down for the count

Bob hated coming to the clinic.   Despite a strong family history of diabetes and early heart disease, he avoided routine check-ups unless mandated by work or wife.   This day was unusual.   This time he came for a check up on his own recognizance because he had not felt well in months and was totally devoid of energy.

“I’m going to need to draw some blood work, Bob,” knowing this would not go over well.

“I was afraid you’d say that.  You know I really don’t do well with needles.”

“We don’t have any choice this time.”

“I know,” he said, looking down to his lap and taking a deep breath.  “Do what you must.”

“My gal is really good at drawing blood and we’ll have you lay down the whole time.”

The tech came in, and as promised was quick and efficient.  Bob did just fine.

Almost.

           The tech had finished the draw and was labeling the blood vials at the counter.   After a few minutes, Bob sat up, and was joking with me when he suddenly went unresponsive mid-sentence, and limply crashed sideways onto me.

I quickly lowered him onto the table, simultaneously kicking the leg extension out to raise his legs, assuming he was just passing out, like he warned us.  His eyes were open, staring, but still unresponsive.   We raised his legs higher.  Still no response.

Then his eyes rolled back into his head and he went from pale to ashen white.

My mind began to race.  Was this just the vagal reaction I expected, or was this a real code?  Seconds ticked away like loud gongs in my head.  12-13-14-15.   He hadn’t taken a breath, he was unresponsive, and his pulse was imperceptible.  25-26-27-28

I opened the door and shouted, “Get the cart!” which started a flurry of activity in the hall.

            “Should we call 911?” the secretary called out.

            “I’ll let you know.”  I didn’t want to be precipitous – but if it was a code, I knew that seconds did count.  I went with my gut.  45-46-47-48

            “Raise the legs higher!” I told my tech as I broached the 90 degree angle with his left leg in my grasp, now lifting his buttocks slightly from the table as well.  I wanted his head down, but we weren’t in a hospital bed that allowed that.  My tech, obviously scared and getting paler herself, robotically she followed suit with the other leg.  “Come on, come on, Bob come back to me!”  I willed him!

            63-64-65-66 and still no color, response or breathing – I checked his pulse as the code cart arrived and was ready to start as Bob took a giant gasp of air and opened his eyes and looked around, initially with a blank stare.  He looked at the code cart, his legs in the air, my terrified tech and smiled and said, “I told you I didn’t do well with blood draws!”

 No kidding.

           As fate would have it, Bob’s blood work revealed that he had diabetes.  Unfortunately, as a result of his reticence to go for check ups, the diabetes was not detected in the early phase of abnormal sugars.   It had progressed to a point of no return.  He required regular blood draws, daily self-testing of blood sugars, and insulin injections.   Imagine telling Bob after that incident that he was going to have to stick himself with needles!

Overall, Bob did very well.  We drew his next few labs with his legs elevated high, and after a few weeks of having to stick his own finger, his fear of needles diminished and actually went away.  A living example of the exposure to extinction therapy used in psychiatry to treat phobias.

“I don’t like needles,” said Bob the last time I saw him, “but they don’t bother me anymore.”

 Moral of the story, kids, eat your vegetables; men get your check-ups!

For more real nursing stories, check out Nursing Chose Me:  Called to an Art of Compassion.

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