Five Quarts: A Personal and Natural History of Blood Read Online Free PDF Page B

is unsealed from its packet, Steve’s told me in the past, he can tell just how new a novice is.
    “A newbie looks at your arms with a great deal of indecision, as if weighing a dozen options. But there are really only two: right arm or left,” he’s pointed out. “And when the person starts poking at your veins, self-narrating about which one looks best, this one, no, maybe this one, that’s when I think,
This isn’t gonna be pleasant.
It’s also a bad sign when the person rubs the alcohol on your arm like they’re trying to remove a tattoo.”
    There have been mornings when I’ve been able to tell how rough a blood draw was by how damp Steve’s T-shirt is. “Three times,” he’d say, for instance, joining me in the waiting room. “Three times to get the needle in right.” Or sometimes he’d say nothing and just flash me his two bandaged arms.
    With Rosemary, no uncertainty is betrayed, and this translates into a confident spearing of his vein. “It’s like cracking an egg without smashing the shell or breaking the yolk,” Steve has said; “swift and decisive.” I now watch her technique. The needle and housing come packaged like a vending-machine sandwich; Rosemary pops open the seal. She then ties a tourniquet to his left arm, swabs the distended vein, and, in the blink of an eye, slips in the three-quarter-inch needle. Steve doesn’t flinch. (I do.) He’s had this procedure done at least fifty times in the past dozen years; he’s used to steeling himself against discomfort and potential bad news. That he’s had to learn this skill, I find heartbreaking. In this context I appreciate Rosemary’s gentleness and competency. Unlike some phlebotomists, she always uses a “butterfly,” a needle stabilized against the skin with tapered “wings” and connected to a narrow, eight-inch tube. At the end of this tubing is a barrel into which consecutive vials are inserted. The vacuum in each vial sucks Steve’s burgundy-black blood up through the thin hose. He loves butterflies. Without one, each vial has to be jammed directly into the base of the needle, which tends to rip up the vein. Butterflies are expensive, so not all labs use them.
    Every piece of equipment Rosemary employs has evolved from basic bloodletting tools. The pressurized vials, which look like test tubes with color-coded caps, are a counterpart to bleeding bowls, large clay or pewter basins placed below the incision site to catch the blood. These were often graduated like measuring cups so the phlebotomist could tally the amount removed before discarding it. The modern syringe has a mixed heritage: Its housing is descended from the small glass cups used for suctioning blood from tiny cuts made in the skin. “Cupping” has a history almost as long as bloodletting. In practice these cups, heated over a flame, were applied to different parts of the body; a partial vacuum held them in place. Doctors used cupping for localized pain or if a patient was too young or weak to be bled properly from a vein. The syringe needle actually has the most ancient origins, reaching all the way back to the earliest human’s use of a thorn or animal tooth to break the skin. Jumping forward to the early eighteenth century, the preferred implement for piercing a vein was the new spring lancet, as compact as nail clippers, with a trigger-activated blade. One Baltimore bloodletter so adored his spring lancet that he was driven to poetry. “I love thee, bloodstain’d, faithful friend!” one stanza began.
    The most cringe-inducing tool of the bloodletter was the leech, although nothing in Rosemary’s work space is remotely related, thank God. Like cupping, leeches had been used since antiquity as an auxiliary to venesection. Placed on the skin, these bloodsucking creatures, close kin to earthworms, fed on a patient until sated. After about an hour, they’d drop off. A doctor would typically employ five to ten at a time, although to be covered with fifty