Vein Cutter

Carly had not known what the job was – even what the word meant – when she read the ad in the paper for a phlebotomist. She just saw that they offered training and some benefits, it was part-time, early mornings, and paid twice as much as her job at the mall. She was a morning person, and she had to do something to pay for college. Butler University was not cheap, nor was the Indianapolis apartment she shared with two other students.

After graduating last year – The Class of 1983 is Free! – she had worked two crummy jobs at the mall before beginning college. Funds were short. Worried that the hospital job was just a fancy name for something involving bedpans or mopping, she picked up her large dictionary from the floor and sat at her tiny desk. She pulled a strand of her long, curly hair under her nose and smelled it. It was an old habit, a comfort for her to smell the mix of her conditioner and the chlorine from swimming. It always made her happy and centered.

She opened to the correct page. The word meant “vein cutter” or “the therapeutic practice of opening the veins to draw blood.” That, she figured, for the money and the benefits, she could do. She sent in her thin resume.

The hospital called the next week and interviewed her that very afternoon. They scheduled her training for Friday morning and she would begin work immediately afterward. Carly moved one class around in her schedule and relaxed about her finances for the first time.

On Friday, Carly woke before her alarm went off and slipped into her swimming suit. She swam twenty laps most mornings in the small, heated pool at her apartment complex, changing strokes every five laps: breast, crawl, butterfly, backstroke. By finding the slipstream in the pool – that space the water made for her, through which she glided feeling the life in her limbs, the breath in her lungs – she found the rhythm of her day. She would release her long hair from the swimming cap for the last five laps, the backstroke, just to feel it stream through the water.

“If it feels like a worm, stick it. If it feels like anything else, don’t,” Phyllis said as she pressed on the inside of Carly’s elbow with her bare, chubby finger. “Feel here,” she said, and Carly felt her vein, like a worm, full of backed-up blood because of the rubber tourniquet on her upper arm. Carly nodded and Phyllis slipped the needle beneath her skin. “Keep the bevel of the needle up, okay? The cut part, so you can see the hole.”

The training consisted of Phyllis drawing Carly, then Carly drawing Phyllis. Carly got her on the first stick, something that Phyllis said hardly ever happened. She showed Carly the paperwork. Gave her a little chart to carry around in her used lab coat explaining which color-coded tube to draw for each test. Then she sent her out to the hospital floor on some easy draws.

Carly had liked that first day, had not missed one vein. She liked gently waking the patients, talking to them softly as she turned their hands to check the identity on their wristbands. The patients, especially the elderly ones, liked this touching, the gentle talking. Carly felt like a parent, holding their hands through something scary, telling them it would be all right. She found that she liked the work, liked pulling her long hair up into a winding bun at the base of her neck so it wouldn’t be in the way.

A few weeks later, Phyllis called Carly aside and pulled out a different phlebotomy kit. “Called a butterfly,” she said. “Smaller needle for hard draws, tubing that spaces the needle from the tube attachment at the other end, see?” Carly nodded, figuring it out. “With this, you can draw from the back of the hand or the ankle of a psych patient in restraints. Go in at all sorts of angles, tape the needle down if you have to, fill the tubes away from a thrashing patient. Works for kids, too. Little veins, little needles. Sometimes I just leave it with the junkies, though, if I can’t find a vein that’s not totally blown. They know every vein on their body. You probably want to leave the room. Unless you want to see an addict draw blood from his groin.”

Carly blinked.

“You’ve got a feel for this,” Phyllis said. “I’m sending you on the harder draws and want to know when you miss. Oh, if you have to draw a blood gas, draw it from the pulse artery in the wrist.”

“The pulse artery?” Carly asked.

Phyllis grabbed her wrist and took her pulse. “Here. Kind of shallow. Watch out for tendons and nerves. This is the radial, I think. There’s a book in the break room with pictures. Blood gas tubes have to go on ice, like ammonia draws, okay? Run them quick to the lab.”

