Ready, Set, Jab!

Man developed survival instincts for a reason, and stabbing yourself with a needle runs counter to all of them.

A few months after I was diagnosed with rheumatoid arthritis in 2000, my rheumatologist put me on Enbrel, a relatively new drug at the time.  

Self-administered injectables

I was relieved and grateful there was a treatment option, as the oral medications I was taking offered me little relief from my symptoms.  However, still adjusting to the realization that I had a degenerative disease with no known cure, I was not overjoyed to discover that I would now need to self-administer injections into my body.

Overcoming the fear

The concept of subcutaneous injections was not new to me.  My sister was diagnosed with Type I Diabetes when I was five years old, and my mother said I struggled with all the changes that created for our family until she let me take a syringe (with the needle removed) to my kindergarten for show-and-tell. 

I witnessed my sister give herself injections in restaurants, airports, picnics, and in cars.  Knowing my sister had to administer multiple injections a day, the rational part of my brain told me that giving myself just two shots a week was no big deal, and that I would learn to do it as casually as my sister was able.  However, the part of my brain ruled by instinct was terrified.

My first injection

My rheumatologist at the time had a horrible bedside manner.  He gave me the briefest overview of how to administer the medication, and then sent me on my way to deal with my first treatment solo.  In those early days of Enbrel, quite a bit of preparation was involved.  First, I injected liquid from a syringe into a vial containing powder.  The concoction had to be gently swirled for several minutes (my swollen fingers and wrists objected to the repetitive motion involved in this step of the process) until no flakes of powder remained. 

Drawing the medication back into the syringe, I then tapped, tapped, tapped on the glass with my fingernail until all air bubbles were expelled.   My anxiety increased with each step.  After swabbing my skin with alcohol, the moment for the injection had arrived.  I held the syringe tightly in my hand, a bead of liquid emerging from the tip, and drew back for action.  Ready . . . set . . . no go.

During the arc of swinging the needle toward my body, I lost speed just approaching contact, and the needle barely entered my skin.  I tried to push it in further, but every cell in my body was telling me not to jab a sharp piece of metal into it.  I drew the syringe away, took a deep breath and tried again, and then again, and yet again.  No dice.

In need of help

Feeling cowardly and defeated, I called my sister for help.  Luckily she lived close by, and she told me to come over.  Doing what a pediatrics nurse had done for her many years earlier, she gave me a syringe and an orange and told me to practice on that.  She also explained that I needed to really make the first swing count, because the needle becomes dulled with each unsuccessful attempt, which in turn requires more force to get it deep enough into the skin.  Full of mercy, she then administered that first injection herself, and told me she was sure I would be able to do the next one.

It doesn't get easier

She was right.  Since then, I have injected myself hundreds of times, along an evolution of different biologic drugs and improved technology such as automatic injection pens.  However, after taking a four-year hiatus from treatment for two pregnancies and breastfeeding, I am now on Orencia, which comes in old-fashioned syringes.  Even after all these years, I still have to steel myself for each injection.  While injecting needles into my body has become routine, I have never been able to consider it casual.

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