It turns out it was nothing to do with my cack-handed needling after all. My fistula, my trusty bulging buddy for the last five years and counting, is on his last legs. Not his fault, the poor little guy; he is exhausted, and adding an extra two dialysis sessions to his weekly schedule didn't help. Yet he has chosen to collapse at the worst possible time: I am a week into my internship, and working on the most important opportunity of my career to date.
Here comes the technical stuff...
After Friday's abortive session, my fistula didn't work on Saturday either, so after an hour of good, solid crying on Ellie, I pottered off to the hospital unit, certain that the nurses could do what I hadn't managed and get a needle into the upper of my two insertion sites. The senior matron rammed one in, but no blood came out; when she started frowning and shaking her head I knew something was wrong.
I managed to start a one-needle dialysis session, but it offers a very mediocre standard of treatment and would have done little to combat the tomatoes and Galaxy I had been ingesting in large quantities over the past two weeks. I was very proud of my little bottom needle - it was The Little Needle That Could; that needle is a game-day player. Four hours later, I went home to watch Celebrity Family Fortunes and eulogise my Saturday night plans.
This morning, I was back at the hospital, this time in the Rapid Access Assessment unit for a hot date with a surgeon. Mr F is a twinkly, grandfather-y surgeon - the type that bothers to ask, "Am I hurting you?" whilst contorting my arm into anatomically incorrect positions. He listened to my fistula, then fiddled with it for a while before confirming what I had already deduced: though the lower part of my fistula is limping on, there is a blockage or a narrowing as it travels up towards my shoulder.
"Fistulas have a relatively short shelf life; you've done very well to make it last this long." I beamed with pride, before remembering I had absolutely nothing to do with this shot of blind luck. We ended our meeting having devised a three-step plan because, essentially, my fistula is fucked. Or it will be, definitively, in a few months time; every step we take from now on is merely palliative.
Step 1
I am going back to the hospital tonight for another one-needle dialysis session; it will be long and arduous, but the alternative was having a temporary dialysis line placed into my groin, and I need my groin for...other stuff. Tomorrow I shall be having a fistulagram: a surgeon will insert a catheter and inflate a small balloon when he spots the narrowing; this should stretch the fistula and let blood pour forth once again. This may or may not work, but assuming it does (and the Valium I shall be insisting on before they ram a catheter up my arm has worn off) there is no reason why I can't be back in the office on Wednesday and dialysing on my bed later that day. If it doesn't work, we go to...
Step 2
Surgery. Mr F will take one bit of my fistula, put in some more plastic tubing, and attach it to another bit, presumably whilst singing
The bottom bit's connected to/
this bit/
and this bit's connected to my/
wristwatch...
His intention will be to bypass the narrow bits and buy me a couple more months worth of use. This may or may not work, and if it doesn't, we go to...
Step 3
A new fistula. This will be problematic, as I don't have many more suitable veins remaining in my left arm which will mean creating the new fistula in my right and seeing as I can't even brush my teeth left-handed I don't fancy my chances of accurately inserting two needles. But Mr F seemed to think there was a viable vein on the inside of my bicep; when he started describing how the vein would need to be plucked from inside my arm and yanked across I did a little bit of sick in my mouth and stopped listening. Having a new fistula created will be a fairly major undertaking and one that will require me to have another, albeit temporary, neckline - and boy do I just love those things. I need to have as much sex as I possibly can before they put one in, because I absolutely will not be getting laid with a neckline hanging out my chest.
I don't really care about the "what"; so my fistula is failing - it is simply another facet to dialysis and one that comes to us all in the end (those of us sans kidneys, that is). I only care about the "when". I cannot believe the universe has been so cruel as to let my fistula fail the very week I start the most interesting, exciting and potentially useful three months of my working life so far. Kidney failure has destroyed every job I have had since I graduated and now seems intent on ruining my internship too. I look unreliable to my colleagues, and I am letting them down; I have been charged with organising a pivotal event for Trekstock and after four days I am already having to take time off. I have worked indecently hard to avoid ever uttering the phrase, "It's not fair..." because my condition isn't unfair - losing your legs in car accident, or all your money in an investment scam...these things are unfair. But I am really struggling to make my peace with the fact this has happened now. I am also dialysing at the hospital once again, a mere three months after making it home, and just a week away from starting nocturnal sessions...the timing is almost comical.
