10 Things Phlebotomists Should Never Say

When I first got sick, I was totally scared of needles.  After getting 27 tubes of blood drawn – yes, I’m not exaggerating, I counted before I passed out (just kidding, I didn’t pass out, shockingly) – at my first rheumatologist appointment, that knocked the fear out of me real quick.

But that doesn’t mean I enjoy getting blood drawn or that it is a particularly pleasant experience.  In fact, most of the time, it’s not.  I’m a hard stick and I’ll be the first to admit that.

After my recent hellish appointment with my new rheumatologist – read until I fire her – the phlebotomists at her office stuck me four times to no avail.  I’d like to blame it all on the fact that I hadn’t eaten lunch or had anything to drink because I ended up spending three hours sitting in the doctor’s office.  But the next day, I went to a hospital lab in the morning, after just eating and drinking, and got stuck four times, as well.  Thankfully, at least the second time around, they were able to get all the blood they needed.

But in the process, between both labs, a lot of pretty dumb stuff was said.  Most of it isn’t stuff that I haven’t heard before.  But the more I hear it, the more annoyed I get. 

So, without further ado and in no particular order:

1.       “You don’t have any veins.”

Clearly I have veins.  I am alive.

2.      “You really are a hard stick.”

My body may be a lot of things.  Weird is definitely one of them. And unpredictable.  But one thing I know with certainty is that I AM A HARD STICK!!!  Don’t say I didn’t warn you.

3.      About those attempts where no blood flows, but as soon as they pull the needle out, out comes the blood:

“Well, at least it’s bleeding now.”

Literally, if another phlebotomist says this to me ever again, I will probably punch them.  This isn’t cute or funny.  It’s called DO YOUR JOB and GET IT RIGHT.

4.      “I bet that didn’t hurt at all.”

Yeah, well, that’s something that I wouldn’t bet money on, because you will lose that gamble.

And don’t ever, ever tell me how I should or should not feel.  Until you’re sitting in my seat, having a stranger poke and prod you, you have no idea what it’s like.

5.      “Can you straighten your arm more please?”

No I cannot.  I have ARTHRITIS.  What part of that is so difficult to understand?  Thanks for asking nicely though.  You get an A for effort and an E for execution.

6.      “Are you sure you’re okay/don’t want any juice?”

I’m super, thanks for asking.  But in reality, if you really cared, you wouldn’t ask that question because you know that the answer is “no”.  There’s nothing enjoyable about the experience, whether it goes “well” or terrible. 

I know that you just want to make sure that I’m not about to pass out and hit my head on the floor and make your job even more difficult than it already is. 

This isn’t my first rodeo.  I’ve never passed out from a blood draw and I’m not about to start now.

7.      “I’m going to try one more time…”

Don’t get me wrong, there’s nothing I love more than getting stuck with a needle, so I could let you poke me all day if you really want to, but if you’ve tried twice and failed, you’re out.  Do not pass go, do not collect $200.  And I don’t care if the lab you work for allows for three or four sticks per phlebotomist.  If you try twice and get nothing, there is a high likelihood that you won’t get anything no matter how hard, or how many times, you try. 

8.     “Wow, the last lab did a really bad job.”

You’re only allowed to say this if you do an arguably better job.  So in theory, if the previous lab stuck me four times and didn’t get any blood, and you stick me four times and get blood, you did a slightly better job.  But to me, unless you get everything in one or two sticks, you haven’t earned the right to bash whoever maimed me previously. 

9.      “You’re going to feel the teensiest, tiniest, little prick.”

And you’re just a prick, no size required.  So I guess it all balances out in the end.

10.  “That’s going to leave a mark.”

I know I bruise easily, and in some ways, it comes with the territory.  But if you’ve stabbed me in such a way that you can already tell I’m going to bruise, we have a big, big problem. 

