Riding the PEP-Train

I’m on PEP again.

And I’m angry. And miserable. But mostly angry.

Because I’m careful. I am so, SO careful all the time, but others are not. I always make my surgical needles safe. But many doctors I assist do not. I always discard my sharps. And many do not. I never point a sharp at someone. Many do.

Here’s a random picture of a zebra I took a few years ago at the Vaal River. Because this post needs something pretty.

I feel like for the past three and a half months, I have been running an obstacle course of infected sharps, and dodging them well. And on Monday’s call, I just could not dodge well enough.

I was cutting my tenth C-section. It was supposed to be a good cut. I started with confidence. It was a virgin abdomen (no previous Caesars) so there were no pesky adhesions in the way. And I did well. I got the baby out in less than 15 minutes. But we had three pending sections waiting for us (it was one of those nights where every baby and its mother went into distress). So when I struggled to grab the lower segment with my Green Armytage, my assisting surgeon got impatient. So he got his hands in there and started tying the corners, and he did not make his needle safe. It was a flurry of hands and I had no way of predicting when the suture needle caught on my glove.

It didn’t hurt. I scrubbed out. There was no blood on my second glove (we always double-glove). I even ran water into the glove to check for holes. None.

But then I saw the thinnest of lines on my finger. I washed and it didn’t disappear. I put some alcohol on it, and it burned. So that was that, I guess, and I went to casualty to get my prophylaxis. Because of course, the patient was HIV-positive. She was so young, and has been infected since birth, and she admitted to taking her medication irregularly. We don’t know her viral load but one can’t take a chance. One should not.

I’m angry because I know I shouldn’t blame-shift. I probably should have just got my hands out of there. But my patient was stable! Could the assisting surgeon not have given me a minute to proceed? And WHO DOESN’T MAKE THEIR NEEDLES SAFE? Seriously????

I’m angry because he simply said, “Oh, sorry” off-handedly. And added, “I’m also on it, if it makes you feel better.” No, it does not make me feel better!

I’m angry because casualty was a mess of stab-chests so I had to grab a fellow intern to take my blood and then I prescribed my own medicine. I could have done with a kind word, but patients needed to be seen and lives saved and I needed to take my first dose and get back to work.

I’m taking lopinavir/ritonavir, lamivudine (3TC) and zidovudine (AZT). Day 5 of 28. And let me tell you: the stuff is vile. It’s especially vile coming back up, which I’ve had a lot of.

They did not make me this sick before. Previously I took stavudine instead of zidovudine. The Lam/Zid combination apparently works better, but what’s the use if I keep vomiting it up? And we expect our patients to take this stuff for LIFE.

I was supposed to go away this long weekend, to a lovely little mountain village for a 16km trail run. I’ve cancelled it because I feel way too miserable. Although the vomiting has abated for the past two days, I am so fatigued that I can barely get myself through ward rounds. When I get home I collapse into bed. I’m not sure how much of it is psychosomatic and how much of it is a true side-effect.

But I have to stick it out. I have to take these meds for 28 days. And I have to pray that they do their job. Because I’d rather take them for a month than for life.