With luck, tomorrow's procedure will prove effective and I shall be able to make it to the end of my internship without further incident; the alternative is too upsetting to contemplate. Come on fistula, just a little bit more. Please.
***
I also want to say thank you. On this occasion, special thanks go to Fiona, Ellie, Steph, Heidi, Rachel M, Amelie, Henry, Coralie, Anthony, Hannah, Benj, Sam and Greg Colette. But I also want to thank each and every one of you who read this blog and offer up your unequivocal care, concern and support, without which, I wouldn't be able to breathe.
Here comes the technical stuff...
After Friday's abortive session, my fistula didn't work on Saturday either, so after an hour of good, solid crying on Ellie, I pottered off to the hospital unit, certain that the nurses could do what I hadn't managed and get a needle into the upper of my two insertion sites. The senior matron rammed one in, but no blood came out; when she started frowning and shaking her head I knew something was wrong.
I managed to start a one-needle dialysis session, but it offers a very mediocre standard of treatment and would have done little to combat the tomatoes and Galaxy I had been ingesting in large quantities over the past two weeks. I was very proud of my little bottom needle - it was The Little Needle That Could; that needle is a game-day player. Four hours later, I went home to watch Celebrity Family Fortunes and eulogise my Saturday night plans.
This morning, I was back at the hospital, this time in the Rapid Access Assessment unit for a hot date with a surgeon. Mr F is a twinkly, grandfather-y surgeon - the type that bothers to ask, "Am I hurting you?" whilst contorting my arm into anatomically incorrect positions. He listened to my fistula, then fiddled with it for a while before confirming what I had already deduced: though the lower part of my fistula is limping on, there is a blockage or a narrowing as it travels up towards my shoulder.
"Fistulas have a relatively short shelf life; you've done very well to make it last this long." I beamed with pride, before remembering I had absolutely nothing to do with this shot of blind luck. We ended our meeting having devised a three-step plan because, essentially, my fistula is fucked. Or it will be, definitively, in a few months time; every step we take from now on is merely palliative.
Step 1
I am going back to the hospital tonight for another one-needle dialysis session; it will be long and arduous, but the alternative was having a temporary dialysis line placed into my groin, and I need my groin for...other stuff. Tomorrow I shall be having a fistulagram: a surgeon will insert a catheter and inflate a small balloon when he spots the narrowing; this should stretch the fistula and let blood pour forth once again. This may or may not work, but assuming it does (and the Valium I shall be insisting on before they ram a catheter up my arm has worn off) there is no reason why I can't be back in the office on Wednesday and dialysing on my bed later that day. If it doesn't work, we go to...
Step 2
Surgery. Mr F will take one bit of my fistula, put in some more plastic tubing, and attach it to another bit, presumably whilst singing
The bottom bit's connected to/
this bit/
and this bit's connected to my/
wristwatch...
His intention will be to bypass the narrow bits and buy me a couple more months worth of use. This may or may not work, and if it doesn't, we go to...
Step 3
A new fistula. This will be problematic, as I don't have many more suitable veins remaining in my left arm which will mean creating the new fistula in my right and seeing as I can't even brush my teeth left-handed I don't fancy my chances of accurately inserting two needles. But Mr F seemed to think there was a viable vein on the inside of my bicep; when he started describing how the vein would need to be plucked from inside my arm and yanked across I did a little bit of sick in my mouth and stopped listening. Having a new fistula created will be a fairly major undertaking and one that will require me to have another, albeit temporary, neckline - and boy do I just love those things. I need to have as much sex as I possibly can before they put one in, because I absolutely will not be getting laid with a neckline hanging out my chest.
 |
| My poor, incredibly hideous fistula... |
With luck, tomorrow's procedure will prove effective and I shall be able to make it to the end of my internship without further incident; the alternative is too upsetting to contemplate. Come on fistula, just a little bit more. Please.
***
I also want to say thank you. On this occasion, special thanks go to Fiona, Ellie, Steph, Heidi, Rachel M, Amelie, Henry, Coralie, Anthony, Hannah, Benj, Sam and Greg Colette. But I also want to thank each and every one of you who read this blog and offer up your unequivocal care, concern and support, without which, I wouldn't be able to breathe.
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