Carly nodded and Phyllis left the room. Carly attached the end of the butterfly tubing to the collection chamber, and tied a tourniquet around her left wrist. She chose a small vein running on the side of her knuckle and wiped it with alcohol. Then she unsheathed the tiny needle and slipped it into the raised vein. She pressed a red-topped tube into the collection chamber and watched her blood snake several inches before filling the glass tube.

She had asked another phlebotomist, Sara, how that happened, why the blood squirted into the tube. Carly thought it was the pressure of the backed up blood. Sara didn’t know. Carly uncorked an empty tube and felt the sucking of the air: they were empty, evacuated of air, which is why they pulled the blood out of the patient. Carly remembered an experiment in her senior high school science class. The teacher had placed a ringing, battery-powered alarm inside a sealed bell jar, then he turned on a vacuum pump. As the air was removed from the bell jar, the sound dulled, then went silent. Carly was astounded because she could clearly see from her seat in the front row that the hammer was still madly banging on the silver bell. “Air conducts sound waves” was the lesson, and the absence of air pulls blood. She tried to tell Sara, but she didn’t care. It was just a job to her, and if she had a hard draw or even thought someone would be difficult, she called Carly.

Eventually, Sara started getting to work five minutes early to sort the phlebotomy slips before Carly arrived, giving her all the draws in pediatrics, all the psych patients in lock-down, all the addicts with their blown veins. These five minutes saved Sara hours of work and the screams of the little kids when she missed and had to stick them again and again and again.

Carly’s life fell into the easy rhythm of swim, work, classes, study. She even took shifts on the weekend to keep most of the rhythm intact. She enjoyed her life separate from her parents on the farm, on her own, where she could think about things. At the beginning of her second year, Carly changed her major to biology. And she picked up the list of suggested courses for pre-med students.

At the end of Carly’s spring term, Phyllis called a meeting of the phlebotomists in the break room. Phyllis stood squashed in the far corner nervously shuffling some papers. Carly sat by Sara at the wobbly table. Sara alternated between yawning and sipping on her coffee. Phyllis counted to make sure the seven phlebotomists were there, then passed around a piece of paper.

“Sign your name so they know you heard this talk,” she said. The paper circulated slowly as they read the heading: Precautions to Take When Drawing High-Risk Patients.

“I hate these in-services,” Sara muttered as she signed her name. She seemed to be the only one not stunned by the title, but that was because she hadn’t bothered to read it. Smiling seductively, she handed it off to Paul, a cute guy who was just hired.

“Seems one of the addicts up on seven has that new gay disease, so we’re implementing new procedures for all druggies and gay guys. Got to wear gloves now for them.”

“I’m not wearing gloves,” Paul said, “Can’t feel the vein properly.”

“Well, I’m not drawing any fags if that thing is catchy,” Sara blurted.

“People,” Phyllis said, “the word is that gay sex gives you the gay sickness, but it seems to be able to spread in the addicts because of the shared needles. So, it’s only logical that we can get it, too, if we get a dirty needle stick.”

Carly raised her hand and Phyllis looked at her. “Can’t the needle just go through the glove?” she asked.

“Sure,” Phyllis replied. “Double-glove if you feel safer.”

The next week, Phyllis discovered Sara sorting the draw slips, putting anyone she thought might be gay into Carly’s phlebotomy caddy. Phyllis implemented a random shuffling of the slips, a roulette of diseases, and Sara quit. Carly didn’t mind the sorting. She liked a challenging draw. She didn’t mind drawing the little kids, the psych patients, or even the one addict who had the strange new disease. He was just a boy, sixteen. She worried for him. She could see the pounds melt off him day by day. But, she had a sense that he would be okay, would recover, because he hadn’t done anything other than used a needle that a gay person had used. She was startled the next week when she went to his room and found a janitor mopping with undiluted bleach, wearing gloves and a mask. The boy had died in the night and no one had cancelled his blood work.