So please don’t state the obvious and don’t pat yourself on the back for a job NOT well done.  Sorry if I’m not signing your praises.  Sorry if I don’t want to see you ever again.  Don’t quit your day job.  Oh wait…this is your day job…

So there you have it.  If you’re chronically ill, you’ve probably heard some variation on many of these phrases.  And if by chance a phlebotomist or future phlebotomist happens to be reading this, please don’t take a page out of this book.  This is a guide of what not to do. 

Sorry if I sound angry.  But if something had been done to me unwilling and without my consent, and I had the bruises pictured below, it would probably be considered assault.  So forgive me if the routine is starting to wear on me. 

  

Last Week’s War Wounds

#thecarnageisreal

It’s all a little too reminiscent of That Time I Got Manhandled By A Phlebotomist. 

That Time I Got Manhandled By A Phlebotomist

The scene of the crime...

Having dealt with chronic illness for over eight years, you would think by now that I wouldn’t get phased by blood draws. 

But I recently had a particularly bad one that was enough to put me off of it for a while. 

Apparently, when I saw my rheumatologist at the University of Michigan Hospital at the beginning of August, the lab there did not do all the tests that my doctor ordered.  I’m not sure how that is possible since it was all sent electronically, but they didn’t.  I was also told that because of one of the medications I’m on, I have to get my blood drawn every other month, even though I didn’t have to do this with my last doctor, who was the one that put me on the medication. 

So in order to get the rest of the labs done and set up the standing order, I went to the lab at a local hospital near me, as it’s not realistic for me to go all the way to Ann Arbor just for a blood draw. 

I expected that this would be a routine blood draw, but not so.  (And by routine, I mean I know that I am a hard stick) 

The first phlebotomist spent about 10 minutes feeling around for veins in both arms.  That was a red flag to me.  I would much rather have had this person feel around and then give up, rather than try twice and fail miserably. 

The first time she tried, she got the needle in and proceeded to move it around.  Like really move it around, to the point where I was ready to scream, to the point where I thought if it was possible for the needle to come out the other side of my arm, it would.  Finally, she pulled the needle out.  But I’m not really sure why she couldn’t get blood from that area because of the amount of blood that proceeded to flow from my arm when she took the needle out.  

Then she asked if she could draw from my hand.  If you stick a needle in me and draw blood from my hand, fine, but if you stick a needle in my hand and get nothing, we definitely are not friends. 

After that, she said she would get someone else.  Yeah, good idea lady. 

The second person came in.  She asked where they normally draw blood from and I showed her the same spot that I showed the first woman, who opted to do her own thing.  The second woman went in the spot I showed her, and sure enough, blood came out, albeit slowly.  She asked me if I drank water.  I told her that if it was about how much water I drank that day, the blood should be flowing out of me. 

And we won’t even talk about the fact that they started decanting the blood into vials and the second woman proceeded to get my blood everywhere.  Well, we will talk about it because it sucks.  It took hard work to get that blood and then you go ahead and spill it all over the place?      

The second person asked if I was okay and needed juice.  I replied that I was fine and didn’t need juice. 

But in reality, I wasn’t fine.  I left the lab pissed off and frustrated.  I didn’t need juice.  I needed a break.  I needed to get out of there. 

I need to escape from the monotony of it all.  Actually, it’s not monotonous.  It’s always an adventure, and that’s what really gets old about it.  In reality, the routine is for nothing to actually be routine or ever go as it should.

And this situation was just too much.     

It feels like a profound violation.  Normal, healthy people don’t allow things like this to happen to them.  But as a sick person, I’m supposed to sit there and take it.  Without question.  Without argument.  And definitely without anger or frustration. 

Is there a glamorous side to chronic illness?  Some people try to find it.  But right now, I’m not seeing it.  I didn’t sit there with a smile on my face despite the pain.  I bit my lip and gritted my teeth.  But more than anything, I wanted to punch the phlebotomist in the face.  I wanted to pull the needle out myself and tell her I was done.  I wanted to walk away.  I wanted to call my rheumatologist’s office and tell them why I was choosing to be “non-compliant”, and why they can’t make me get my blood drawn, even if they threaten to take my medication away. 

