You might feel a sharp scratch with this piece
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.
Bloodletting is as old as medicine itself. Long before the microscope began to make blood intelligible, it was a remedy, part of the Hippocratic cosmology that saw illness as having an excess of something. Bodies were vessels awash with the drama of fluids, where oceans met and churned. Unbalance these – being filled with too much black bile for example – and fever, dropsy, or cancer could appear. Phlegmatic, choleric, melancholic: these were the personalities of excess.
For millennia, to be cured was to be rebalanced: through purging and bleeding, through laxatives and sweating, through diet and sex. Even so, bloodletting always had a special place in the doctor’s armamentarium. The dogged bravery needed to drain litres of blood marked out the cool, steely nerves of a physician.
It was not without its victims. Caught in the hail of a Virginia winter, George Washington developed a cold and took to his bed. A physician bled the father of his nation of two litres in 12 hours, even as his blood thickened and slowed. Soon after, he died.
It was unsurprisingly not without its critics either. After an encounter with bloodletting, Napoleon said of doctors, ‘medicine is the science of murderers’. Byron was bled several times before his death and was reported as saying: ‘Come as you are, I see a damned set of butchers. Take away as much blood as you will; but have done with it.’
As a new kind of medical knowledge emerged in the 19th century, public arguments were waged, and careers made and unmade, over the real value of bloodletting. Diseases transformed into the pathologies of organs to be studied under microscopes and in autopsies, washing away much of the humoural universe. Yet some habits are hard to let go. Bleeding was still recommended as a treatment for pneumonia as late as the 1940s.
By this point, doctors had already begun to develop a new kind of relationship with blood. First, by examining how it clotted in a test tube, and then, by ensnaring and documenting its different types of cells, doctors began to make a science out of this ancient art. Soon after, blood’s ingredients began to be listed, its salts and proteins measured out and checked against normal ranges. Suddenly there was a radical new way of knowing a person, a new kind of medical gaze. We became no less than the sum of our parts, as numbers became the object of a doctor’s work.
Blood groups were discovered in the early 20th century and mapped on to the world’s races. The purity of blood was already a preoccupation for scientists, as the historian Donna Haraway has written, and those who subverted it – the non-white, the Jew, the homosexual – were the vampires of the cultural id, ‘sucking the blood of the rightful possessors of the land’. Little did it matter, as it turned out, that blood groups varied more within than between ethnicities.
Both known and yet unknowable, it wasn’t long before blood’s negative space was filled with a new invisible threat. As the AIDS epidemic emerged in the early 80s, doctors penned panicked op-eds about the risk of needle-stick injuries. Some physicians refused to treat HIV patients for fear of their bloods somehow meeting and, as in the belly of Donne’s flea, producing a transgressive intimacy.
Blood and sex are bound together, caught up repeatedly in our beliefs about hygiene and decadence. When you become a doctor you must take an HIV test – you offer up your own blood first. In the name of risk, the result could mean you are barred from working. Until as recently as 2011, gay men were forbidden from donating blood. The stigma of this still hurts, that blood can ensnare you vice-like in a strange and violent history. ‘My blood was full of ghosts,’ the poet Seán Hewitt has written, ‘I carry the weight of the past in my veins.’
On a surgical ward early in my training, I stood in front of a stick-thin 30-year-old man half-dressed in a hospital gown. I wanted his blood. I had begged him for it. He had a painful chronic bowel condition which meant he couldn’t eat or drink, and which no medicine or surgery seemed to be able to cure. Over the years, his body had been relentlessly battered, injected, tubed, bled, cut and stitched, all with little improvement. He had given up on medicine, and wanted to be left in peace, but an ambulance had found him on the street unwell and brought him in. We needed to know how to help him, to know what his blood might say. But still he refused.
All he wanted was an ice lolly – its coolness soothing some of the pain. So, with a dirty quid pro quo agreed and a trip to the shop, he eventually relented, lolly in hand. I remember his balsa wood wrists covered in tufts of the soft downy hair that grow in starvation. I held it delicately between my fingers and it felt like it might snap. When I eventually found a vein deep in his arm, my colleague held it in place as I pushed into it with a needle. After a long minute a single black viscous drop emerged. I checked the position of the needle, but it was in. I used a syringe to create some suction but still nothing else came out.
He had no blood in his veins; his extremities were shutting down. What little liquid remained was pooling in his centre in a desperate attempt to stay alive. It told us all we needed to know: we were already too late. After that he wanted nothing more to do with us. The next morning, we found him dead in his bed, his face at last at peace.
I’m not sure when I realised I didn’t want to work with bodies anymore – perhaps it was this experience or another difficult one, though none amounted to more than the expected allotment of occupational horror. Medicine’s heroic fantasies had certainly begun to lose their appeal, its quixotic centuries-long attempt to master the pneumatics of flesh. In the end, I think it was something more banal: I lost my appetite for gore. I hadn’t started out squeamish, but I had soon learned to be.
So I started in psychiatry instead – a job still full of violence, but of a largely bloodless kind. It lacks a grand theory for the diseases it treats and is forced instead to focus on symptoms and stories. Some argue that this makes psychiatry akin to medicine before the discovery of germ theory, when fevers – like madness – were manifest mysteries, the unknowable consequences of a humour’s ebb and flow. It suited me well.
Blood-taking now feels like a distant memory. Although I am occasionally still asked to do it, in an emergency or on an understaffed ward. It always comes back easily. One day you may even see me entering a ward with some blood bottles in my hand. Let me take you by the arm and sit you down. I’ll put on some gloves and feel your veins. I’ll tie a tourniquet around your arm. And then, when there’s nothing else to be done, I’ll say, ‘sharp scratch’, and I’ll begin.
