Five Quarts_ A Personal and Natural History of Blood - Bill Hayes [16]
“The garbage?” Steve pulled back, appraising me. “Oh, the trash man’ll love that.”
Steve went silent, clearly expecting me to speak.
“I’m so sorry,” I responded. “I—I’m an idiot. I didn’t sleep. I—”
“Look, I’m glad you’re all right. But . . . do I have to hide these?” He tapped the box.
I didn’t reply. I was still checking Steve’s math in my head. “Eight in the bag? Are you sure that’s right?”
He walked away from the table. “Count ’em yourself.”
I counted. And did so again, later, while Steve went to Walgreens to get a Sharps container. Still, it took me a couple of days to shake the conviction that I’d used a dirty needle, that I might be HIV-infected. Likewise, it took Steve as long to understand my reaction, why my fear lingered. I felt as if I’d nearly been in a car crash, I was finally able to explain to him. And even though I knew I was perfectly safe, I could still hear the screech of tires, still feel the blood rush from the near hit, my pulse racing.
When declaring a person clinically dead, the attending physician or EMT must note in writing that there is no pulse. The carotid artery, just below the curve of the jaw on either side of the neck, is the site most often felt. The pulse is both the last and, in the living, often the first of the vital signs checked. It is the heartbeat by proxy, each throb caused by the powerful contractions that propel oxygenated blood out into the arteries. This outward surge of blood carries such force that the vessels swell to accommodate it; hence a palpable, visible, sometimes even audible pulsation. In all, seven pairs of arterial pulse points dot the human body: at the neck, inner elbows, wrists, and both sides of the groin; in the pit of the knees; behind the ankles; and atop the feet. Typically, arteries are buried deep within the body, but at these points they lie near the skin’s surface and over a bedding of bone. This makes them ideally situated for palpation, examination by touch.
In American Sign Language, the sign for “doctor” is the finger-spelled letter d tapped inside the wrist, which captures in a simple gesture the most fundamental part of a medical exam, the iconic act of taking the pulse. Performed in every culture, this basic diagnostic test is as old as the practice of healing itself. The careful placing of two or three fingers along a tiny stretch of artery used to be considered an art form, a notion largely lost in the mad shuffle of contemporary health care. One needs to page back a good hundred years or so to rediscover a time when this vital sign retained all of its, well, vitalness. I’ve found no more erudite an advocate than Sir William Henry Broadbent, personal physician to Queen Victoria and author of a unique monograph, The Pulse (1890). In its pages Sir William is a spirited defender of what he calls “the educated finger.” In an early passage he subjects the wrist and its pulse point to a curious clinical analysis, as if describing a patient with an odd case history. He is long-winded, but endearingly so: “At first sight it seems strange that the radial artery, which supplies [blood to] merely the structures of a part of the hand—a few small bones with their articulations, a few muscles and tendons, the skin and nerves distributed to it—should afford the varied and far-reaching knowledge we look for in the pulse. The hand is not essential to life, it contains no organ of any importance, and a priori it might have been supposed that the variations in the circulation of the blood in so small a member could have no significance.” There is little about this passage I do not love, from the doctor’s crisp visual dissection to the delicious irony he’s blinded to in his academic fervor: If not for the irrelevant hand, he could not even take the pulse, let alone write about it. But I digress. The distinguished doctor, who’d practiced medicine for more than thirty years by the time his book was published, goes on to state without equivocation that the wrist pulse is a “trustworthy index,” a reliable gauge for the