Learning how to take somebody’s blood is the first violent thing you do as a doctor. It’s a strange sort of initiation. Before that moment, the body is an abstract thing, learned in principle from textbooks or anatomy classes. Afterwards it feels real: it bleeds and flinches. It’s also the first in a line of increasingly gruesome skills you must acquire. After bleeding your patients, there are peripheral lines to insert, arterial stabs, ascitic taps and joint aspirations to perform, lumbar punctures and chest drains to master. There are always new places to put needles.
You learn in groups of other medical students, and, because no one else volunteers, you learn first by bleeding each other. It is painful, the logic goes, but reciprocally so. It might also be the first time you ever see so much blood up close. I remember watching the young student who practiced on my arm, his face taut with concentration as he nervously pushed the needle under my skin. As my blood flowed, he turned sheet white, let out a short psychotic giggle, and promptly collapsed. ‘It’s always the men who faint,’ said the weary nurse teaching us, propping him onto a bed.
Your first attempts are like water divination, scatter-gun acts of hope, but after a while you sense where to find a vein under the skin; not by its look, people say, but by its feel. You want to feel a thick, almost spongy texture, while avoiding one that’s thready and collapsable. Soon, it becomes a subconscious urge. You find yourself absent-mindedly prodding any arm to hand, often to the disquiet of friends or lovers.
All this practice means that when you first qualify as a doctor, taking blood is one of the few things you can confidently do, while the rest of the job remains obscure. This is good, because much of medicine seems to be taking bloods. Every patient will have theirs taken on admission; many will have it again and again, sometimes for good reason, at other times for none at all except that it is unclear what else to do. ‘For completeness,’ you are told sagely by a senior, when you ask why someone needs them.
Nurses and other professionals can take blood, but they know that if it’s too tricky, they can ask a doctor instead. Doctors can only ask more senior doctors, who are busy and might resent being bothered. This encourages a dogged persistence – which is when the violence really begins.
Working in a hospital at night means stalking fluorescent corridors before turning into the darkness of a ward full of bodies trying to sleep. Except they don’t sleep. They are kept awake by snoring and rustling, by lights or nurses’ voices, by the heat and the smell, and by doctors coming to take their blood.
There is a moment on a night shift, close to dawn, when tiredness blurs into hopelessness and the clocks stare back defiantly as you watch them. This is when you are called to see an elderly lady asleep in her bed.
You stir her, perching on her bed and sweating from the heat, a single lamp illuminating you among the darkness. You feel for her veins and, finding one, plunge the needle, trying to make it quick for you both. But then blood spews out like a B-movie horror. You realise you’ve hit an artery, something you’ve never done before. You also realise that you’ve forgotten bandages, so you grab her arm with your hand to stem the bleeding. You look at her, and she looks at you, both stunned. Your frantic apology she takes remarkably well, even as your hand turns technicolour red. At last a nurse rescues you both with gauze, and you retreat, a bashful spectre, back into the night.
