My PICC Line

Last week, at the clinic it started with a question. Does a transfusion dependent person need a type-and cross every three days or four? A type and cross is a blood test to determine the best blood for a patient prior to transfusion. The doctor said four days. Settled. That test would not be necessary today.

I waited for an hour or so for the two units of blood to arrive, the blood that I was told had been ordered already.

Please note, I have no issue waiting in a doctor’s office or clinic or emergency room, I understand this is part of the process, and as long as it’s justifiable it’s something patients need to accept.

“Excuse me Matthew,” one of the staff  interrupts as I’m sitting in a waiting room reading my magazine, “we need you back for a moment.”

As we walk together she informs me “They just need to run a quick blood test.”

I ask which one.

“A type and cross.”

I’m confused, I was told it wasn’t needed today. They say it is, despite whatever was said earlier. So it was done, I needed to be transfused and it wasn’t happening without this test.

Long story short instead of finishing up around 2 p.m. that day it was more like 6 p.m. Time isn’t the point here though. The point is this was all avoidable.

This is the part where I list my complaints.

When I left the clinic that day, after two transfusions, I had no better idea whether the type and cross was needed every three or four days, and I was asking everyone. Some said every three, some said every four days.

In a conversation with a veteran nurse this week, I finally received my answer. Protocol calls for the test to be run every 96 hours, or four days. The doctor I first spoke to had it right. The nurse informed me the time frame had switched from three to four days just a few months ago and it had caused confusion among the staff. I have no pity. This specific clinic specializes in severe blood disorders, by their own admission they see anywhere from 70 to 110 patients a day. Most of those patients, like me, are transfusion dependent— how can they not know how often a test is needed that is mandatory for blood transfusions?

I mentioned a doctor, a nurse practitioner, and nurse originally told me I didn’t need the blood test. I didn’t mention that a few hours later it was a different doctor, different practitioner, and nurse affirming that I did. It’s disheartening enough that there was this much confusion, but to not even be able to speak to the original doctor who could corroborate what you were told, is nutty. But the place sees between 70 and 110 patients in a day. It’s a factory. See one patient for five minutes, move to the next. There’s no other way to service that many sick people. And so the environment lacks cohesion, with a couple of doctors buzzing in and out of rooms, and an army of nurse practitioners barking the doctor’s orders to the nurses(who never see or speak to the actual doctor), signals are going to get crossed. The result is a population of patients who receive fragmented—rather than optimal—care.

I received an unnecessary test that day, a test that costs me. It cost me money—my insurance qualifies any blood test as “diagnostic” that means I’m obligated to pay 20% of its’ total cost. At a point when I need so much, avoiding paying for things  that are unnecessary is especially high on the priority list. The question is how many times does this happen in hospitals, clinics and doctor’s offices a day? A week? A year?

More importantly than monetary expense, is the cost of chance. Every time blood is drawn from my piccline it increases the chance of infection—another set of hands, another syringe, another possibility someone coughs, another breath. I have no immune system, one germ can put me back in the hospital, can complicate my treatment, can lead to possibilites I care not to mention.

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