Moby Me ?: Tale of a Liver Biopsy

“He jests at scars, that never felt a wound.”

-- William Shakespeare 1564-1616: “Romeo and Juliet” (1595)

Having postponed multiple previous liver biopsy appointments designed to check the status of my liver scarring post chemotherapy, and having not had this procedure in 5 years, I decided it was time to allow the liver docs a look. In truth, I would have postponed again, had I not promised to participate in a research study.

In the fall of 07’, when I spent a lot of time at the UM Cancer Center, I had many blood draws. I rehash this here as a preface to the story I’m about to tell. The nurses who do the blood draws at the UMCC are pros. Oftentimes you can’t even tell you’ve been poked. Yesterday was different. Mind you, that which follows is small potatoes compared to the plight of some of my other ailing friends, but I’ll try to make it interesting to those of you who enjoy a bit of squeamishness. Appropriate, don’t you think, for this Friday the 13^th?

So this pert little Howellite comes in, has me sign off on every possible complication. You know, the usual: collapsed lung, internal bleeding, and death. She then informs me that she, a research assistant, rather than a nurse, will be drawing my blood. As these things go, I’ve had enough experience that I’m fairly calm about these thing. So, when she misses the veins in my right arm on three tries, spraying my contaminated blood all over the room, I tell her to try my left arm. Her ineptitude now has her agitated, so she starts behaving in a way that I’m sure many of you have experienced yourselves: she tells me "I’M" not relaxed. It’s classic Freudian projection in its most typical manifestation. Switching arms, she drops the syringe on the floor, and begins to sweat while trying to make some boring small talk meant to distract attention from her obvious lack of medical skills. She tells me that she would never move from Howell (home of the Michigan KKK) because she wouldn’t want her children to grow up in a liberal Sodom and Gomorrah like Ann Arbor. All the while my criminal child, a thoroughly corrupted bubble girl from A2, is grinning like a coon. Having warned her that the veins in my left arm might require some serious digging and gouging, it was no surprise to me when she couldn’t find any blood. With this, she just gave up and said she had collected enough from the right.

After 20 minutes of needling, and multiple bloody punctures later, they wheeled me down to the MPU (Medical Procedures Unit) where the biopsy would take place. The patient is placed on their left side on a stryker frame, the right arm is extended up and behind the head, the right leg is draped over the left, the body is then stretched in a way that the torso is splayed sufficiently that the cartilage between the ribs presents the maximum surface (so that the needle might avoid piercing the bone). The insertion area, about nipple level slightly to the back of the side, is then swabbed and numbed up with lidocaine, after the fashion of a dental visit (including the short, sharp, stinging sensation on the skin’s surface), after which a 1/8 inch incision is made to accommodate the needle. The patient then takes a half breath, blows out all the way and holds (so that the lung is not punctured and thus collapsed), at which point the physician plunges the ultra-thin trocar deep into the liver and extracts the sample tissue.

Now that I’ve set the scene, allow me to introduce the players. Upon entering, I’m greeted by the attending physician, Dr. K. (I don’t think the last name was Kervorkian), a resident, Ryan something, a nurse, and the infernal health wench that botched the blood draw. Then, using a magic marker to delineate the proper target area, the attending shows the resident how to locate the optimal point of entry. So here we go.

Patiently resigning myself to bend to their will, and donning an attitude of dutiful compliance, I steel myself for the command to take a half breath, blow it out, and hold it. The order comes. I blow and hold…whump…it’s just as I remembered it, or better, a reminder of why I had been so quick to forget it. Imagine a long ice pick heated up on an electric stove burner being suddenly plunged into your gizzard. It only takes a second, but what a second. The nurse says, “breathe, it’s over.”

The attending physician walks over, looks at the core sample and says, “not enough tissue. We’ll need to do it again.” I think, “Fuck you,” and silently resolve to stop everything and have them take me to the recovery area. But I don’t. Instead I say, “what do you think I am, ‘Moby Dick’?” The attending, with almost a glare, tells me he’ll do the procedure this time. With a twisted kind of a soulless half shit-eatin’ sadistic grin he says, “blow and hold.” He then plunges the trocar deep into my liver. The millisecond of blinded by the light pain comes again and is gone. “We’ve got enough now,” he says, barely concealing his glee at harpooning an uppity patient.

By the way, he says, as I’m wheeled out, “since we had to take two samples, you’ll be here four, rather than two, hours.”

Love - Randy