Minor intimacies: how queer, the blood draw

“Scratch the surface, and things get strange.” - Candace Vogler

Years ago, I glided needles into other people’s arms. This occurred approximately 6,000 times. As I drew the blood of 6,000 strangers, I’d think about intimacy. Since then, I’ve tried to look into the guts of that precise, bloody, and delicate relationship between my patients and I. This is an exploration of those guts.

Intimacy is tricky in that one can’t quite track it. Queer theorist Lauren Berlant explains that “intimacy builds worlds; it creates spaces and usurps places meant for other kinds of relation” (282). In other words, it’s messy. Specifically, intimacy in the space of a blood draw is a kind of excess. It exceeds the conventional dynamics through which one forms attachment to another. Berlant suggests that intimacy perhaps emerges “from much more mobile processes of attachment,” and continues that “while the fantasies associated with intimacy usually end up occupying the space of convention … it is a kind of wild thing that is not necessarily organized that way, or any way. It can be portable … a drive that creates spaces” (284). The kind of intimacy to which I am referring is wild, unpredictable, mobile. Its presence goes beyond, outside of, in excess of convention. And it’s born in a vein.

To pluralize and specify, as Eve Kosofsky Sedgwick’s Epistemology of the Closet advises, it seems important to be precise in this conversation. The intimacy in a blood draw differs vastly from socially legible intimacy within a couple or a family. Philosopher Candace Vogler explains the usual course of this known dynamic: “We let another within the boundaries … marked by clothing and by full self-control and monitoring. Through the layers of public defenses and faces, another is admitted to see a more vulnerable … you” (333). Vogler’s definition of intimacy implies consent between people, a willingness to engage in mutual vulnerability. Can the intimacy created by a blood draw be called consensual? Do the phlebotomist and the patient want there to be any intimacy at all? If not the legible sort of intimacy, what kind of intimacy is created when our “boundaries marked by clothing” are rolled up like a shirt sleeve in order to draw blood? “Full self-control” does not seem possible when another manipulates a sharp object in one’s body. Given these considerations, when I say that intimacy is created in the space of a blood draw, I do not mean that each party is actively attempting to make intimate contact with the other. I mean that a specific emotional landscape is entered, without warning, by two people positioned unequally in power.

To further specify, this kind of blood draw-specific intimacy should not be conflated with that of the medical institution at large. The distinction lies in how blood draws are uniquely represented as not worthy of note, minor, noninvasive. Unambiguously illustrating the steps in a blood draw, however, reveal that representation as false. Blood draws are inherently aggressive. The protocol, after the initial puncture, goes as follows. The phlebotomist tunnels a needle down, slicing through tissue until the needle’s bevel breaks into the top of a vein itself. At this point of entry, the phlebotomist attaches a vacuum tube to the back of the needle, and the subsequent negative pressure in the evacuated tube pulls blood out of the vein, into the tube, often rushing and splattering audibly.

The experience of hearing, seeing, and feeling one’s blood be pulled out of one’s body is no small matter. It is a visceral reminder of one’s exquisite materiality. Beyond the vulnerability produced by this knowledge, the phlebotomist is controlling the whole procedure. During the draw, the patient is helpless in the hands of another, hoping to be taken care of, and not hurt.

A phlebotomist meets another intimately while drawing their blood. Through piercing, they gain a physical knowledge of a person, at a vein level, whether the person wants them to or not. When I drew blood I would seek out the good veins, my fingers and hands exploring the patient’s arms, the crooks of their elbows, sometimes up their biceps or down their hands. I would press into their muscles and tissue, palpating for sponginess (a vein’s calling card). In case you, reader, ever find yourself drawing blood, don’t go by sight. The only way to be sure of a vein is to touch and press. This physical exploration of another is intimate because of its immediate, insistent contact with a stranger. And at the moment of the stick, the quick puncture imbues the space with queer intimacy. As Berlant states, “the immediacy of trauma is always sensual” (287). Especially because the power in this relationship is unequal and inflexible – the patient doesn’t get to draw the phlebotomist, after all – thickly complicated emotions present themselves on both sides. Sedgwick, in “A poem is being written” describes this sort of emotional underbelly as:

