Shake, Rattle and Roll

Paracentesis

Paracentesis is a procedure to take out fluid that has collected in the belly (peritoneal fluid). This fluid buildup is called ascites. Ascites may be caused by infection, inflammation, an injury, or other conditions, such as cirrhosis or cancer. The fluid is taken out using a long, thin needle put through the belly. The fluid is sent to a lab and studied to find the cause of the fluid buildup. Paracentesis also may be done to take the fluid out to relieve belly pressure or pain in people with cancer or cirrhosis.

Thursday at around one o’clock I got to experience the above procedure first hand. Not a lot fun actually. But then, really, what medical procedure is? Colonoscopy, nope; Endoscopy, nope; MRI, not really; Cat Scan, nope; stress test, downright torture; rectal examine…hmmmm; turn your head and cough, not so bad as long as it isn’t your Webelo troop leader administering the examine. That’s just wrong and it won’t even get you a merit badge. I’d have to say the paracentesis procedure so far is down in the bottom three my least favorite medical tests to date.

I got to the radiology department thirty minutes before my appointment was to begin and unfortunately Nurse Ks ineffective assistant didn’t confirm it. No record, no appointment. Thankfully they were able to fit me in. I always get anxious in the waiting room, waiting, looking around at my companions, shuffling about in their half opened johnnies, dragging there hanging iv’s behind them like stray dogs. Hair disheveled and lethargic. One woman wheedled in from a nursing home, balding, bloated, sitting in that chair, hacking into a washed out rectangle “catch all” the last remnants of her dry toast of a lunch. Poor lady, where has her dignity gone? Is this me in weeks, months or years? Am I starring at my ghost of hospital waiting room futures? Should I change my name to Scrooge and just camp out on one of these tired intuitional chairs watching looping news reels?

Fortunately, I’m called back into the inner sanctum of procedure land. I was under the impression I’d be sedated thanks to the info passed on to me by Nurse K’s assistant. I was wrong. Well, that sucks, my wife took time out of her day to drive me in and out, plus I was prepared for it. Mentally, you have to get your head in the right place for some of these things. Normally I’m not the type of person that necessarily needs order and an agenda, but in regards to my health I sort of like to know how things might transpire. Also, the resident and the attending nurse who were performing the procedure, (overseen by a Doctor Kevorkian look alike) came from two different countries with two very distinct different accents. As they talked over and around me prepping for the big event I had to wonder how they understood each other when I barely could make out what they were saying.

They attempted in their thick ESL accents to tell me about what would happen. Resident of unknown origin held up huge syringe and explained they were going to stick this in my abdomen and extract about 800 ccs of fluid. Wow, that’s nearly four cups, to be more precise it’s about 3.38 cups. That’s a lot of fluid.

“Will it hurt?”

“No, you will feel a small pinch.”

“How small?” I ask.

“Small, small, like a small shot.”  She says.

“Is that a medical terminology? Small, small, like a small shot?”

“Yes.” She smiles and screws on a needle of approximately 6 inches in length.

“That looks scary and not like a small shot. Looks like a really fucking big shot.” I start to sweat a little.

She laughs with her Pakistani–Hindu-Bangladeshi accent. “No… no… no… you should see what we use in my country.”

I hoped to never find out. Jin the attendant has me lift up my shirt, smears me with cold lube and starts running an ultra sound head all over me.

“Why you doing that?” I ask lying there, slightly panicked.

“Don’t hit organ, bad jojo, bleed inside.” She pats my belly like I’m a pig and she’s whacking me to see how tasty I might be.

Jin and the Res search, press and probe with the ultra sound discussing the best point and angle of entry.  Finally after about 15 minutes of deliberation and a wee bit of bickering on their part they put an x on me with a sharpie. Jin gets on the phone and calls the Doc in.

Kevorkian arrives to oversee everything; he needs to make sure the Ressie doesn’t really screw things up. Looks at the point of entry and syringe; he tells Jin to get a longer needle. Oh yeah… a longer needle, I like the sound of that. Jin unscrews the six incher and goes to an eighter, which should do the trick. She looks at me and smiles. All of them put on welding masks, stand over me and start to get busy. From what I hear being said they suck up some local and begin to force that horse needle into my belly. Not so bad at first, my skin resists then a prick and a burn. Okay, this I can deal with. Kevorkian “Deeper”, the resident pushes deeper and flushes me with more local, okay, more burning and pinching. I’m sweating, Ouch! I’ll bite my bottom lip and just think happy thoughts. “Unicorn Shitting Rainbow’s… Unicorn Shitting Rainbows… Unicorn Shitting Rainbows…” Okay, that didn’t do the trick, maybe not happy enough, just weird. The Ressie pushes further and the doc tells her that’s enough, pulls the tube and let’s mine some belly juice. She starts extracting fluid and apparently the tubing dries up. “Deeper” the Doc says. Okay, not I’m thinking that the sedation might have been a good thing. “Ouch, Grunt, Gasp. Fuck! Okay that hurts.” Sorry they say with hidden grins. “Is your hand cramping?” Kevorkian asks the Resident. She nods. Shit, I knew that, I could feel the tip of the needle bobbing and weaving inside my abdomen. She wasn’t rocking steady, just look at the level of my grimace Doc! That should tell you what’s going on inside. “Work your way through it” He says. Digging deeper I grunt, gasp and groan more as she extracts more fluid… “Ahhh good…” says Dr. K, “Now we got a gusher.” After what feels like an hour but was probably more like 5 minutes, they extract the syringe and put a band aid on me. I pull my shirt down, wobble a bit as I stand up; the Doc pats me on my ass, “Good Boy.” He says as he sends me on my way. As the door closes behind me I hear him say to the Resident “You need to get some hand grips and develop some strength or you’re going to really hurt somebody someday with all that shaking.”