The Vein Hunter

I am a vein hunter. A tracker of blood, a tribesman of the tributaries of the heart, a pursuer of the pleasures of deoxygenated blood.

Every day, I'm asked to find small veins in elderly people. They tend to be invisible, barely palpable, and wriggly. Holding them down to get a small needle in is like pinning down Harry Houdini on how he did his tricks, or Gordon Brown on when the next election is.

It sounds like a truism, but the real differences between junior doctors and medical students are actually quite subtle. As a student, I often tried to take blood or insert a cannula. But every time I approached a patient, it was with the knowledge that success would be a bonus rather than the expected result.

Now, even though the task is the same, I take three times as much equipment with me: come what may, I have to come away with the red stuff. Failure is not an option. I don't want my patients to croak before the ward round tomorrow. Neither do I want the indignity of having to ask a nurse to do it for me.

This constant focus on finding veins is disrupting my personal life. Tube journeys are nothing more than a prolonged look at strangers' hands. Same goes for parties and restaurants. Flicking through the tabloids over breakfast, even the more popular parts of page 3 girls get only a cursory glance before I assess their venous access. It's embarrassing.

Maybe it's just an obvious sign of a deeper malaise. I rush around without ever having the time to examine someone properly. Clinical skills teaching with the medical students on my team is about the longest I spend with any one patient. So it's not surprising I'm constantly trying to pick up things with simple observation.

This doesn't mean you won't be a little nervous if you catch someone on the bus staring at your hands. But maybe you shouldn't shove them in your pockets straight away. Try pointing to a vein, and smiling encouragingly. It'll make your junior doctor's day.

The Meaning of Pain

I have awarded Jenny a Pain ASBO. She is no longer permitted to complain about pain within a 1-mile radius of the hospital.

Before the PASBO, Jenny claimed it was agony each time I took her blood - despite my getting it first time, with a tiny needle, no digging around, in and out in 30 seconds. She found the experience excruciating, despite receiving the "Magic Cream".

The "Magic Cream" is a local anaesthetic that you can rub into the skin, deadening the nerve endings. It's used mainly in paediatrics, mostly because children like the idea of magic.

We all smiled when Jenny requested the cream - especially when she earnestly referred to it as "The Magic Cream". Jenny's a 60 year old lady, and you could hear the capitalised letters in her voice. We stopped smiling when we realised she was serious, and wasn't prepared to have any blood tests without it.

It's easy to envisage a world where hers would be a perfectly normal request. As people emphasise the importance of customer service in medicine, and patients become 'clients', the idea of leaving a customer in any pain at all sounds increasingly ridiculous. The hospital's Pain Team - a nurse-led conglomerate of specialised nurses and anaesthetists - even talks about the human right to be free from pain.

But pain, just like blood pressure and temperature, is a really useful indicator of how things are going. When the pain of the next blood test is the worst thing on the horizon - not the pain of the disease that brought you into hospital - things are actually looking up: you're probably getting better. So, whilst you're cringing at the thought of that needle, the doctor's cringing at the thought of the discharge paperwork.

I don't think being in hospital can ever be a totally comfortable experience. If you really wanted a relaxing couple of days with a good-looking man in a white uniform, you'd book yourself into a spa, not somewhere that looks like Wormwood Scrubs. Still, it needn't be agony. A quick chat with the medical team about how reassuring it is to fear the odd blood test should make things less painful all round.