281 ~ Uncharted waters ~

(Reminder: All names mentioned anywhere on the blog are changed)

Sometimes the waves flow in a rhythmical motion and you settle comfortably into the ease of swimming along steadily at an effortless pace..

Then your eyelids blink open to a moment that strikes without forewarning. Suddenly the tides swell higher and crash downwards with a mighty force pushing you towards uncharted waters. You cannot resist the power controlling your direction and the only option is to submit…


A night when Eid-Ul-Adha turned into a haunting flipover of drip dramas as Salmaan (the paramedic) came over to set up my routine infusion. Unfortunately because I extended the fortnight period into an extra week to test my body’s capability and limits of pulling without an infusion, it lead to an extreme peripheral vascular shutdown and we lost total vein access in all four limbs – both hands, arms and feet.

Salmaan is skilled in the field of handling veins because it’s part of his daily job being an intermediate life support responder so the dilemma wasn’t partly due to a lack of experience or anything as such. He tried every feasible point with great cautiousness but to no avail.

After a full 40 minutes of several failed attempts he concluded that all veins have collapsed and there is absolutely no backflow when inserting the needle nor a drop of blood after its removal along with a considerable delay in capillary refill.

Capillary nail refill is a test is done on the nail beds to assess dehydration and shock levels by the amount of blood flow to tissue. Pressure is applied to the nail bed until it turns white. This indicates that the blood has been forced from the tissue under the nail and is called blanching. Once the tissue has blanched, pressure is removed.

As a person holds their hand above their heart, the health care provider measures the time it takes for blood to return to the tissue. Return of blood is indicated by the nail turning back to a pink color.

Salmaan was now trapped unsure if he should resort to the next painful route of insertion via the external jugular vein – (An EJ). After contemplating over the circumstances for a few moments he decided against it and advised me to drink a rehidrate then shower in the morning saying he will return after fajr or eid salaah as the veins might be more dilated by that time.

Whenever I land in a risky situation we are suppose to call prof and seek his advice regarding the problem at hand but with the sudden disarray, it slipped our minds completely and Salmaan returned home leaving my brain in a befuddled state.

Should we not have opted for an external jugular? Painful is the least of my concern when fluids are vital knowing that a complete peripheral shutdown is my danger sign of heading towards hypovolemic shock and the foremost reason for which I require the infusion is because I cannot hydrate or nourish myself as necessitated with the consequences of Gastroparesis.

Furthermore, how do I shower a second time when my plasma volume has already dropped and hot water lowers blood pressure which then makes me a faint risk..

My calculation equals double danger

I know trauma cases differ and in that scenario they usually drill into the bone marrow (Intraosseous Infusion) but is it not the responsibility of an emergency service provider to find a way of gaining access regardless of the site point.

Was he’s judgement perhaps clouded by other unvoiced concerns. Did he think I can pull through the ‘danger’ for a night incognizant about my history of shutting down in rapid progression.

Nonetheless I tried my utmost best to hydrate although deep within I knew my efforts might not be very fruitful due to malabsorption.

Endless questions swirled around my mind and I thought it best to clarify the aforementioned concerns when he returns.

The night passed in a puzzling state of restlessness. Daybreak appeared while the mellifluous chants of takbeer reverberated from Eid salaah on our patio and the early morning qurbaani atmosphere peaked while I basked in the wonderment of being alive, physically feeling rather deflated and wondering if we shall gain better luck when Salmaan arrives…

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