Needles

something else is going on though: I can’t understand them wanting to give up profits. Especially Beloved is a for-profit company making billions of dollars… I suspect they and their shareholders would like to make billions more.”

“When does the vote come up?”

“Thursday. The bill will fail: it does not have the votes. — How is the bhatura?”

“Evocative. Some Appam would be even more so, but outside Kerala it is hard to find good Appam.”

“We have to enjoy what we have in life” I say with a smile

“I do my best” Mark responds with an expression I can’t read.

Mark was at dialysis today the day after ‘2022-114’ went down in flames. He must have had to get home to Palo Alto because he is not in the parking lot when I get out, and he apparently doesn’t have his Hoyst app running. Instead of just offering me a ride, Mark needed to use Hoyst to formally leave dialysis (and the clinic’s responsibility) and return to work as a driver. Otherwise the clinic could get into trouble for letting a patient drive another patient home. By turning his Hoyst app off, Mark (accidentally I am sure) ghosted me. I don’t have his email… maybe I should Google him to find it?

NEEDLES

January

The committee of gods don’t say anything but on Friday I am scheduled back at my normal Menlo Park clinic. I hope Nancy doesn’t think I ghosted her. I can’t call her and never got her email address, so

I guess I will have to visit her in Sacramento soon. I am thinking this is the beginning of a beautiful friendship, even if there were initially intended (but unperformed) ulterior motives.

History

Inserting dialysis needles into your arm is painful for most patients. The needles commonly used for hemodialysis are ‘15-gauge ’, which means 15 of them will fit into an inch diameter tube, 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’ providing blood to your arm is about 10mm in a 50-year-old). Returning to the needles, that means a 14-15 gauge needle is taking up about a third of the ‘tube’ of the fistula. 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 could 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?”), or would have to be carried. And in either case, someone needs to put them into your 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.

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