Satisfying

In nearly every hospital I've been, when there is a patient who is a difficult IV and everyone else has failed, the anesthesiologist gets called. Usually when I arrive, everyone feels relieved, including the patient who often has two armfuls of bruises. I always get (and still get) a little knot in the pit of my stomach because I'm the last resort, and often these patients absolutely need IV access.

There are a few tricks I've picked up over residency. Most nurses won't try the ventral (inner) part of the wrist (the veins are fragile and tortuous and it is painful). In adults, there are usually visible veins on the fingers (including the thumb). I'll look at the ankles and feet. I'll consider the external jugular in the neck. IV drug users who have scarred every other vein usually miss the back of the elbow. And there's always ultrasound and the central line as a last resort.

It's most satisfying though, when I manage to get an IV with a single attempt after the patient is exasperated, exhausted, and at wit's end. A 7 year old boy comes in with appendicitis. Four nurses have each tried once, and finally I am called. I sit down and we chat about Finding Dory, second grade, and swimming. I make out a bluish tinge along the wrist which we sometimes call the "intern vein" and he doesn't even flinch when I get it.

It's strange how anesthesiology involves so much, so many procedures, so much cerebral decision making, but on some days, the most satisfying thing is a simple IV.

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