Why I lost six months of sleep

February 15, 2008

A small incident in the office became nerve-wracking because of what this physician failed to do.

Late one Monday afternoon, as I was returning the last of the day's phone calls, my partner knocked on my office door. "Could you come and look at this patient's leg?" he asked. The woman had a large abscess on her upper thigh and he wanted me to drain it. Since I enjoy doing procedures, I readily agreed.

The patient, who was in her 50s, was lying on the exam table with a drape over her legs. My partner introduced us. Then, as he and his medical student watched, the nurse handed me a syringe of lidocaine so I could numb the 4-centimeter abscess. Then I incised the skin, and pus came rushing out.

"I knew she could do it!" my partner told his patient, before turning to discuss the likely bacterial pathogens with the student. As I withdrew the scalpel, it slipped from my hand. I grabbed it before it hit the floor and felt the blade prick my palm.

I was tired and just wanted to go home.

I finished cleaning and bandaging the patient's skin, and then, with trepidation, went to the sink and rinsed my glove. To my horror, there was a blossom of red under the surface. I took off the glove and scrubbed my skin. A small spot of blood welled in a tiny cut. I grabbed the bottle of hand sanitizer and dumped half of it onto my palm. It stung.

I put a Band-Aid on the cut and tried not to think about it.

I did think about the patient, who'd been well dressed and well spoken-surely not a drug abuser or someone at risk for HIV or hepatitis C. When I got home, I looked up the incidence of HIV transmission from percutaneous exposure when the source was known to be HIV positive. It was one in 300 from a hollow needle, and negligible from solid objects such as scalpels and suture needles.

I barely slept that night.

The next day, as I sat down to write my procedure note in the patient's chart, my eyes fell on the previous page. Under social history, my partner had noted that the patient's boyfriend was HIV positive. My heart felt like it had stopped. I quickly flipped to the lab section of the chart. The patient had been tested for HIV, and the results were negative-but they were more than a year old. Visions of developing end-stage AIDS filled my head.

I wondered what to do. I could confess to my partner that I'd been exposed to the patient's blood and ask that she be called back for an HIV test. I'd volunteer to get tested, too. But I was too embarrassed, so I decided to try to forget about it. After all, the odds were in my favor, given the patient's previous negative HIV status and the type of injury I'd sustained.

Denial can take you a long way.

A common cold produces uncommon fears

A month later I developed a sore throat and a low-grade fever, which gave way to sinus congestion. Could this be seroconversion, I wondered in a panic? My symptoms resolved and I decided that it had been just a cold.

I continued to be haunted by the idea that I could be harmed by practicing medicine. Somehow with all of primary care's other problems-the long hours, the fights with insurance companies, the growing demands to see more and more patients, and the constant threat of a lawsuit-this seemed to be the ultimate injustice.