By the middle of her junior year, Carly was promoted to training the new phlebotomists. Next to Phyllis, Carly was the most senior person due to high turnover because of the ninth floor. That’s where the gay men were kept. Paul had called it the “fag floor” when he quit, saying he refused to go up there, that we should let them die, that they deserved what they got, and why should we foot the bill for their deviance? Carly knew that Paul was from a conservative Christian family with strong, unyielding convictions about what was "right" and what was not. It seemed to Carly that he had tried to get Jesus into her heart right before he tried to get into her pants. She had resisted both intrusions.

With her added responsibilities at work and heavier class load, Carly barely had time for a social life. Not that she missed it much. She had dated around a bit early on in college, had gone with a couple of guys for a couple of months, but nothing seemed to stick with her except the swimming, the phlebotomy and the studying. She liked the rhythm, the stroke of the day, the gliding through the water, slipping the needle in the vein, sliding the knowledge into her brain. She saw her friends at lunch and that was enough.

Sara surprised her one day by sitting down at her lunch table. She was taking classes at the college to finish her degree while she worked back in retail. “Can’t believe you’re still drawing blood,” she said.

Carly blinked. “I like it.”

“Yeah,” Sara scowled. “You always did. How’re you handling the fag floor?”

“Please don’t call it that,” Carly said.

“Heard you got fifty guys up there now, all having sex with each other.”

Carly was stunned. She remembered drawing the seven young men that morning, how this particular group seemed to be evenly spaced out along the quick path from infection to death. One boy was newly diagnosed, would probably be released tomorrow with medicine for the strange infection in his mouth. He was scared. She followed procedure by wearing gloves when she drew these patients, but only put them on after she had done all of the tasks up to slipping the needle into their vein. The boys seemed so scared, so hungry for reassurance. She would check their wristbands and gently inspect both arms for the best vein and tie the tourniquet all before gloving. This seemed to fulfill a little bit of that need to be touched that the boys felt so acutely now that no one would ever touch them again because of the virus within. They knew it was a virus now, researchers had discovered it. She wished she didn’t have to wear the gloves at all, but it was a regulation, though one that made no sense to her. The needles were sharp, beveled and pointed. Carly knew that a needle would pierce a glove as easily as it plunged through the skin to the infected blood that flowed within their veins.

The last of the seven patients was at the end of the disease process and would probably not make it through the night. She had to wear a disposable gown and mask in his room because he had a strange pneumonia. Carly had gloved up even before entering because he was in a coma, lying skeletal on the bed, unable to feel the touch of her soft fingers on the back of his hand where she found a tiny vein. She slipped the butterfly needle into the space in the center of it where the blood, ravaged and dying, slowly pulsed.

“There aren’t fifty,” was all Carly could muster in response to Sara.

“They brought it on themselves,” Sara hissed as she picked up her tray and stomped away.

Carly didn’t see it that way, but knew many people did. She wasn’t sure how she saw it. She remembered the first scared addict boy and knew she would have to think about it some more. Smokers up on three seemed to get more sympathy than the guys on nine, though the situation seemed the same: risky behavior linked with disease brought consequences. Carly reasoned that smokers got lung cancer, gays got the deadly virus, but she couldn’t understand why only the gay men were so reviled.

The jokes in the lab were brutal; Carly had to leave the break room when she heard someone begin to tell the latest one. She could not separate the faces of the scared boys from the jokes. The punch lines bruised her.

Carly had gotten close to two of the young men up on nine, Steve and Thomas. They called her “Carly Simon” because of long, wavy hair and made a game of talking to her in song titles.

“‘Carly Simon!” Steve would say.

“‘Embrace Me, You Child!’” Thomas would say, giving her a hug.

“Sorry. I have to draw you guys again,” she’d say, laughing.

“‘Anyone But Me,’ girl!”

“You have to hurt,” Thomas would say to Steve, “to understand, have to get by the best you can…”

“Beep! Violation! That’s a lyric, not a title!” Steve would giggle.

She had thought they would somehow make it, fight it off together. They were lovers and also the best of friends. They had pulled together when they found out that Steve had the disease, and had stayed together after Thomas was diagnosed.