The reality is, all of these small violations take their toll.  I am used to being stuck multiple times per blood draw, I am used to bruising after a blood draw, I am used to lab techs saying stupid things to me, like telling me that I have to put my arm out straighter even though I have arthritis and cannot physically accommodate that request. 

But when all of those things happen at once, when I am attempting to do my duty as the dutiful patient, and it all goes horribly wrong, it’s just too much. 

So yesterday’s anger and frustration has transferred to today.  And so I’m writing the shit out of this experience because I don’t want to stay angry.  I know that there are bumps in the road.  I know that some days are easier than others.  And yesterday was a bad day.  My body reminds me almost daily that I’m sick.  So these not-so-subtle reminders that I truly am sick are sometimes just too much.    

Maybe the bruises on the outside show a fraction of the physical pain I feel on a daily basis and the emotional pain that sometimes occurs as a result. 

I wish I could say that I got in a fight.  I wish I could say, “You should see the other guy”.  But the other guy doesn’t care.  The other guy has education and training to draw blood.  But even I can stick a needle in myself and get nothing out.  Maybe I should learn how to draw blood.  Is it possible to draw your own blood?  If so, I’d probably have about the same success rate at the phlebotomist who manhandled me.  But at least I’d be doing it to myself and not allowing someone else to do it to me.   

New City, New Care = So Far, So Good

Well, establishing care in New York hasn’t been as easy as I’d hoped, but the care that I have received so far, other than at the student health center, has been pretty good.

I have student health insurance, so I have to get referrals from the student health center.  I went there, and was honestly less than impressed, but have basically set up a relationship so there is someone I  can e-mail there when I need a referral.  This means I do not need to make the trip to the student health center every time I need a referral, and I think this relationship works well for all parties involved.  I don’t think they really want to deal with my complicated situation, and I’m not sure I really have a lot of faith in trusting them to deal with my complications.  (And I don’t think this is necessarily unique to this one student health center, certainly my prior experience suggests otherwise)  So now that, that’s out there…

I got a recommendation for a primary care doctor, but when I tried to get an appointment with her, I was told she was no longer accepting new patients.  Strike one.  When I called to get an appointment with the rheumatologist I wanted, I wasn’t able to get an appointment until the beginning of December.  Strike two.      

But that was a function of me not having my new insurance information until the beginning of September – and the student health center being unwillingly to help me set up care over the summer – because I think I’d be crazy if I tried to suggest that there is a shortage of doctors in New York City.

Anyway, I was able to pick a different primary care doctor, who I was able to see a few weeks ago, and she gave me a recommendation for another rheumatologist, who I will be seeing at the beginning of November.

So far, I’ve noticed some major differences from the care that I had previously that I am pretty impressed with:

They actually – both doctors and support staff – know how to use their electronic medical records (EMR) system.  My previous care team, a year into using the system, still had no clue what they were doing, and this caused a lot of extra work for me.  But my new care, not only do they push the system on patients, but they actually utilize it, and do it well!  And it’s funny because they actually use the same system that my previous doctors use.

In New York, while I was able to transfer my prescriptions, I was told that they only allow one refill with the transfer, so I would need to get new prescriptions.  My doctor submitted all of them directly to my new pharmacy so they will be there when I need refills. 

Another major difference was that my blood was drawn in the exam room, rather than being sent to a lab somewhere else, either onsite or offsite.  That’s a nice change! 

I also didn’t feel like a sick person.  Maybe that’s a weird thing to say, but I didn’t.  Maybe part of it was the fact that I didn’t have to go sit in the waiting room of a lab where I was the youngest person, and everyone looked at me with pity.    

Every time I call to get an appointment, as soon as I give them my information, they say How can we help you today, Miss Rott?  I don’t feel like I ever got that kind of respect from my previous medical care team.  In fact, the support staff were usually pretty disrespectful, if not downright mean. 

And so I have to wonder, what’s the difference?

