When groin injection goes wrong

A cautionary tale by Max Alexander

There are some hidden dangers in this game we play with drugs. One nearly took my leg. I’ll share the tale, so hopefully you won’t hit the same pothole that I did.

The first warning that something was wrong came with pain deep in my groin. I was isolating in my flat at first, hoping it would pass by keeping my leg raised on some tattered throw cushions as the daytime TV fleeted by. But the pain persisted and got worse. I carried a degree of denial at first and projected my pain outwards with anger. First with myself, then with my family.

It was the night after I stormed out on my father one final time that I woke up and I could no longer walk.

Perhaps I should have made my own way to hospital to save the stress on my family, but I chose to call Mum and asked for help.

“I think I need hospital. I’ve done myself a mischief,” I said on the phone.

She sighed, but dropped what she was doing and came to help.

25 minutes later she pulled up in the back lane behind my flat, and I grabbed my keys and hobbled at a snail’s pace down the hall, swivelling my body to pivot down each step, one at a time, as I tried to navigate the few steps down to meet her.

I greeted her with another one of thousands of apologies she’s heard from me in her lifetime. She drove me down the road, navigating the morning traffic, and into the ER car park of a hospital that shall remain nameless.

Once I’d told the story to triage, how it all started with me carelessly hitting myself with needles in my deep vein and not caring about swabbing, how I’d hit the artery, and perhaps even injected some of my heroin and Unisom concoction into it. When I was finished my care was fast tracked. As I said, I’m a lucky boy.

As Mum hung back in the emergency waiting room, I was wheeled in by a hospital porter to get my leg ultrasound. The gel was cool on my thigh, the dull pain became extreme when the operator pushed the handheld device deep into my flesh right where I’d done the damage.

“Does that hurt?” She asked.

“Yes,” I responded curtly, confusing stoicism with surrender, or surrender for stoicism.

She had a serious look on her face as she looked into the monitor.

“Will it be okay?” I asked. This was the final fork in the road in my diagnosis.

“It’s serious,” she replied. A ball of despair lodged in my throat.

“You’ll need emergency surgery. I just have to type up this report and we’ll get you moving.”

This was the point I surrendered, like when I’d had psychedelic trips that went sideways on me in my youth, and needed to remind myself it would pass. Time to let go, hand my care over to others and hope for the best.

The ultrasound done, I was wheeled out back into my ER booth. They needed to take blood but that, of course, was a nightmare. First a nurse tried but could only get a dribble out of my hand with a butterfly.

“No access,” I heard her say to the other nurses after three attempts. It was time for the nurses to call in a more expert hand.

My surgeon introduced herself. For the life of me I can’t remember her name, but I’m forever grateful to her. She used a hand-held ultrasound device to put a cannula into one of the untouched veins deeper in my arm. Still, the blood came with a trickle. It was a disaster in the making, but she got just enough to send my samples up to pathology. It wasn’t long before she returned with the news.

“Your infection markers are through the roof. Honestly, I don’t know how you’re not sicker than you are right now. You’re a very sick boy. Ultrasound found an aneurysm the size of a golf ball in your femoral artery. We’ll need to do surgery and I’ll be honest with you: it’s a high-risk procedure. You were likely not clean and sterile with your injecting and didn’t use swabs.”

My mind flitted back to the evening I think it started when my hands were shaking so much from my medication regimen that I hit my artery. Of course, I was so impatient to get my fix in me that I didn’t bother with swabs. Bad mistake.

“We’ll need you to be CT scanned as soon as the room’s available, so we get a better image of what we’re dealing with.”

At this stage my mother came in, and I let her know the bad news. A forlorn expression fell on her face. “Why do you do this to yourself, Max?” she asked, picking at a cuticle on her finger.

The surgeon introduced herself to her, and they talked among themselves as my head ran off on a tangent, asking myself the same question.

A porter came in, and my ER bed was wheeled into a room with a cream-coloured donut shaped machine with a GE logo, and some radiologists sitting behind a window. It was time for my CT scan. A radiologist came in to briefly explain the procedure.

“Now, this device will pump some radioactive dye into your blood so we can see your injury better.”

My arm vein got hooked up to a transparent plastic tube leading upwards to two huge cylinders with two different coloured liquids. One clear as water, the other with a radioactive yellow hue. They shuffled me from my ER bed onto the white platform extending from middle of the donut.

“We just have to leave you in here while the procedure happens. We’ll be just behind the glass,” she informed, motioning to the big glass wall on the side of the expansive room. “This won’t be long, and try to keep very still and keep your leg as straight as you can.”

“Easier said than done,” I replied, “But I’ll try.”

I kept my leg dead still and straight as I could despite the pain, as the hum reached a crescendo. I saw light flash indicating the radioactive dye was about to be pumped into my arm.

Immediately my arm bulged like a balloon. Something was wrong. It hurt a lot. I called out to the radiologist.

The machine stopped immediately, and the radiologist came in and inspected my arm.

