Friday, May 28, 2010



I was doing a liver biopsy today on a man with Hepatitis C. He needs it before he can get his kidney transplant. Fortunately, he's HIV negative and already immune to Hepatitis B.

I was numbing him up with 20cc of xylcaine. I finished and went to recap my needle. I don't always recap. I often leave it laying out, attached to the syringe. But, I'm always afraid that I (or someone else) will get stuck reaching in to the tray for a gauze pad or something. So, I found the cap and pushed the needle in, without using my hand to hold the cap - just like we're taught. But, the cap kept sliding around, so I used my knuckle to brace the cap. Well, I pushed the needle too hard, and it popped through the cap and poked my knuckle. Hard.

I immediately knew what happened, and I could see the blood pool under my glove. Dang it. I tried to biopsy the patient, but somehow missed. In my defense, he had tough anatomy. Oh, and I just stuck myself with a needle. Right. So, Dr. P stepped in and did it; he got a great sample, so it was all good. I degloved, washed my hands with soap and water and put a bandaid on. I finished up with that patient and started on the next one. I had a presentation to give at noon, so I had to bail on the next biopsy and head up to the conference room.

I didn't tell Dr. P right away. I was embarrassed - I should've known better. I could have just left the stupid needle uncapped. Plus, I didn't want him to lose faith in my ability to do more biopsies. I'm still committed to this patient population, and I want to learn this skill.

So, as our afternoon clinic winds down, I finally tell him that I stuck myself and ask if I can leave clinic to get to employee health to get my labs done. He was shocked, and said of course. While I'm in employee health, my cell phone rings: Dr. P. He says he was shocked to hear of the needle stick, and he wants me to know that he's there for me and with me during this whole thing. It was awesome of him to call and say that. He said to make sure the physician assistant (PA) in employee health orders an HIV RNA PCR now, at 2 weeks, at 4 weeks and at 8 weeks. He said he can get the PA a dozen articles saying that is the best way to handle acute Hepatitis C. I thank Dr. P and hang up.

The PA said he can't order it, because it's not in the protocol. He says he will order a Hep C Antibody. I ask him if he really thinks I've started making Antibodies in the last 3 hours. I'm not mad at him, but I'm trying to show that the Antibody is a waste of a test. So, I call Dr. P who has left clinic. He says he'll go and meet me back in clinic so he can order the proper tests himself.

Normally, if you're going to get infected, the PCR is positive by week 3. In acute Hep C, if you have a positive PCR and it doesn't decrease on it's own by 8 weeks, you need to start treatment to cure it. He admitted that I'm a low risk in the sense of the way I was stuck, but it's fairly high risk given the patient is known to be Hep C positive with a high viral load.

So, I've become Dr. P's personal patient. He's quite the world expert in hepatology, so I'm very fortunate that he's overseeing my care. He has taken quite a liking to me, and he has really pulled me under his wing to learn about Hep C and all liver diseases, really. It's nice to know he's in my corner, even though I'm pretty confident that I'll come through this with just a bruised knuckle.

Sunday, May 9, 2010

To Whom It May Concern

I did some moonlighting this weekend, which was much needed since I just signed up for my ID Boards - $2060. For a stupid test I don't even want to take. {serenity now...}

I had an interesting juxtaposition of patients this weekend, two in particular.

Patient 1 was a new admission. He's in his mid-20s, a student of some kind. I couldn't ask him because he came in unresponsive with a Glascow Coma Score of 6 (1+4+1). Why did he have no purposeful movements? He had been partying the night before with crystal meth and GHB. Oh, and his tox screen later revealed cocaine. GHB is often used as a date rape drug because it renders its users unconscious. However, before this end result, it can give a euphoric rush. So, his friend brought him in barely breathing, heart rate down to 50, body temperature a cool 94 degrees Fahrenheit. It's hard not to get angry at your patients in situations like this - a young kid, his whole life ahead of him, just spinning the Roulette wheel with his life.

Patient 2 is just over 60. Her lymphoma came back and isn't curable. She's actively dying. Her sister flew in from the Midwest and asked how long I thought she had. I guessed about 3-5 days. She asked if I could write a letter so she could go get herself instated as the patient's durable power of attorney. I know this is what the patient wanted, so I said sure. I wrote a simple letter, something like this...

To Whom It May Concern;

This woman is my patient, and she is unable to make her own decisions due to losing a long battle with a fatal disease. According to her wishes, her sister is to act on her behalf.

It made me want to write a letter to Patient 1.

To You, For Whom I'm Concerned;

Don't blow this life. Don't make the mistake of thinking you are invincible and immovable. You, like the rest of us, are made of frail skin and bones, and your heart is but a muscle that can only be stretched so far. Take this opportunity to get your life in order. You've been spared Death, just barely, this time. But, Death is fickle, and he may not be so forgiving next time.

Tuesday, May 4, 2010

"You'd be amazed."

This is a completely non-medical post, so if you normally read this for the medicine, you can skip this one. Just to make it worth your while, here are two snippets: 1) we may have a man with measles up at the Zoo and b) we have a super resistant bacteria in a patient with no good options to treat him. So grab your Purell and come back in a few days, I should have a medical post by then.

I have been having a few days of feeling unappreciated. Underappreciated? Whatever. You know those days where you think, "Why doesn't anyone say thank you? Am I completely invisible?" I started thinking that I could disappear for a few days and relatively few people would notice and probably even fewer would really care or worry. I just starting feeling insignificant.

Now, to be honest, I haven't gone to church much lately. Ok, at all. In like weeks. OK!, OK! months. Geez, cut me some slack, I work most every Sunday. I remembered that song from Veggie Tales - "God is bigger than the boogie man..." And I realized that God cares, God appreciates me, God smiles when I do something nice for someone.

I read this blog that reminded me that not only is God an encouraging supportive force in my life, but God is also a strong protector. Check out this blog if you have time; grab a box of tissues before you go. This woman has the strength of an ox, and she reminded me that with God we can do anything. I love love love how she finished a recent blog, so I'm going to leave you with her thoughts:

"If this past year has taught me anything, it is that I can lean hard on my God. He can handle it all. Every priest and pastor who has counseled me along the way has said just that. The error comes in thinking that He cannot, in thinking that we have to shoulder the fear, anger, frustration, and hate ourselves. We don’t. It is not our job. God can even handle the F-bomb. You’d be amazed."

Amen, sister. God can handle the F-bomb.