Friday, May 28, 2010

Stuck

Literally.

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.

1 comment:

Mark said...

Wow. ....wow. I was sending your blog to another MD pal, and read this. Holy crap. I'm going to be checking in every week...you know that, right?