HIV, HEP C, PPE, COVID-19

In the fall of last year I suffered a needle stick. I knew as soon as I felt the needle that I was in trouble.

It was early in the morning and I responded to a code blue, a cardiac arrest, as I do on a regular basis. The patient needed an emergent line; this means I needed to access a large vein in his groin. Usually, we place central lines in a sterile fashion wearing a gown, gloves, a mask, and a bouffant and the patient is draped with a sterile cover. But in emergencies, I only don gloves. Sterility is not important when the patient is actively dying.

I knew this patient. They were on my service. I knew they were HIV positive. And when the needle pierced my glove and my finger I knew I would be starting six months of frequent lab draws and prophylactic medications. Fortunately workers comp covered it all, the two meds I needed were each more than $2000 per month.

Time has passed. I am HIV negative. I have completed the meds.

Last week I found myself in a code. A patient was having a cardiac arrest. They needed emergent access. I found the vein I needed. But in the process I sprayed myself with the patient’s blood. I was literally covered in it. I knew the patient. They were on my service. They were positive for hepatitis C.

Fortunately this patient has an undetectable viral load and I do not need to worry. This is good because there is no prophylaxis for Hep C.

PPE is so important. PPE, Personal Protective Equipment. I have never had a time in which this resource has not been available to me. As evidenced above, there have been times in which I have chosen not to don this equipment. And times in which that choice has put me in danger. Most of the time I wear the gown and the mask and the gloves and put on all the things and do all the things.

I have thought a lot about HIV lately. Wondering what it was like for those health care providers in those early days. Caring for patients who had a virus that no one understood, that was killing people, that had no cure. I’ve wondered what the hospitals wards were like, what the anxiety and stress level was. I wondered who the nurses and healthcare providers who volunteered in those days to take those patients were. I’ve wondered what motivated them, what scared them, and how other people treated them.

Years and times and science has passed so that I can now walk into an HIV positive patients room during a code, only wearing gloves, suffer a needle stick, and take meds for six months to find that I am not infected by this devastating virus, to move on, to exist as though nothing happened.

Years and time and science has progressed so that I can now walk into a Hep C positive patients room during a code, only wearing gloves, find myself covered in their blood, and find that because they have an undetectable viral load I need not worry. I can wash myself and move on as if nothing ever happened.

And now we have COVID-19.

I have seen my world change the last few weeks in ways that I have never seen before. Health care workers are full of anxiety and confusion about how to best care for the patients with this virus. We are taking volunteers at the beginning of each shift and they are donning the PPE that we currently have available, making the best decisions that they know how to make, but not knowing if they are the best choices are not. We are watching people die from a virus that we do not understand and that has no proven treatment and no real cure. And more and more people are coming.

More and more health care providers are themselves contracting the virus. We all wonder who will be next. If we will get it.

In time we will run out of PPE, rooms, beds, ventilators, medications. I fear in a shorter time than we know.

I do not know what the days will look like then. I do not know that reality.

HIV.

Hepatitis.

COVID-19.

These are all viruses. Antibiotics do not work on viruses. Time will teach us what does.

I love my job. I have always loved my job. I still love my job.