Five Hundred

normal clinic. So they must be at least happy.

Inserting dialysis needles into your arm — is painful for most patients. The needles commonly used for hemodialysis are ‘15gauge ’, which means 15 of them will fit into an inch diameter, or each is about one-fifteenth of an inch in their outer diameter. For metric people that is a bit less than 2mm. I have heard of patients that use 14-gauge needles, which are more than 2mm. This is big enough that it is quite difficult not to flinch, and I regularly fail in spite of the lack of actual injury. I commonly chat or play music to distract myself.

A matured fistula used for hemodialysis is normally about 6mm, so a bit larger than a major vein (the ‘great saphenous vein’ returning blood to your heart from each leg is 2-4mm) and a bit smaller than a major artery (the ‘femoral artery’ in a 50-year-old is about 10mm). Returning to the needle, that means a 14-15 gauge needle is taking up about a third of the ‘tube’. Presumably the other two-thirds are to make sure your arm does not fall off due to gangrene.

In my case, I have a bit-better-than-normal sized fistula (8mm) and given gangrene is not an issue, I can use quite a bit bigger of a needle. But this would be a bit too conspicuous since needles are physical objects and would need to be in inventory (“do you have any 8mm / 2-gauge needles available?”) and someone needs to put them into my arm. Not a good way to keep a vampire under cover.

Instead, I use normal needles and the machine lies about its flow rate. The 15-gauge needles in my arm are used by the dialysis machine to pump huge amounts of blood through my body at a much higher pressure (flow rate) than normal. This is equivalent to having larger needles and enables me to support dialysis for a dozen people during the four hour session.

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Removing dialysis needles — from your arm is less painful but more problematic. The problems arise from having two 2mm holes in your body, that have been there for as much as four hours. Your body does have a desire/ability to close these holes. But at the same time, your blood stream has a desire to take advantage of them: they are like two holes in a dike and are the “easy way out” for the blood.

For a fistula, the dialysis needles are taken out in reverse order: the downstream needle (closer to returning to your heart) is taken out first and covered with _a lot_ of gauze and then pressurebandaged to your arm (or leg) to plug the hole. This combined with either hand-pressure or a mechanical (plastic) pressure system will enable the body to close the hole without the blood streaming through it getting in the way. The second needle is done the same way, but (for me at least, post-dialysis when my blood has been replenished), this one has a lot more pressure on it and is more likely not to be closed if anything is amiss.

An unclosed 2mm hole sprays blood into and then through the gauze quite quickly. Then down your arm. Onto the chair, floor, neighboring patient, helpful RNs, and so on. The solution is simple though: be like the little dutch boy and stick your finger into the dike… until a technically savvy nurse with a lot more gauze can come and help. As mentioned above, this has happened to me multiple times, and by just using the ‘dutch method’, I have managed to live through all of them [cough].

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SIRIUS BLACK

The amber light — from the streetlight is casting a glow that makes the hedges look black. “Black on black” would be hard to see, but that is not the spectrum that I use for this kind of task.

Earlier a family of raccoons wandered by in search of water, fish, trash cans, or whatever their nightly need was. A skunk ventured right by me, but I didn’t move and Pepe Le Pew did not notice me.

I have been sitting here for a couple hours, hoping to see the runaway in what may be their periodic trail. I am sure they are nearby: I just have to catch them mid-stride. Maybe five feet would be close enough, so I continue to ‘recline’ into my shrubbery. I need a nap

A hint of red — turns the corner onto Bryant by the bridge. Part of the difficulty around the task is that this path is for bikes only, so you can ’t just cruise back and forth in a car. In a car you have to skirt around the poles (bastions) by shifting a couple blocks and then coming back. But in that time, the target could have wandered away. And being actively on-foot is likely to scare the quarry as well. So I just sit and watch as the faint red gets closer and closer.

Three hours later — I drop Sirius Black (a cat… but pitch black, so they at least got one thing right) at the front door of the Waverly house. Sirius spent the night with me in a cage in ‘El Toro’ (my car, which snorts like a bull when you turn it off) given I thought it a bit rude to ring the doorbell at 3AM. Rose greets Sirius with open arms, gives me a kiss on the cheek, and I head off to my morning coffee routine.

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I have done about one lost pet a fortnight since my discharge, always based on postings on Nextdoor that are not resolved within a few days. Most pets are just opportunists taking a little trip into the world, but some get a bit lost and another ‘night prowler’ can relatively easily return them home. The pet return program is both a public service and good practice for other stealth operations.

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