Real Medicine, Studying Medicine

The Time I Got Injured On Duty

It was hot summer afternoon and I was on my rural Family Medicine rotation; the Friday leading up to my birthday weekend. I was looking forward to an off-weekend, and I’d be going home to spend my birthday with my family for the first time since 2008. I had dressed up in a new skirt, a pretty pink top, and had even worn my contact lenses to work. I wanted to look “pretty” for going home.

A very, very sick man was brought into our clinic by his mother and sister. He was emaciated, shivering and delirious. Because I had been in the area for two weeks and the area has an incredibly high rate of HIV, I knew, or at least very strongly suspected, that he was a patient with the virus. I also strongly suspected that he was suffering from cryptococcal meningitis, because I’ve seen so many cases of it.

iod blog

 

On suspicion #1 I was correct. For suspicion #2, he required a spinal tap for CSF analysis and CLAT. Due to the delirium, he was a very, very difficult patient who bucked and screamed during the attempts. His sister, mother and the security guards all struggled to keep him still. For such a sick man, he had remarkable strength. I eventually stepped back, afraid of being pricked. After my supervisor was eventually successful (a bloody tap but nonetheless), he dropped the long LP-needle in the kidney dish… and at the same time that I heard a clink in the kidney dish, I felt something – a droplet perhaps – in the corner of my eye.

And I was calm for all of five minutes, telling myself how it was probably nothing, and how I am forever feeling things in my eyes, but then I started to freak out on the inside. Because I knew this man probably had a sky-high viral load, and that the virus in this area has many drug-resistant mutations.

The moment I asked my supervisor, “Do you think I’d know for sure if I got a splash?” he dropped everything. This is something I am still so grateful for. He didn’t question me. He didn’t laugh it off, or tell me that I was being paranoid. He dropped everything, took me to a private room, and rinsed my eyes out with copious amounts of sterile water.

I was in such shock that I wasn’t sure if I wanted Post-Exposure Prophylaxis (PEP) – but of course I needed it! And so the doctor gave me enough for the weekend, and my first dose immediately as per protocol, knowing that once the shock wore off I would request the full six-week dose, because the risk of not taking it is too big.

It’s been more than three months since “the incident” now. I have wanted to write about it, but at the same time, I was too traumatised. It has been probably the biggest, most awful thing that has happened to me in five and a half years of medical study, and it has changed me forever. And I am sorry if you have suffered worse trauma, and I know that worse trauma is out there, but for five years, this has been the stuff of my nightmares.

When this happens, it doesn’t matter that the chances of contracting the virus are minute, and even smaller when you use PEP correctly. It doesn’t matter that I didn’t know if it was really CSF in my eye. Because there is still a chance, and you keep running that through your head. You realise that you were never safe. You realise that your choice of profession means that you will forever be at risk.

And you realise that stigma is everywhere. Stigma is still inside of you.

Because after I told my parents, I asked them not to tell people. It was hard enough dealing with my emotional response and fears, and I didn’t want people thinking that I had done something wrong or irresponsible to get an IOD.

And in asking my family to keep quiet, I perpetuated stigma. And I withheld from them the emotional support they could have got from their friends.

I will be writing a few posts on this as time goes by. I think there is a need, because when I Googled frantically for people with similar experiences, I got very little. The closest to my experience was actually not a healthcare worker at all, but a young gay man in 2012.

I want healthcare workers – and especially students – to know that it’s normal to freak out when you get exposed to an infectious agent. That it is the situation that is abnormal, not your reaction. I want them to know that it’s okay to need help. To need therapy. To reconsider every belief you have ever had. I have listened to a lot of my colleagues’ IOD-stories in the past few months and I have come to the conclusion that we all have similar responses to the shock. But we hide it, because that’s what medical school teaches us, right? Hide your emotions. Be strong. Everybody goes through it.