… a not unfamiliar mix of pain and anger and disgust, yes, and furtive arousal, also yes … (120)

So what is to be done? No legible social space exists for the phlebotomist and the patient to hold the queer intimacy – a mess of fear, responsibility, erotics, repulsion, care – created between them. “What happens to the energy of attachment when it has no designated place? To the glances, gestures, encounters, collaborations, or fantasies that have no canon” (Berlant 285)? Where can this “energy of attachment” go? Does this it grow sideways, like Kathryn Bond Stockton’s queer child? For in the back rooms, where the draws take place, queer intimacy makes itself known, and bubbles up in surprising moments of vulnerability: the phlebotomist tenderly cleaning a patient’s elbow crook with an alcohol wipe; rebandaging a patient who has bled through their gauze; the phlebotomist trembling as they slide the needle into the patient’s vein; a patient making eye contact with the phlebotomist throughout the whole draw.

After these exchanges, the socio-medical transaction of a blood draw, what do the patients have to bear? What is the residue of charged trauma? There is a physical reminder, of course, left in the crook of a patient’s arm. The puncture site, a small wound, marks the body. Those scars are proof of the intimate exchange – that something strange and real did occur here. But how are the emotions held?

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Very little has been written about blood draws, save actual venipuncture protocol and a few texts about bloodletting. But once, in “A dialogue on love,” Sedgwick writes about the experience and feeling of being drawn. In this piece, she expresses worry because of her bad veins, and the phlebotomist “plays darts” in her arm for awhile. As she almost faints from the unsuccessful sticks that drew no blood, the nurse takes her to a recovery room, “a long dim dormitory-like room, with beds on both sides … ” (629). Here they sit with each other, bound up in the queer, asymmetric intimacy of needing to take and needing to give up blood:

And she made me lie down, and she sat on the chair next to the bed. I could feel every pulse of her impatience. There was some rustling somewhere else in the room. Eventually my own heartbeats let go their grip of me, and I realized that someone was crying, trying hard not to be audible. Silent sobs, near-silent muted hiccups. Somebody else somewhere was whispering. I could almost make out words.

I could hear the moment when the nurse relaxed. When she realized that she'd never get blood out of me unless she could step away from the assembly line of her own temporality and simply stop. She silently put her hand over my hand on the bed.

I realized something, too. I had to stop hating her enough to give her the blood. Or it would all never end. I closed my eyes, withdrew my attention, tried to relax every muscle, tried to float freely away on the childish sensation of 'white bed'...

From her touch I could tell, now, that she meant to help me do it. (629; emphasis mine)

Works cited:

Berlant, Lauren, editor. Intimacy. University of Chicago Press, 2000.

Berlant, Lauren. "Intimacy: A special issue." Critical Inquiry, vol. 24, no. 2, 1998, pp. 281-288.

Stockton, Kathryn Bond. The queer child, or growing sideways in the twentieth century. Duke

University Press, 2009.

Sedgwick, Eve Kosofsky. "A poem is being written." Representations, vol. 17, 1987, pp. 110-143.

Sedgwick, Eve Kosofsky. Epistemology of the closet. University of California Press, 2008.

Sedgwick, Eve Kosofsky. "A dialogue on love." Critical Inquiry, vol. 24, no. 2, 1998, pp. 611-631.

Vogler, Candace. "Sex and talk." Critical Inquiry, vol. 24, no. 2, 1998, pp. 328-365.

Photo credits:

"Intimacy: A special issue." Critical Inquiry, vol. 24, no. 2, 1998.

cover: http://criticalinquiry.uchicago.edu/past_issues/issue/winter_1998_v24_n2/

Blood draw sketches: http://www.remotephcmanuals.com.au/publication/cpm/Collecting_blood_samples.html

#phlebotomy #AnneJohnson #blooddraw #power #intimacy #queertheory