Scared Of Healing

The PICC

Paul and Crystal walk into the room, ready to move Ellie down to theatres. Crystal starts unhooking Ellie from her monitors, getting her ready for transport as Luke starts asking her questions. Luke has done the first information check before we walk behind the bed as Paul pushes it. Ellie is completely silent all the way to theatres until we get to the waiting bay and the anaesthetist comes to do the second information check. She asks all the same questions that Luke asked while we were still in Ellie's room, receiving all the same answers before Crystal and Paul go back upstairs.

After a few minutes, an intern walks in to grab Luke. "Ok angel, I'm gonna go get ready now, I'll see you in a bit" he says before leaving the room to scrub in. The bay then goes back to silence as Ellie waits anxiously. "Ellie..." I start, breaking the silence. My patient looks up to me, allowing me to continue, "do you want me to come in with you?" I ask. She just nods silently, smiling weakly and I nod back.

The intern soon comes back out and we are directed back to the theatre. Ellie seems completely unphased by all the lights and the amount of people in the room, all the things that would usually make a young patient nervous, but I can tell she is worried about complications. We move Ellie's bed next to the operating table and slowly move her onto it, pausing to let her stabilise as she becomes dizzy. We then get her to lay back down and are able to start connecting her to monitors. The intern comes over and starts to introduce herself, "hiya beautiful, my name is Alyssa, I'm just gonna stick a few stickies to your chest so we can keep an eye on that heart of yours, is that alright?" she asks, Ellie nods slowly, allowing Alyssa to attach the electrodes for the continuous monitoring. Once she has finished that, she moves on to the next part, "ok possum, next is just this little clip on your finger" she says, showing Ellie the monitor. Ellie just holds out her index finger, allowing Alyssa to gently place the clip on it.

Luke enters the theatre, immediately taking Ellie's attention. "Hey angel, are you feeling ok?" he asks, walking up to his patient. Ellie just nods, "ok, and just double checking that you've had a PICC line in awake before?" he questions. Ellie nods again, "alright then sweetheart, are you ok if we get started?" he asks, walking around to Ellie's side. Ellie just nods again, "I'm going to have to touch your arm a bit angel, can you be calm when I do?" he checks. Ellie closes her eyes for a second and lets out a slow deep breath through her lips, "I trust you" she whispers. I see a smile tug at Luke's lips behind his mask as he gently takes Ellie's arm in his gloved hands and places it out so he can access it. He takes a seat on his stool and starts looking at her arm.

"Can I have the tourniquet put on please Alyssa?" Luke mumbles, knowing that it is out of his sterile field. Alyssa quickly tightens the tourniquet around Ellie's arm, helping Luke find viable veins. "Alright angel, what I'm gonna do now is just use my ultrasound so I can see which vein to use" he informs Ellie, who just nods silently again. "Are you alright sunshine?" I ask, knowing that she likes knowing what is going on and is probably unhappy about not being able to see her arm. I just receive another nod and decide to save my distraction techniques for the bad parts.

I watch as Luke presses the probe to Ellie's arm as he stares intently at the monitor showing the veins. Ellie sighs in relief as she realises that the monitor is in her view and she stares at it as well, seeming like she knows what she is looking at. "Ok angel, I'm gonna clean off your arm now, you're doing really well" Luke says, standing before wiping the orange sterilising solution over the inside of her upper arm. Luke sits back down and I then see the anaesthetist walking over to Luke with the needle full of local anaesthetic and I know this is going to be the difficult part. These injections are genuinely very painful and it isn't quick to administer. I find that most patients end up visibly uncomfortable, especially kids. Luke takes the needle, "Ellie, I want to numb your arm now, you're gonna feel this but I need you to stay super still for me" he warns. Ellie takes my hand, knowing what's coming, leading me to sit on a stool next to her and start my distraction techniques.

I start telling some of the most awful dad jokes, leading to some very harsh insults from Luke and some of the other staff in the room, making Ellie smile. "Alright angel, little pinch as the needle goes in..." Luke warns. The smile quickly vanishes from Ellie's face. "Here comes the sting sweetheart, take some really nice deep breaths for me" he says as he starts the injection. I continue with my jokes, keeping Ellie's eyes on me and squeezing her hand comfortingly as Luke keeps slowly injecting the anaesthetic. Suddenly, an amazing joke hits me... "hey Luke..." I say, "mmhm" he mumbles, briefly glancing up to me, "if you steal someone's heart, do you get cardiac arrested?" I ask, trying to stifle my own laughter. Luke just scoffs, shaking his head, "I'm so sorry this is the best distraction we've got for you at the moment Ellie" he laughs, making Ellie smile. Luke quickly looks up to me again, "look at him, he's so proud of himself" he laughs, making fun of the smile behind my mask. Ellie's demeanour then changes as she takes a deep, shaky breath and I know she is still very uncomfortable. "Good girl Ellie, you're being really good" Luke says softly, trying to calm her slightly as I soothingly rub my thumb over her knuckles. Ellie is being so good. It's obvious that she's in pain, but she is staying completely still and hasn't made one complaint, she is just trying to focus on me as she waits for it to be over.

After about a minute, Luke disposes of the needle, "ok angel, that's the worst part done" he says happily, leading Ellie to let out a sigh of relief. "You just keep listening to Mikey attempt to be funny, and I'll try to get this done as quick as I can for you" he continues. Ellie just looks back to me with an eyebrow raised, and I continue "attempting" jokes. Luke keeps going with the ultrasound, triple checking his selected vein. Once he is sure of his plan, he pipes up again, "alright Ellie, just a bit of pressure here, let me know if it gets too much or if it hurts" he says, waiting for a nod from her. Once he has received it and I restart my distractions, the needle for the PICC is inserted. I see Ellie hold her breath at this, "you're ok sunshine, do you need us to stop?" I ask. She just shakes her head, "sorry angel, keep taking those nice deep breaths for me" Luke chimes in. Once Ellie starts breathing again, I see Luke create the incision in the vein so he can insert the line.

Ellie visibly relaxes as Luke takes the pressure off her arm and she lets out a sigh of relief. "You're being so good sweetheart, almost there" I say, trying to offer comfort. She smiles at me tiredly, "you can close your eyes if you want sunshine" I say softly, receiving a nod before Ellie's eyes slowly close. Luke carefully feeds the line up her vein before pulling out the guidewire, making absolutely sure that the top hasn't snapped off. The positioning is then checked with x-ray and Luke is happy with his work.

We slowly get Ellie back upstairs and let her sleep, happy knowing that the line is in. Now we just have to pray that her vein holds.