Despite the fact that my superior was very supportive, I still feel there is not enough support for students who have this experience. It would be three weeks before I could speak to a counselor for debriefing. There was nothing to help my family on how to react, and what they could do.

I was the best one to give my family the information that would make them feel more at ease, but I was too emotional to do a good job.

Online stats were confounding and best not looked at. The expectation from doctors and professors seemed to be that I should get over it, move on. Many of them would tell me that they had been exposed five, eight, ten times even! And look at them, they’re okay! And although some of them meant it in a genuinely comforting way, it really wasn’t enough to make me feel better.

This is my story. I will write more, in due time.

Have you or a friend/family member ever had an IOD – HIV-related or otherwise? How did you respond?

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29 thoughts on “The Time I Got Injured On Duty”

  1. I am so sorry you have to go through this. But thank you for telling your story. I am sure it will help someone else to know they are not alone.
    I haven’t had a scare or injury that was so significant. I can only begin to imagine what it is like.
    I have had a needlestick injury (after drawing bloodwork from a combative patient) while working in blood collection between my undergrad and med school. It was very much brushed off and I was criticized for my “negligence” in getting stuck and having to leave the clinic for a half hour. We both tested negative for everything with the first bloodwork and I didn’t follow up afterward because I moved and was scared. I did have to get re-tested before electives in med school and I remember wondering while waiting for the results what would happen IF…
    I have been splashed in the face with body fluids. I have had blood on my bare hands. Thankfully, my glasses protect my eyes and my hands were wound free at the time.
    I am lucky to live in a place where HIV and Hepatitis aren’t as prevalent. It also means I think we are, at times more flippant about it.

    1. Thank you, Trisha. Your situation still sounds scary, and I think it’s awful that you were criticised for it. I’ve heard that happens to a lot of people and it’s just not on. Victim blaming much?!
      I understand the what if… When I had to be tested right after the incident for my baseline I had the same worries.
      I’m a little envious of places where HIV and Hep aren’t that prevalent. I hope we can be like that someday soon too.

  2. I had a needle stick injury about 3 weeks ago. I can relate to every part of this post. My injury happened on good Friday and thus I had to go to F1, they gave me my weekends supply and I left in a terrible state. That was probably the worst weekend of my life; a combination of nausea, fever and the worst type of anxiety. I also asked my parents to keep it to themselves. The Tuesday after the weekend I went to campus health, the nurse was very reassuring about the low risk of transmission but still how can I not stress? I haven’t had a good night sleep since. Also I keep on asking myself is this job worth it with all the occupational risks…yes I had an amazing time in my rotation pre incident, but after I hated every moment and I am dreading later rotations. You said you had a 6 week course of PEP I only got a 28 day course?
    On a lighter note: congratulations on passing your ChB exam, you rock! ( I saw this on twitter lol)

    1. Hey, thanks for the congratulations.
      I’m so sorry that it happened to you. It’s an awful feeling, emotionally and physically.
      I have asked myself the same questions about the worth of the occupation. I will write more about that soon, but the long and the short of it is the only way that you can answer that question for yourself is by working through all of the trauma and the questions.
      As for dreading future rotations – I know what you mean. Talking to the campus psychologist really helped me in that regard but it’s still a daily struggle. Also running through potential situations in your head helps to make you feel prepared. For example, run through the motions of drawing blood. Then figure out what you will do if a patient jerks away during the blood draw.
      You’re on family medicine next if I remember correctly – there is not a lot of exposure there, or at least there wasn’t in my year, so you have time to recover at least a little bit 🙂
      Also, you are only supposed to get a 28 day course – I still need to correct that.
      Good luck! And keep in touch. I believe you will be alright. Hang in there!

      1. Edit – there isn’t a lot of exposure in Fam Med third year – as opposed to SI, obviously. I realised afterwards that it might sound contradicting since my IOD was on Fam Med…

  3. My sister-in-law (a nurse) has had more than one exposure via an infected needle and it rattles her every time. It doesn’t help that she works in research and almost exclusively sees HIV patients.

