[Ann Emerg Med. 2009;53:827.]
It was the tiniest of mistakes. A mere slip of the wrist, or was it the fingers? I can't really remember; it was such a brief millisecond of time. But I felt the hint of a prick on my finger and saw the jagged edge of a rent in my glove. I discarded the needle, pulled off my glove, and stared at the small drop of red on my flesh. My blood? Or his? Endorphins surged through my body, making my scalp and toes tingle, but they weren't the good kind like after running or sex or good news. They were the scary kind, the kind that make you say, crap, now what do I do? So to stall and to give myself time to think and to try to figure out what next, I washed my hands (plus, that's just the right thing to do when you don't know if it's your blood or his). I scrubbed and scrubbed and then I squeezed and squeezed and for the life of me I couldn't see any more blood in that same spot. Did that mean that tiny, tiny needle hadn't actually pierced my flesh? Or was the opening to my body so small that it had already clotted over, quickly fixing the break in my barrier against the world, but only after his blood had comingled with mine? I ran through his history in my mind. Well, not his history, just the facts and studies that we doctors deem worthy as we pass on the paragraphs of our patients: “57-year-old male with a medical history of end stage renal disease, congestive heart failure and hypertension here for increasing shortness of breath. Also, questionable history of hepatitis C.” Crap. Crap, crap, crap. Hepatitis C is worse than AIDS in some ways. Much, much higher rate of transmission during needle sticks and sometimes just as devastating results. It cripples the body and eventually kills as well. Crap. Now I was really scared.
I never thought medicine would be frightening. Oh sure, there's the nervousness that comes with doing a new procedure for the first time, or the hesitation when dealing with a difficult attending or the jitters that accompany so many days. But it's not the same as being scared. I don't want to be scared. When I read “the big ones” in a chart—hepatitis, HIV, tuberculosis—I don't want to rush to put up the barriers between me and the patient. Gowns and gloves and masks and better put on another pair of gloves, just in case. It takes away their humanity, and it takes away mine. Patients can't see me smile if my mouth is hidden, and a comforting touch loses its effect when it's filtered through plastic or latex or whatever the hell gloves are made out of now. And it's not just health care workers that the patient is separated from. It's everyone. How can a child feel her mother's skin against his if he has to put on an x-large, nonpermeable, hot-as-hell gown before he can enter her room? How can a wife kiss away the fear she sees in her husband's eyes when she has to have a mask between her and him, lest she catch what he has?
But we need all that plastic and cloth and nonpermeability. Without it, everyone would be coughing up blood from their tuberculosis while evacuating their guts out from their Clostridium difficile. Drug companies would be broke, because no antibiotics would be effective against the resistant bacteria that have run rampant through the hospital. And nurses and doctors would be gone—scared away by the inevitability of infection or killed by the reality of it.
But that doesn't mean they won't fail. At 1 am, if I am not alert and vigilant, a needle can slip and my glove can lose its protective nature. I come back to my finger. Still not bleeding. I look at it as closely as I can. Still no evidence of a break in the skin. I think I'm safe this time. I'm not going to go through the “needlestick protocol.” No blood draws, no just-in-case medicines. No having to explain to the occupational health nurse how stupid I am and how the “exposure” occurred. The fear starts to subside and the endorphins go back to their cells, ready to jump out the next time something jumps out at me.
But I'm still a little scared. Not so much of what just happened, but of what might. Will I eventually stop seeing my patients as people and see them only as diseases? Will I assess only their threat to me, forgetting the threat I also pose to them? Will all the protective barriers become so deep that a literal wall separates me from them?
I don't know. It just might. I don't want to turn a fluorescent shade of yellow as my liver fails from the virus inside me. I don't want to gasp for breath because one lung is down, filled up with the cavitary lesions that TB is known for. I sure as heck don't want to assess the risk I pose to my husband, given female-to-male transmission rates of HIV. But I didn't come to this job to put distance between people and me. I came here to be with people. Can't I have my cake and eat it too?
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