutters before finding another seat to rest on. She starts explaining what’s about to happen and guides me into a large room while asking me to change into a hospital gown. Despite oversized images of the local landscape projected onto the walls, it still looks scarily like an operating theatre. I take in the equipment and people before disrobing, dumping my t-shirt, vest and bra on a chair, I sense I don’t have time to fold them neatly, and I fumble putting the gown on. Every detail in here, every movement, every quiet word screams efficient control. I pick up unspoken words, ‘Be quick. We weren’t expecting you today.’

The radiology consultant nods a greeting while nurses move in the background and explains what’s going to happen. His efficient delivery might be his natural style, but I can feel his frustration. I’ve gate crashed today’s list. I sense a small turf war between departments, my allegiance naturally with the chemo nurses but his team of nurses are gentle, supportive, suggesting I look the other way as he scans my left arm.

I thought he was still scanning me, but he’s already found a vein and deftly inserted the PICC line. It’s done without faff or fanfare, over in minutes.

It’s pathetic but I start to weep with gratitude, thanking everyone as they gently usher me towards the exit. I feel lighter, there’s almost a spring in my step heading back to Andy, not thinking about what’s coming next.

‘That was quick.’

‘Yep. straight in, scan, found the vein and bingo. PICC line inserted.’ I sink into a chair and tilt my head backwards, breathing more easily than I have done all morning.

‘God, I’m pleased that’s done. Charlie’s picking Saskia up, isn’t he? Does he have a key? Wendy has a spare, so maybe I’ll text him to let him know he can go and pick one up if needs one. I can let him know we’ve been delayed. I think Ollie’s coming straight home too, isn’t he?’

‘Stop worrying. They’ll be fine.’

‘Are you going to go back Ilkley, to check they’re ok. I’ll be fine, maybe wait til I’m hooked up, but once I am I’ll just be sitting there, I won’t be going anywhere.’

‘Maybe. Let’s just see.’

I almost skip into the treatment room when it’s time for my pre-chemo meds and checks. The nurse methodically going through her checklist, before attaching my new PICC line to the drip.

It’s time.

I get up off the chair and start the hospital drip shuffle, across the corridor into the chemo lounge and stop. What’s the etiquette? Do I wait to be seated? Do I choose a seat I like the look of?

A few shuffled steps into a beige room to be greeted by a few pale-faced patients dozing, reading, staring into the middle distance. What an anti-climax. Where’s the clap of thunder, Carmen Burana blasting from the speakers? Frankly, I feel disappointed. I get Steve Wright on Radio 2 and a whiff of disinfectant that’s partially masks the smell of a room starved of fresh air at the end of a busy day. Sick humans and leftover food.

The nurse carries my bag for life and chooses a recliner with its back to the window. I like being able to see the whole room and, in the months, to come when there aren’t enough chairs full-stop, recliners a rare commodity, partners and friends banished to the restaurant and nurses have to squeeze past drips, and tip toe around feet and chair legs, I’ll look back on the calm quiet of that Monday afternoon with a strange longing, but not now.

Another nurse in blue scrubs wheels a stool over and sits down next to me. She’s tucked in close, I can almost feel her breath as she balances an A4 folder on her lap, trying not to knock my drip, as she checks my notes, the drugs, a huge syringe, the drip and me.

‘I have to hand pump Epirubicin into you, so I’ll sit here with you for this first bit. Has anyone told you about Epirubicin?’

I furrow my brow, not liking to admit that I don’t know, but it’s clear I don’t.

‘Well, I don’t want you to be shocked when you go to the toilet later.’ She smiles and showing me the bag of Ribena pink liquid.

‘Shall I leave you to it?’ Andy’s perching next to me. ‘If I head off now, I’ll have time to check on the kids and be back by the time you’ve finished.’

‘Oh, are you going home.’