Over the months of repeated hospital stays – first for Steve, then for the both of them –they drew her into their lives, their confidence. They were her friends. They dealt with the disease with humor. And they dealt with each other with a love that she had never, ever seen in her parent’s long marriage.

One evening she returned to hang out with them. She heard music in their room and saw them lip synching to Carly Simon’s “Hold What You’ve Got,” vamping up the spoken parts about holding on to your man, then dancing close and singing the refrain together at the top of their lungs. She watched them through the slit in the door until the end of the song when they gently kissed. She backed away, feeling like she had seen something almost… holy.

There was tenderness between them that made her break down and cry one evening when she had returned to play cards with them. They had embraced her until she calmed. She could not understand the injustice of this disease nor how they could still love so beautifully through it.

Steve had pushed a loose strand of her curly hair back behind her ear. “Hey, Carly, don’t cry. We ‘Haven’t Got Time For The Pain,’” he whispered.

Thomas playfully punched him in the arm and said, “No more song titles! This girl’s ‘In Pain!’”

The three of them laughed together. “It may be impossible to have a conversation without her songs,” Carly said.

“Well, you just did it, girl,” Steve said, wiping a tear from her cheek with his skeletal hand. “Talk. We’ve ‘Got Time—”
“For The Pain,’” Thomas finished.

They had talked and laughed until her morning shift began. They shared all their secrets. They talked about their families, how they were cast out for different reasons, the men because they were gay, Carly because she chose to pursue a life of the mind instead of marrying the neighbor boy and staying on the farm.

“Damn cow town,” Thomas said when he heard where she was from.

“Will you stop!” Steve said, winding himself with the force of his words.
“What?” Thomas asked.

“That’s a Carly Simon song! ‘Cow Town’ from her 1976 album!”

“Seriously,” Thomas said, “I think you’ve listened to too much. I’m cutting you off.” Thomas looked at Carly. “Your parents. They’ve got to be proud of you, right?”
Carly nodded. “I guess. I’ll be the first in the family to get a college degree. I haven’t even told them I’m thinking about med school. That would blow their minds.” She smirked. “They worry about me living in the big city. That it will contaminate me.”

“Indy? Big?” Steve chuckled.

“Yeah, how are you gonna keep the kids on the farm once they’ve seen Indianapolis,” Thomas added, throwing his arms wide, “the Paris of the Midwest!”

With morning approaching and Steve sleeping, Carly kissed Thomas on the cheek, then put a gentle hand to Steve’s thin, scruffy face. She left to begin her rounds drawing blood as the moon set.

When Thomas checked on Steve as the sun was rising, he found him inert. He had died in his sleep from a brain hemorrhage. Thomas scooped Steve up in his arms and stepped out of the large window at the end of the hall on the ninth floor, still cradling him against his chest, his cheek pressed against his lover’s cooling face. They mashed together on the roof eight stories below. And, since they had not landed street level, the hospital administration was able to keep it pretty quiet. They quickly and permanently sealed all the windows on the ninth floor.

Carly had not heard about it; she had seen it. She got off the elevator, holding her phlebotomy caddy filled with tubes with color-coded stoppers. She watched Thomas walk down the hall carrying Steve. She saw him lift the window sash with his foot, then his hand, and she thought how odd it was for him to be holding Steve like that, that he should be in bed so she could draw his blood. The sky was golden that morning, looking more like a sunset than a sunrise. Carly was struck by the beauty of the golden light on the lovers. It was as if their love was illuminating them. Her thought as Thomas stooped and stepped out onto the ledge was that they were going to fly away together to a better place.

And, when Thomas stepped off the ledge cradling Steve in his arms, they did.

They were showing up in her dreams now, calling to her to play cards, asking about their white blood cell counts, cracking jokes about their predicament, and singing, forever singing to each other. Carly still drew blood from the guys up on nine, had assigned the floor to herself to spare the young men the insults and sneers of her co-workers. But she began to glove up earlier in the draw, didn’t touch them as much. She knew this virus was a death sentence and didn’t want any more of them crowding her dreams.