“Your vein rejected the dye,” she informed, then quickly walked out, fetched an ice pack and returned to reduce the swelling. She called the surgeon and informed them of the problem.

The surgeon seemed annoyed.

“That cannula was perfect,” she said as she got out her handheld ultrasound, to repeat the process.

Again the staff left the room, leaving me alone in the behemoth machine. Again my arm blew up like a balloon.

“Your veins really don’t like this dye,” said the exasperated, but professional surgeon. This clearly wasn’t her first rodeo with an IV drug user. “We’ll need to call in someone from anaesthetics.”

I expected one person, instead I got a whole team. It turned out there were a couple of anaesthetists who wanted to watch one of their colleagues work. I didn’t really mind though. I was just grateful to get care.

He put in a PICC line, which is a line that required an incision in my arm that fed through a deep vein, and near my heart to deliver medication where my veins were larger.

Finally the CT scan worked, and the surgeon got the images she needed. It was time for my anaesthesia. A porter wheeled me to a small room with a thick metal safe attached firmly to the cream-coloured wall, and the anaesthetists got to work.

“Have you had any issues with ketamine in the past?” One of the anaesthetists asked me.

“No,” I replied, conjuring up in my mind the numerous K-Holes I’d been in over the years. I was about to be spoiled a bit. The three anaesthetists worked together in unison, each grabbing vials of various sorts, creating a concoction.

The surgeon came in with a clipboard and some paperwork. She could have easily just said “sign your life away”, but she was compassionate and intelligent enough to show more tact.

“This is your consent for surgery form. You need to understand the possible outcomes of this procedure. Max, you need to understand that you might require amputation, or you could lose your life. This is a serious procedure. We may also need to leave the surgery wound open and unstitched so you can pack it with silver gauze to prevent re-infection.”

“Okay doctor. Take care of me,” I replied, signing at the dotted line.

“That’s what we’re here for,” she comforted.

I overheard the anaesthetists say the word “midazolam” as they plugged a syringe into the port on my PICC line. This was it. Possibly my last hit. I looked down to my leg, and ran my hands down my thigh, feeling the hairs under my palms for what could be the last time. Then I went blank.

I remember waking in a large room with my mother sitting at the end of my bed, picking away at hairs on a cheap black and round plastic hairbrush that I’d taken from Woolworths in one of my petty thieving sprees. My mother’s anxiety always presents with cleaning or picking. It appeared she was doing both.

“Mum…” I uttered.

“Hi Max,” she replied. “You’re okay.”

I looked down at my leg. It was still there. I was still too groggy and drugged to feel gratitude. I looked under the crisp, white hospital bed sheet. There were two white dressings covering 8 inches of skin extending down my right groin and upper thigh. The wound must have been stitched up completely, as I couldn’t see any open wound.

Mum came to sit by the side of the bed.

“I brought some clothes from home.”

One of the nurses from the hall noticed I was awake and came in.

“Welcome back to earth, Max!” she exclaimed.

“Barely,” I slurred in my haze of residual anaesthesia.

She inspected the dressings, and pointed to the machine to the left of my bed that was patched by clear plastic tubes to my drip bag.

“Max, this machine delivers your pain relief. If you start feeling breakthrough pain, press the button and you’ll be delivered some Oxycodone to help.”

Needless to say, I smashed that button relentlessly all day until I was nodding. So much so, the nurses took it away from me and took back control of my pain management.

I stayed in ICU for one more day, before being moved to the cardiology department where I shared a room with an elderly woman who’d lost half her leg to diabetes. Despite her awareness of my drug use, we became quite friendly during my stay.

But my recovery was slow and arduous. I still had to stay on IV antibiotics for a month. While this could be done out of hospital, with nurses visiting me at home on a daily basis, they expressed extreme reservations over the possibility that I would end up using the PICC line to inject street drugs. “Max, if we’re going to let you out of here, you have to promise not to use recreational drugs with the PICC line.”

“No, no way!” I replied.

The thought hadn’t even crossed my mind although it did after she told me not to. Tell me not to do something, and I’ll probably at least consider doing it.

Thankfully the stars aligned, and a bed opened up for me in the detox facility that adjoined the hospital. I ended up staying there for close to a month, over which I had to carry a transparent plastic pack in my pocket that delivered strong antibiotics into my bloodstream 24/7. It made me feel sick, and need to go to the toilet constantly, but overall I didn’t feel too unhealthy.

One of the most depressing days of my recovery was when I first went on a walk outside the detox facility. I just couldn’t keep up with the other people walking. Up-hill, my leg would run out of gas after 10 metres. The realisation caused my stomach to drop.

I wondered if I’d ever walk properly again, incapable in the moment of being grateful to at least still have my leg … and my life.

If there’s one lesson to learn from this, it’s that swabs are there for a reason. And that groin shooting’s bloody dangerous. So please, play safe everybody. Swab up before you hit-up and stay alive. Your limbs will thank you.