Wednesday, June 8, 2011

Stick it

There are very few moments in life where one can say with conviction , "you know I really didn't see that one coming", but that day God knows : I really didn't see it coming. Sometimes there's a less than supernatural premonition about which way a story will go and which angle a confession from a friend will take. Mostly, it just takes an articulation to tie the subconscious facts together. You've noticed her tardiness at work, the dark rings under her eyes, the strained conversations over the phone and you know that during your next hear-to-heart she's going to tell you about the boyfriend-turned-cheater.This was something altogether different. Even now, it seems so far from reality, so far from how the world should work.

During my stint as a Medical Officer I was sitting in my consulting room during a generous tea break. I had my own problems : I was preparing for a diploma against the backdrop of my father lying comatosed in hospital after a hi-jacking. So when a good friend came into my room looking like she was ready to offload some news, I wasn't sure that I was ready to handle it. But good friendships come with the caveat that you will be available in times of crisis. So I put my books aside and listened.

I held a clicker of a black-pen in my hand and wore a tie-die pink dress. It's strange the details that you remember so intimately when you recall hearing big news. Like how I remembered the red scarf that I wore and the CD that we were listening to when we received the call that my dad was shot. I pulled my chair back watching her sip on tea - it had to be ginger tea because the scent of fresh ginger waded to my side of the room. I had noticed her looking really run down over the past week - physically drained. I knew that she was having some domestic troubles. I also noticed that her eyes had lost some of that luster that I usually associated her with. Her eyes were tinged with ... yellow?

"Ah ginger tea, " she said ,"good for immunity"
"You have a flu?" I asked.
"The strange story gets even more interesting," she said, "I have HIV actually - from a needle-stick injury"

I measured my reaction , instantly toning down the shock and obviously modulating my tone. But those tell-tale tears building up over my bottom eyelid must have been a give away. If she noticed them, she showed no signs of letting them unsettle her. "Don't be patronizing," I told myself, "play it cool".

She went on to explain how this all happened during her pregnancy when she was an intern. Her shift was over and she could have handed over any outstanding work to the next doctor on shift. She noticed that one of her patient's intravenous lines were out, so being the thoughtful doctor that she is, instead of handing over the work, she decided to insert the line. This was a very sick patient she tells me, he had AIDS - a very advanced stage of the disease, he hadn't even moved for days. As she was inserting the needle, he moved tossing the needle into the air and then it landed puncturing her skin - I can't remember whether it was her hand or foot. But the damage was done.

Most of the doctors that I've worked with are flippant about taking antiretrovirals after an injury - we have so many near encounters with infected fluids that we would be spending a large amount of time on drugs with some serious side-effects, if we took treatment with every suspected HIV encounter. Occupational health Specialists tell us that the risks of contracting HIV from a needle-stick injury are low, with the statistics being something close to 0.03%. We also carry a measure of bravado believing that we are healers and altruism won't go rewarded with a life threatening illness. But here was a clear injury - and a very ill patient. My friend started the therapy - but she was pregnant and reacting very badly to the medication, so she stopped taking them altogether.

Later on in her pregnancy she was admitted to hospital with a strange illness.Doctors wrote it down to a vague pregnancy related illness, but she never fully recovered. Eventually a specialist encouraged her to get tested for HIV, and the results spelled out the diagnosis that she would carry with her for all her years.

She talked without scathing, hatred of her situation or self-pity but with a determination that was admirable and a conscience that was alive. The reality of it all still hits me every-so-often. It could just as easily have been any of us. I've had two needle-stick injuries in my three years of practice. I was so sick form the side-effects that I even considered stopping the treatment. My friend's story finds an echo with other similar stories lurking in doctor's tea rooms and over shared gossip in the operating theater. It terrifies us, because it brings home the reality of mortality - the concept that 'Doctor' is not infallible and that this job that brings with it (often undue) respect and good money, carries risks, big risks ... life-changing risks.

(I have received permission to mention my friend's story - anonymously)


bb_aisha said...

Just before reading this post, I was reading an article on CPJ's report on sexual violence against journalists.
Many female journalists don't speak out because they're worried they won't get sent on assignment if they do.
And while it's unfair & unjust women face this risk, it's also a reality. & I thought 'I'd never put my life at risk for career accolades.'

And then I read this & it hits me that for health professionals who work in public healthcare, there is no escape from a risk like this.

I'm curious though-do all pregnant react badly to ARV's?

Infallibility. While in Libya I met some seasoned war correspondents, & many other journos (who like myself admittedly) wanted the 'thrill' of being there.
And sometimes we do think of ourselves as outside the danger zone, thinking we stand apart as journos.

Spoke to some older guys (& 90% of the older experienced war correspondents are male) & they mentioned surviving Iraq & Afghanistan, & once surviving something big, feeling more emboldened, feeling they can get through anything.
Some mock those who've been kidnapped/injured/killed, saying they aren't 'skilled' enough.

But it's not about skill, it's about luck. Nobody's infallible.

ayesha said...

bibi- i can't remember where I reasd it - MAY have been the 'bang-bang' club (PLEASE READ IT) but we need to have a certain level of apparent invincibility or belief in safewty to continue with the job - especially you guys on the front lines. sometimes an injury snatched that away from us but then it's a process of re-building or something like that. I'll try to find the quote.