Carly backed the final tube of blood out of the needle holder. The tube had a lavender stopper, so she inverted it twice to mix the thin blood from the comatose patient with the anti-coagulant. She slipped it into the caddy next to the other five tubes she had drawn from this man so close to the end of his young life. She placed the folded square of gauze on the crook of the man’s arm as she withdrew the needle, and pressed down. She taped the gauze on his arm before picking up the cap and lining it up with the tip of the needle. It was at that moment that the patient’s arm that had been so lifeless twitched just once, bumping her hand, causing her to miss sheathing the needle with the cap. Instead, she plunged it through the glove and deep into her finger.
For a moment it seemed unreal, impossible. It was only when the red blood bloomed beneath her glove that she was forced to deal with the shattering reality: she had been infected.

A nurse found her standing at the patient’s bedside, shaking, unable to speak, and pulled the needle from her finger. She guided Carly down to Phyllis and reported what had happened up on the ninth floor. Phyllis began the reams of paperwork and started the procedure for testing and tracking the rapid progression of the disease.

Phyllis assured Carly that the hospital would stand beside her all the way. That she would be treated on the ninth floor where she had worked these past years.
“But you can’t draw blood anymore,” Phyllis told her, “I’m reassigning you to specimen processing. No more patient contact.” Then Phyllis left the room because she wasn’t one to cry in front of other people. Carly cleaned out her locker, then went home. She ignored her studies and classes, and fell into a deep sleep.

Before dawn the next morning, Carly went for her swim. She set her rolled towel down at the end of the pool and touched the water with her hands. It felt warm compared to the cool morning air and she slipped into it, grateful for the intimacy of the water’s touch.

Carly began swimming laps, first the breast stroke, her breath puffing fog in front of her in the cool morning air, the steam rising off the surface of the water. Next, the crawl, her face in the water for two strokes, breathing on the third. Then five laps of the butterfly, her body undulating, her arms slicing the water, her body firmly in the slipstream now. After those fifteen laps, she surfaced at the end of the pool and pulled off her swimming cap. She released her hair and shook it out behind her, feeling the thousands of strands divide by the trillions of water molecules like fingers stroking, touching it.

It is an easy thing for a phlebotomist to find veins and even arteries. She unrolled her towel and found the scalpel. She had spent many breaks studying the book with drawings of the circulatory system. She had felt the pulse in the major arteries in her body. She located and opened the shallow ulnar and radial arteries on her left wrist. Then she located the radial artery deep in the inside of her right elbow and plunged the blade deftly down, bisecting it. She removed the blade thinking that she would also have to cut the femoral or subclavian, but her blood pulsed into the warm pool with each rapid beat of her strong heart and she saw that it would not be necessary. She released the blade and watched it sink, twirling to the bottom through the tinted water.

She had only five more laps. Backstroke. She pushed off the side and glided on her back. She watched her arms rise above her, illuminated by the pool lights and the early morning bounce of the sun off the edge of the earth. Her arms were streaked red. She could feel her life pulsing out of her. Her breathing got shallower as she made the second turn underwater, eyes wide open, the pool now a rosy pink, a cloud of darker red swirling around her. She thought it beautiful. She surfaced and stroked along, trying to find Mars, the red planet. Finding it after the last turn, she kept her eyes on it as she sighed, then submerged.
She saw the future.

She watched the moving vans take so many people away from the complex. She saw them drain the pool and fill it with earth and plant a tree in the middle of the space through which she once glided with such ease. She watched as the roots of the tree pushed through the soil slowly, slowly, slowly, finding the slipstream between the grains of earth.

Loreen Niewenhuis pursued a life of science, getting a Bachelor's, then Master's of Science degrees. She worked in a hospital laboratory, basic animal research, and as the Research Coordinator for a bone marrow transplant group before returning to get her MFA from Spalding University. Her short story collection, Scar Tissue, was a finalist for the Flannery O’Connor Award.