Papery skin that bruises if you so much as look at it is surprisingly tough when it wants to be. The mess of haemosiderin in varying stages of decay splotched over cubital fossas and the cool flaccid turgorless dorsal surfaces belying the sheer grit of vessels that stare down the tip of my guide needle and dare it to pierce the flesh. And yet, even as I push and pull and prod, probe in one hand, fingers nimbly dancing with needle, each subtle stroke as with an épée, those who have most to complain about so rarely do.
"I'm Jennifer" I say brightly, clacking into the rooms with my very high heels and my pretty dresses and the hair that refuses to behave and ruins the whole effect, "I'm one of the doctors". And so many of them, on hearing this, relax straight away. As if those letters after my name actually mean something tangible and meaningful and that the fact that I'm about to poke them with sharp things is not something to worry about.
Sometimes I sit on the end of the bed, and have a chat about what we're about to do. Sometimes I chat while I'm washing my hands. Sometimes I hold onto the papery mottled hand and smooth out the bruises and cluck while vowing to not put another purple mark on skin that is so fragile and yet so tough.
Sometimes as I explain, the fear creeps up over skin, especially in those that are younger and the thought of pain has them recoiling from me while sheer force of will keeps them stoic. Some want to see my tiny needles and are reassured. Some screw their eyes up tight and look the other way.
When I am chasing a lesion - a mass of cells that doesn't look quite right - I turn the screen towards so that they can see too. They're there and they're part of this, it's not right for me to hide it from them. "See that white line in the middle of the screen?" I gesture as I hold the probe in one hand and point awkwardly with the other. And there's a definite pride that almost everyone gets when they realise what they're looking at, as I describe the bits that are important. And while almost no one wants to watch the needle or the biopsy gun pierce their skin, often they will be riveted to the screen as the sharp white line of my needle comes into view and reaches the mass of cells that they can identify too. Solemn quiet until the sharp click of the trigger as I withdraw.
"That wasn't so bad" is one of the commonest responses I get. But the one I get most is often "Thank you". I find it awkward when I'm thanked for hurting someone, because there are always bits that are a little bit painful, but I always hope that it hasn't caused fear and that the things I've explained, and described, so that the unknown ghosts can be chased away a little have helped.
Sometimes the response I'm given is that "That looks easy" and in some ways it is. It only takes a steady hand and some coordination. A bit of training and an understanding of the anatomy so that my needle pokes into the mass of cells and not into an artery or some such other important structure. And as I switch between hands, sometimes left dominant, sometimes right dominant (I'm sure the nurses think I'm doing it just to confuse them) it feels easy now. My needles go where I want them to go and I'm quick. I'm quite proud of that, because the frustration that gathered between my eyebrows the first few times as everything felt clumsy is largely abating. Sometimes things are harder, and I bite my lip and frown at the screen and fiddle with the dials until things look better, but I no longer feel like I'll never be able to do this, because I know I can.
And when I see my neat little purple line, exiting through the tiny hole in the skin; and the antibiotics can be hooked up or the chemotherapy started and my neat clear dressing is snapped into place and I don't see any bruises, I feel ridiculously satisfied. When I've applied my clean white dressing over the single tiny hole that leads to the subacromial bursa my pride gets a satisfied pat. Or when I'm standing next to my machine after the biopsy is all done and I can point with unsterilised hands to the point where my needle went in and the picture of how close we were to the artery or the nerve or lung or aorta but how I could see where I was all the time so that I wouldn't cause any harm and that look of amazement crosses both our faces, as we realise what we've both just achieved, I know that this is all very worthwhile.
I help. I heal. I still hold hands. I still explain even if it takes too much time. But most of all I love what I do.