Stuck FREE

I felt a brief prick on the pad of my right third finger. I did not say or do anything to alert the resident with whom I was working, but instead continued until the lumbar puncture on our patient with end-stage AIDS was finished. Then I stared at my glove before taking it off, putting it in a bag and then in my pocket so I could scrutinize it later, without arousing suspicion. I examined my finger and there was no puncture, no gash, and no blood. While I meticulously scrubbed my hands, I debated whether or not to call Employee Health. It was 11:45 p.m. and I was tired. I had a desperate urge to go home, kiss my kids, long asleep, and climb into bed with my husband. I did not want to make a big deal out of this in the middle of the night.

After my drive home, I walked in the house and scrubbed my hands again. Then I doused them with bleach for good measure, not remembering whether or not this was helpful. I crept into my daughters' rooms to complete our nightly parental ritual of checking on each of them before going to bed. I do not know how long I stood and stared at them, wondering whether our lives would ever be the same again.

I awoke the next morning with a deep dread. From home, I called a friend who is an infectious disease consultant, luckily on service that month. I related my story to him, and he sprang into action, swiftly arranging for me to be seen first thing that morning in Employee Health to get a dose of zidovudine and lamivudine. He first admonished me for not calling him sooner. But he must have sensed the mounting panic in my voice and kindly reassured me that I did not do irrevocable harm with my delay. Later he met me for lunch, armed with what seemed like the world's literature on needlestick injuries in health care workers. Gently, he recited the statistics and reported that my risk for seroconversion was 3 in 1000. He was encouraged. I had been hoping for 1 in a million.

After recounting the details of my exposure again, he recommended 30 days of prophylactic drug therapy. Grateful for any ammunition to ward off HIV, I agreed that I could take any concoction for a month if it would stack the deck in my favor. Before deciding which drugs to take, my friend suggested that I meet with another expert in this area. Though I was leery of telling anyone else, I allowed my friend to make the arrangements.

The expert paged me that evening. I met him at his HIV clinic, feeling self-conscious immediately upon walking through the door. In one of the exam rooms, I told my story again. Though his work in the hospital was not done and it was already 6 p.m., the expert was patient, thorough, and sympathetic. I will always be grateful that I shared my secret with him. He decided on a three-drug combination of zidovudine, lamivudine, and nelfinavir, one of the newer protease inhibitors. I would feel like I had the flu and would have a significant chance of diarrhea. He gave me pointers on how to prevent the diarrhea by eating Metamucil bars along with twice-daily calcium. He tactfully reviewed how to protect my husband and family. I added condoms to my mental grocery list.

I left the clinic with my prescriptions and strategized how and where I would fill them with the least wagging of tongues. The pharmacy where my husband works was out, as was my neighborhood pharmacy. I decided on the seemingly anonymous hospital pharmacy. When I brought my prescriptions to the window, the pharmacist looked at my white coat, then at the prescriptions again and asked, “Are these for you?” I replied affirmatively, causing her to quickly avert eye contact and awkwardly busy herself. After the prescriptions were filled, I was nervous when I saw a familiar face at the pick-up window. The pharmacist and I exchanged pleasantries, and he admirably hid most of his surprise at the drugs I was getting. I felt compelled to explain my story to him so he would not judge me as I felt the other pharmacist had done. He wished me luck in a pitying sort of way. I nearly ran back to my office.

There was still one more task before heading home. I had to have baseline labs drawn. Knowing how vulnerable a computerized record can be, I asked the Employee Health nurse to allow me to have my labs drawn under an alias. I shed my not-so-anonymous white coat in my office and reluctantly walked toward the lab with my requisition. I got questioning looks from the check-in person, as well as from my tactless phlebotomist, who asked me why I was getting my blood drawn with an alias. I explained that I was an employee and I wanted to keep my medical care private. That produced the same aversion of gaze I experienced earlier at the pharmacy counter.

Finally at home, my girls gave me their customary welcome mauling and then ran into the backyard to finish some sandbox creations. As soon as I made eye contact with my husband, I burst into tears. He tried to comfort me, but I would have none of it. The events of the day and my own imaginings of the worst possible conclusions to this incident squashed my usual optimism.

That night, when putting my daughters to bed, I hugged them tighter and longer than usual, crying silently as I lay down with each of them that evening. I imagined how HIV would affect my family. I calculated how old they would be when I would begin to suffer the ravages of the disease. Would I embarrass them? Would I be a burden? Would they forget how vital and energetic I used to be? As tears streamed down my face in the darkness while I hugged my youngest, I was immediately taken aback. What was the concentration of HIV in human tears? I quickly let her go, jumped out of bed, and ran out of the room to wash my hands and face.

The first week after my needlestick was the hardest. Already worn out from nearly a month of being the ward attending, I began to feel increasingly achy and sluggish. My eyelids seemed to gain 20 pounds as I uncharacteristically fought to keep them open at every conference or meeting. I became hypervigilant about touching my family. One evening after I absentmindedly licked my fingers before rubbing some debris off of my daughter's cheek, I became nauseated with dread after realizing my mistake. This new obsessive antiseptic approach was going to be hard on our family of lackadaisical hand washers, who seemed to share a lot of body fluid, not to mention the occasional toothbrush.

Over the next few weeks, I played more and worked less, coming home much earlier than usual. I noticed the blooming zinnias in my backyard and started cutting them for arrangements. My husband and I began taking long walks after dinner. I joined my daughters' tea parties and swung with them on their swing set. I read few, if any journals, instead focusing my efforts on novels I always wanted to read. I did not exercise as much, partly from exhaustion and partly because it did not seem to matter. I became impatient with patients who came in with “trivial” concerns. Time was wasting, after all.

The next milestone was my first follow-up HIV test. I was not bothered as much about the inquisitive looks at the lab this time. After a month of the three-drug regimen, I was spent. How did people take those toxins month after month? I hoped I was not going to find out. For several days after my test, I got a sick feeling in my chest every time I was paged to a number I did not immediately recognize, sure I was going to get bad news. About a week later, a letter from the hospital came for me at home. Though I was fairly sure that positive results would not be sent in the mail, I made my husband open the envelope. I finally exhaled after finding out I had dodged the bullet that time.

During the next few months, I searched my soul and reprioritized my life. I became a better mom and wife, a more empathetic doctor, and a more caring friend. Like Sleeping Beauty, my life changed with the prick of a finger. I was now holding out for the fairy tale ending.

Christine Seibert, MD

University of Wisconsin Health-East Clinic; Madison, WI 53718