The Yale Journal for Humanities in Medicine

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Radial Artery

Prakash Thomas is a fourth-year medical student at the University of Connecticut.

The final hour when we cease to exist does not itself bring death; it merely of itself completes the death-process. We reach death at that moment, but we have been a long time on the way.
--Lucius Annaeus Seneca, Epistulae ad Lucilium, epistle 24

Seneca, Stoic philosopher and advisor to the terrible Nero, returned to his villa far from burning Rome during the final days of the emperor’s reign. In his tyrant’s paranoia Nero sent soldiers to execute him. Seneca, knowing his end was upon him, chose the Roman dignity of ending his life. He slashed his vessels, but due to years of frugal living, they would not bleed. Again he cut and waited in vain. Finally, he called to his servant to kill him with his sword.

She comes to the ER because she cannot breathe. She developed emphysema during the past year at the age of 75 though she has been smoking since thirteen years old. Sixty-two years. She is a thin woman with dry flaking skin reminiscent of ancient leather. I lift the sheets to examine her. Her water-hungry body shows straight red lines of broken skin like torture on her skin, belly and back. “My kittens scratch me trying to climb up on me. I scratch myself because of my rash.” Her fingers are stained as though with henna; her nails are long and dirty. Her mouth is a cavern of dry and angry red membrane like a symptom of an auto-immune disease. Social services calls her home uninhabitable because she has cats too many to count. They say she crawls the hallway to go to the bathroom. I cannot make sense of this. Her son is with her. He is in real estate, with hair greased back, wearing a Rolex and smelling rich.

The attending tells me to obtain arterial blood for gas analysis. How much oxygen in her blood; how much CO2 is she retaining. The figures will help determine if she stays in the hospital. Her O2 sat drops at the slightest shift of her venti-mask. I press my finger against her radial artery, feel the steady pulse, seeming strong. I put the needle in but no blood comes out. I pull back the needle a bit and try another spot, fishing for the slight resistance of a vessel, the give, then gushing blood filling the vacutainer. None comes. I try another needle. Minutes pass. I leave to ask the attending and return with the smallest needle I can find, a 23.5 gauge butterfly. She speaks her pain every time I put the needle in. I am in silent pain searching for the artery. I will try the femoral after this I tell myself though I have gone too far already.

I stick her again, studying her wrist. I notice a thin white scar nearly imperceptible amidst the parchment of past years. “I don’t remember. Maybe as a girl,” she responds when asked. In 1925 she was born; in ’38 she started to smoke: when did it come to slashing her wrists? And to what do the smoke and scar point in her lost girlhood? Yet her son is here, calling her mom, assuring her he will see to it there’s a TV by her hospital bed.

Finally red drops appear in the tube, I encourage the artery by pulling up the plunger. The vessel will not part with its blood, so thick with scarce water. I wait minutes for a few more drops, less than a cc in sum, maybe not enough for lab analysis. No more will come. I pull it out and leave the room in defeat. The results come back; I do not need to stick her again. I am no Stoic, nearly in tears. Not for my hardship at obtaining blood. No. For something else. Perhaps that the body can fight for life so, even when tight against a wall with death near.

Published: January 23, 2002