As my boyfriend pointed out to me, there are several major hospitals in the area, and because they are competing for patients, the quality of care and treatment that patients receive is better than it might be elsewhere.  For example, where we lived previously, there was really only one game in town as far as a major teaching hospital was concerned, and so, knowing this, I think they skimped a bit sometimes.  Or maybe they just didn’t care because they knew they were the only game in town. 

It’s not necessarily that I didn’t receive good care, but the extra touches weren’t there.  And I guess I didn’t really know they weren’t there until I now have care where they actually exist. 

Sometimes change is a good thing!  And sometimes a little competition is healthy!  

From Bad To Worse: My Worst Blood Draw Experience Ever, Ever

In trying to get to the bottom of my recent flare, I saw my PCP earlier this week and she ordered a bunch of labs.

It seems like I have a lot of issues when it comes to the student health center’s lab techs drawing my blood, but I didn’t really have a choice in the matter.

So I went to the lab, and of course, horror ensued. 

The first stick was a foreshadowing of things to come.  At first nothing came out, then the tech totally blew the vein and promptly a dark, red pool of blood spilled out onto my arm.

“Now it decides to bleed?” says the lab tech.

Really?  Really?    

Normally, each lab tech is only allowed to stick you twice, but for some reason, this particular tech decided to go on a personal crusade, hell-bent on taking my blood.  She ended up sticking me four times.

But that’s not before she got the idea that the reason she was having a hard time was because I was dehydrated.  She made me sit there, drink three large glasses of water and three small cans of orange juice.

No one has ever done this to me before.  It was totally ridiculous, especially because all of that drinking made me really cold. 

And there are some things that phlebotomists should just know, like when someone is freezing cold, it is a lot harder to draw their blood.

So that was a great plan.  

Another tech sticks me once, and I think I’m good to go.

But then they call me the next day and say they need another tube of blood.

Of course they do.  As if the day before wasn’t enough.  The carnage from the day before is still fresh.  If you look at my arms, I look like a drug addict. 

And they want more for me.

Well, I’m not feeling particularly generous at the moment; I don’t have any more to give.

The tech that stuck me the fifth time tells me she let the blood clot and didn’t realize it, and it clogged their machine for an hour.  Her fault.  Why is she telling me this?  I don’t want to know. 

So in case you’re keeping score, that’s six sticks for three tubes of blood.

The student health center needs to be called out on their shit.  I am sick of them only being able to deal well with acutely ill 18 to 22 year olds.  It’s not right. 

As I sat there guzzling water and juice, I heard girls coming in and giving their birthdates, 1990, 1991.  They’re easy.  Just on tube.  And anyway, they have underutilized veins.  They aren’t getting blood drawn all the time, like I am.    

To be honest, I don’t think that some of these lab techs could draw blood if you handed them a glass full of blood.

I guess blood is not that useful once it’s outside of your body, but do you ever want to yell and scream at the lab techs, “Hey, that’s mine!  I want that back!” as you watch it sit in the tube and coagulate?

As I’m leaving the lab the second time, the woman at the desk tells me to take a juice, that I deserve it.

A consolation prize for their incompetence, that I ultimately pay for.

Guess what?  I don’t want any f***ing juice.  Why doesn’t anyone understand that?

I just want them to do their jobs and leave me alone.

I really want to file a complaint.  The behavior of these techs, all around, is just incompetent and unprofessional.  But I’m not sure what good it will do.  I don’t want them to see me coming and run the other way.  But I also don’t want to be treated like I’m causing World War III just for a couple lousy tubes of blood. 

As a patient, I want and deserve respect and compassion, both of which are lacking here. 

I’m getting tired of the system, because the system doesn’t work.  No one is using a holistic approach.  Everything is done in isolation of everything and everyone else.       

Shit Tactless Idiots Say To Sick People

So this “meme” might be “over”, but I couldn’t resist calling out some people on their shit.  These are things that have been said to me recently. 

Seriously. 

