Riding the PEP-Train

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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.

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.

26 thoughts on “Riding the PEP-Train

  1. Aw, I’m so sorry, love. I’m angry for you — how irresponsible and just plain shitty of healthcare professionals not to make keep their sharps safe, ESPECIALLY in a country like South Africa where HIV rates are so high.

    Sending you big hugs and a nice cup of tea.

  2. This is awful. It makes me especially angry that there’s just no one who cares. You literally put your life on the line at times to care for others, but when you are facing a crisis all you get is a “that’s too bad”. It shouldn’t be like that. Thank you for sharing this. You’ve again reminded me why I’m studying to be a counsellor. Thinking of and praying for you.

  3. Ugh, I’m so sorry this happened. I hope the assisting surgeon who stabbed you with his carelessness sees this, and realizes the impact of his heedless suturing, and will be more cautious in the future. It’s hard when there are things you CAN control and things you CAN’T control. Sounds like it is time to start a campaign to raise physician awareness and change provider behavior to get rid of those wayward sharps. What will it take to create a sense of shared responsibility for avoiding sticks?

    • I’m not certain what it will take, to be honest. I think many physicians will take offense and say, “But I’m always safe!”. And they’re probably right, it’s probably not all physicians who are so lax with sharp safety, but that doesn’t change the fact that some ARE. I’m going to ask one of my supervisors what I can do this week though, because I’m still really unhappy with what happened and I do think a campaign of some sort is necessary.

  4. I enjoy reading your posts, but this post certainly shocked me. I’ll pray that the meds work and you get well and be safe soon. You have every right to be angry, but try not to stress yourself. Your job is frustrating, but what you do is more than a profession in my opinion. I hope your goodwill for helping others does the same thing to heal you.

  5. So sorry to hear of this. I enjoy your posts as they are so insightful.

    I pray that you feel better and are alright. Maybe the hospital should have a workshop on safety with sharps and overall surgery safety as it seems to be a big problem. No one should have to be fearful when they are trying to perform their tasks/duties on a daily especially by someone that’s suppose to be apart of the team.

    • Thank you, sweet Cara. I think everybody knows about safety but there is a certain point of confidence that many doctors reach where they seem to think that they are somehow above normal safety measures. It’s weird.

  6. I am also so sorry to hear this has happened again. Of course you are angry, I am angry at that guy, too!!!! I am so glad you are being careful with your medicine, and grateful there is medicine that is effective, but hate that you have to go through the horrors of these side effects again. And, I wish you had received that kind word at the right time…”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”. It’s kind of awesome how healing that would have for you. Know that right this minute I am sending kind words for you to tuck away in a nice safe spot for when you need them. ❤

  7. Im sorry to hear this. It really sucks when it’s not even your fault. Ive had numerous scared myself and I know the feeling, its the worst. I hope the meds turn out to be kind to you for the days further.

  8. Hi, I’m just a complete stranger who likes reading the blogs of other people living in developing nations. Your blog has been interesting, so thank you very much for sharing.

    I’ve never been on it but I know that PEP can be brutal; I’m sorry you have to go through it.

    Hope you come through it okay.

  9. Pingback: Running Update (See What I Did There?) | Barefoot Whispers

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