Ten Minutes

When you remove an arterial line from a patient, you must hold pressure over the site for at least ten minutes to ensure proper hemostasis has been achieved.  This requires at least ten minutes of close physical contact with the patient, which usually prompts me to fill the awkward silence with small talk.  I typically ask mindless questions about their job, their family, and what they are watching on television as I count down the minutes until I can remove my hand and get back to my never-ending to-do list for the other patients on the floor.  

A few months ago, I went to take out an arterial line from a teenaged patient who had been shot multiple times in a random act of violence.  According to the fragmented narrative, the bullets were meant for somebody else, and he had simply been in the wrong place at the wrong time.  Part of me hoped there was more to the story; the shooting of an innocent adolescent was nearly impossible for me to stomach.  When I met him, however, I believed it.

After preparing the materials and explaining to the patient what I was going to do, I quickly pulled out the arterial line from his wrist.  I felt his body relax from the anxious anticipation he had internalized.  I immediately held pressure, and I began my ten minute countdown.  I looked around the room for ideas of things to talk about.  I wasn’t used to taking care of teenagers, so I couldn’t ask my usual adult questions about work or children.  He wasn’t watching television, so that wasn’t an option, either.  I glanced at the clock on the wall, begging it to hurry up.  I fumbled for a few minutes before pointing out the nice view he had of the Philadelphia skyline from his window.  I asked him about his neighborhood, his high school, and his favorite hobbies.  Kid stuff.  After I ran out of conversation starters, I stood quietly for a while before he somberly broke the silence, unprompted.

“I was just trying to hang out with my friends, the weather was so nice…I wish I never would have gone outside.” 

His quiet words pounded against my ears, and my ordinarily stoic eyes welled up with tears, which I quickly tried to blink away.  No amount of small talk could fix the psychological trauma imparted by those bullets, the nightmares that would haunt him, the fear he would feel in his gut every time he stepped outside of his front door for the rest of his life.  I remained quiet as I let the heaviness of his words sink into me, knowing that my presence and an opportunity to speak were all I could offer him.  I was stuck there, holding pressure, forced to taste his pain.  

I looked back at the clock.  I had forgotten how many minutes I had left.  The arterial line removal guidelines don’t tell you how much time you should factor in to listen to the lamentations of an adolescent shooting victim.  Nobody taught it to me in medical school, either.  I stared out the window at the broken city I call home, and I silently screamed at her.  When I was finished, I released my grip on the patient’s wrist.  His external wound had stopped bleeding, but I knew his invisible ones still gushed.

I dressed the patient’s wrist, and I left the room to find the police waiting outside.  They wanted to get a statement from him and begin the usual and likely futile process of bringing his shooter to justice.  Kid stuff, in North Philadelphia.  As I walked out of the room, I noticed the patient’s father standing behind the curtain.  He was crying quietly, trying to compose himself to a façade of strength before he emerged from his hiding place to sit with his son.  Here was a father who cleared his schedule to pace around a hospital room all day, who knew that the greatest gift he could give his child was his company.  I wondered how he felt when he looked at the clock on the wall.  He probably would have savored every one of those ten precious minutes with his son that I had wished away.

When you remove an arterial line from a patient, you must hold pressure over the site for at least ten minutes to ensure proper hemostasis has been achieved.  I think I might start making it fifteen.