And sometimes, rather than be upset about something and turn it inward, it’s better to let it out.  Because the reality is, it’s not me that has a problem; it’s the people who have said these things to me that are the ones with a problem.

“You made my job really hard” – Lab Tech

Context: This comment was made by a lab tech at the student health center after she stuck me twice for four tubes of blood and basically got nothing. 

My hypothetical response: “You make my life hard, and you don’t hear me telling you about it.”

“You made me work for my money today, and I don’t make a lot” – Lab Tech

Context: This zinger came after the lab tech above, from a different lab tech at the student health center.  She stuck me twice, and while she did get the blood she needed, she had plenty of time to tell me exactly what she thought about me and my veins. 

My hypothetical response: “Really?  That’s your effing job.  I don’t get paid at all to be a patient, and that’s a full-time job.” 

“I’m a little sick too, but doing well enough to come in” – Co-TA

Context: If the intent of this comment wasn’t asshole-ish, I’m not sure what is.  I was pretty much floored by this e-mail response to me telling my professor and co-TAs that I wouldn’t be in class.  I had several rebuttals, but ultimately erred on the side of saying nothing to the person that said it.  It just wasn’t worth it.

My hypothetical response: “I had a colposcopy today, asshole.  Look it up, and then tell me if you would have come to class.”

“So, aside from lupus and RA, you’re perfectly healthy, right?” – Doctor (won’t tell you which specialist it was, but it wasn’t my rheumatologist)

Context: This was said to me the first time I started seeing a new doc. 

My hypothetical response: Honestly, I don’t have a good response because this comment just doesn’t make any sense to me.  Being chronically ill and perfectly healthy just don’t jive with one another.  If she had asked if I had any other significant medical issues, that would have at least made a little more sense.  This comment feels kind of patronizing to me. 

“Come on, you really can’t bend your arm any straighter?” – Various lab techs

Context: I really hate this.  It happens nearly every time I go to get blood drawn.  I wish they could put a note in my file that every lab tech sees, telling them to absolutely not say this to me.  It really bugs me.

My hypothetical response: “No, I can’t bend my arm any straighter.  I have rheumatoid arthritis, thank you very much.”

“Your charts so big, I didn’t bother to read it” or “I wasn’t sure if I’d met you before, but then I saw the size of your chart and know I would have remembered you.” (and other similar versions) – Various Doctors

Context: This has happened to me several times.  And it is really frustrating.  Yes, I have a big chart for someone my age.  But I’m not going to apologize for it.

My hypothetical response: “Bigger is better, right?”

“As nurses, we hate when insurance companies deny prior authorizations because it’s so much paperwork for us and takes so long.  Don’t get me wrong, it’s my job, but appealing takes so much work, especially if they deny it again.” – Nurse from GI Doc’s Office

Context: This was said to me over the phone by a nurse from my GI docs office.  My insurance denied the prior authorization for Amitiza.  Unfortunately, because my prescription insurance changes on October 1^st, there was really no point in trying to appeal because they probably wouldn’t be able to make a decision in time. 

My hypothetical response: “Yes, it is your job.  And your loyalty should be to me the patient, not pandering to the insurance companies because it adds extra work for you.  Think of all the extra work added to my life by being chronically ill.”

Ultimately, there are a lot of stupid and tactless people in the world.

The thing that I think frustrates me about of all these comments is that they all point to me, the patient, making ones job harder, whether it’s doctors, lab techs, pharmacy techs, insurance people, nurses, etc.  When in reality, the only person I really feel for is myself. 

I don’t mean that to sound selfish, but I’m being blamed for things I can’t control.  I can’t control my veins, the size of my chart, the fact that my insurance company is stupid, and all of the other comments being lobbed at me.  I’m the sick one.  

Thank goodness that I have a filter, because I would have reamed these people out otherwise.

Have you had similar things said to you?  If so, what are they, and how did you deal with them?

Please feel free to add your own zingers to the comments.  I would love to compile responses, and am thinking of making this the theme for PFAM when I host in December.