‘Yes, I thoughts that what…’

‘Yes, yes. Sorry, I couldn’t remember what we agreed but yes, that makes sense.’ A wholly predictable wave of tiredness washes over me. I have no words and as Andy leaves, I reach into my bag, feeling for my headphones. Putting them on feels like a huge, rude ‘Do Not Disturb sign’ as the nurse is still sinking drugs into me, but I’ve hit a point where I don’t want to, can’t explain myself.

‘Shall I recline the chair for you?’ I nod and hear a ‘pfft’ as the mechanism slowly tilts me backwards.

‘Can I get you anything? Tea? Juice, water? Have you eaten? We might have a cup of soup still if you want that?’ A volunteer has wandered over and, on my smile, places a mug of American-tan Yorkshire tea on the table next to me. I close my eyes and zone out.

My drip beeps, alarms go off but it’s another half an hour before it’s time for the second drug, Cyclophosphamide. The nurse is back and deftly sorts out my drip and starts its automatic release. I’m left alone as it seeps into my veins.

I push my lower back into the chair, scrunch my toes, flex my ankles and feel this colourless drug spread through my body. There’s a gentle fizz moving from my legs, through my pelvis and up towards my chest. A warmth that builds in heat and intensity as it moves through me. Pressure builds in my head and my cheeks redden. I keep my eyes closed and focus on breathing through it as nausea catches the back of my throat. I drift off into a not-quite sleep.

How did I end up here? I can’t process it.

When Andy arrives back, I’m almost the last person sitting.

‘You must call us if you’re worried about anything. Do you have a thermometer at home? We’d rather you call to check with us than sit at home worrying.’

I nod and say thanks, but I just want to go home, even to my not-home. We’ve been here eight-hours. I roll my left sleeve down over the bandage covering my PICC line and we walk out, holding an appointment card for my first PICC line flush the following Monday, my drugs and a large clear plastic tube to keep my arm dry in the shower.

The corridors are quiet, the shutters are down on the reception desk. Empty chairs in the out-patients area. A quiet hospital is eerie, unsettling.

I feel eyes on me as we eat, or they eat.

‘Why were you so long?’

‘We had to go to Wendy’s to get a key.’

‘You don’t look any different.’

‘Well no. My PICC line is covered with a bandage.’ I start to roll up my sleeve to show the bandage.

‘Ugh, don’t. I don’t want to know.’ They wince and pull faces.

‘When will your hair fall out?’

‘I don’t know. Not today.’

‘Will you definitely lose your hair.’

‘I don’t know for sure, but I think so.’

‘At last, I won’t be the only bald one in the family.’

Forks hover mid-air and we ignore the dad joke.

‘But how are you all? How were your days, tell me about school.’

I flag as they chat, waves of fatigue and nausea increasing in frequency and intensity. I focus on sitting upright and listening, but their words wash over me.

‘I’m sorry. I need to go and lie down. I’m not sure I’ll be able to sleep, I just need to lie down so pop in and say hi, but please don’t leave all of this for dad to tidy up.’ 

Lying down doesn’t feel right either and I’m not ready for sleep, so I prop myself up with pillows and cushions. I’ve emptied my leaflet-filled plastic wallet on the duvet, only now reading the pamphlets explaining what happened today.

I shuffle down the bed until I’m lying and feel nausea travelling up to my throat. I don’t think I’m going to be sick but still I roll onto my right, then my left, and my back trying to find a position that lessens the taste of bile. I settle on my left, feeling my stomach drop and I stare at the white-painted slatted wardrobe doors. The chemo buzz I felt in the recliner earlier that afternoon returns, and I feel heat rising up my body while pressure builds in my head, and I cry.

Big fat soggy, snotty tears.

I just want mum. Tucked up in the foetal position, it hits me. No mum, no dad. Not my own home and hundreds of miles from my family. I cry angry tears and don’t hear the door open, or Andy come in, but I feel him sitting next to me, an arm that first rests on my side, and then gently rubs my back.