    I’m glad you saw a counsellor, though it shouldn’t have had to be three weeks.

    1. Wow. It must be so scary for her. Thanks for sharing that!
      I am still upset that it took three weeks to see a counselor. But where I was there was no mental health services, and it’s awful to think that there are people in our country who have no access to counselors at all!

  4. As a Clinical Laboratory Scientist who has been in the field for 30+ years I share your pain. I actually had a splash of blood in my eye (while wearing contact lenses) while doing VDRL testing. That was the last time I wore contact lenses while working. I had to stop and wash my hands before I could remove the lens which made me feel like the exposure was prolonged. I also had a needlestick while pregnant. This was in the days before rapid HIV testing and I had to take the prophylaxis treatment for 3 weeks before the initial test was non-reactive on the patient I was exposed to. I continued the treatment until we did follow up testing 3 months later as the patient was an IV drug abuser. The good news is that I stayed non-reactive, my baby was fine (she is 26 years old now) and the patient’s second test was non-reactive. I was stuck when I recapped a needle which is a no-no now but everybody did it then! I also kept that to myself and didn’t tell anyone except my husband.
    Stay strong! You are going to be a fabulous M.D.!

    1. Hi Kim, thanks so much for sharing your story. One of my friends works part-time at a lab and she also got splashed while testing once. After my splash I have also never worn contacts to work again, not even on days that I’m sure I won’t be exposed.
      I can only imagine how scary it must have been to be exposed 26 years ago, especially since supposedly ARVs back then were a lot worse in terms of side effects. If there’s one thing that scares me more than being exposed, it’s being exposed while pregnant. I’m so glad you and your daughter are fine!
      Some of my friends have been stuck while recapping… people still do it even though they shouldn’t.
      Thanks so much for your care and support!

  5. I’m sorry to hear of your scare. I have been lucky. As a med student visiting Mali/Gabon in 2003, two of my colleagues ended up on ARVs due to blood exposures–one from a horrific car accident where her blood mixed with others, another from a needle stick in lab. They were both okay. They were also both very open about it–maybe because we were all in a different place, together, and we shared a feeling of a calculated risk in choosing international rotations. Potentially needing PEP was the risk we had chosen to accept. Interestingly, I say “needing PEP” rather than “contracting HIV.” Only one doctor friend has contracted HIV, and he’s not sure how/where he got it (on the job? international work? sex? drugs?). He didn’t do PEP, since he didn’t know he had been exposed.
    I am sorry that your nightmare came true, and glad that the end of this story is a happy ending.

    1. Thanks for sharing about your friends – I’m always sorry to hear of exposures, but it helps to hear of people being okay. Sorry about the doctor friend who did contract HIV though. The idea of being exposed without realising it is quite scary too.

  6. OMG… so scary! Bravo to you for blogging about it! I’m sure there are tons of healthcare professionals and students out there who have or will experience the same thing. On several occasions, Doc H has come home with the first report of his day, being a resident was stuck by a needle. It never sits well with anybody… everyone worries.
    Thanks for linking up for MM!

  7. Oh, girl, I can only imagine how scared you must have been! Nothing like that has ever happened to me before, but I hope that if it does, I have someone there to help me like you did. ❤

  8. Wow. this made me rather teary eyed. It is reassuring to know that I alone am not terrified of being infected in my work. I work in a Lab, so the risk is much less, but I also had a few horror filled months when I accidentally messed some infected blood on my skin. Although I had no scars, marks, or anything remotely open, I had nightmares for weeks afterwards. I am happy to say that a year afterwards I am still testing Negative, but I will never forget that mind numbing horror. Thanks for sharing!

    1. Thank you for sharing your experience, Natasha! I have a friend who works in a lab and also had an exposure recently – she touched her eye with her gloved hand which had blood on it. I’m sure it’s as awful no matter what the setting is. I’m glad everything went – and is going – well for you! Keep up the good work 🙂

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