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Thursday, September 22, 2011

She cried, good Luck with needle stick!

She cried not that she was stuck, she cried because I was stuck with her needle.

Sometime back I saw her initially in the ER, around 4:30 in the morning; she was a young girl, a high risk IV drug user who was septic. She was in shock, confused and burning. Her anxious father was pacing nearby; I was afraid that he was going to pass out any time.
I provided not much comfort to him when I told him that she was in septic shock and that she has a guarded prognosis.

She initially refused a central line placement but after much debate she consented but only if my other colleague in the ER would do it. Maybe she found my ER attending to be more comforting. I spoke with the ER physician and she obliged and placed the line.

The next 24 hours were tough for her, but utilizing the 6 hour and 12 hour sepsis bundles we were able to stabilize her. I was questioning a vegetation on her heart valve. During a transesophageal echocardiogram, cardiologist saw an artifact in the atrium. Assuming that this could be the central line, we pulled back the line and the artifact on the echo disappeared. Viola… no vegetations.

As I was almost done with securing the line I stuck myself. For a second my mind went blank, thinking about the significance of this needle stick from a very high risk patient. Naturally I started to think about my wife, my daughters and our baby who is on the way. All the statistics about needle stick started to resonate ….. risk of transmission after HIV infected blood 0.3%, risk of Hep B 30% and Hep C 10%....

Initially I was very angry at myself, I didn’t know what her status was, I should have been more careful, I should have double gloved or ….. done something else. For a moment I felt anger towards her too, though I knew it was not her doing.

As I was desperately washing my hands, squeezing as much blood as I could, she found out and started to cry. She tried to reassure me by saying “I do share needles but I always clean them”…. not much of a comforting thought.

In the middle of this suddenly a sense of calm came over me, I found peace with myself and with her, and I thought for a second and said “it is not your fault that I stuck my self, though it shows that how our actions can affect other people lives.”

I started the HIV prophylaxis, I need testing in 6 weeks, 12 weeks and 6 months. These medications were not easy to take and there were lots of them.

She walked out of the hospital, determined not to use again and plans to go to rehab, she was doing wonderful. On her way out she winked at me and said “good luck”.

So what is the lesson from this?........Sepsis Bundles work!….

Blog you later.

PS: About the picture, I saw this in field's museum in Chicago. Myth is that some diamonds bring bad luck. So it is a good thing that I do not own this rock.

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