“Technically they’re latex-free gloves,” Carleton said. “Because so many people have latex allergies.”
“Right.” Fastening the glove, I felt for veins. “His veins aren’t great,” I said as David wrinkled his brow and looked at his arm. “Have you ever heard of the intern’s vein?”
Carleton shook his head. “What’s that?”
“It runs along the thumb. Works every time.”
Enjoying my new role as teacher, I took out an alcohol swab and wiped down the vein as David looked away. I uncapped the butterfly needle and attached it to a thin plastic tube. The tube was fastened to a small vial and placed in a bucket next to the patient’s right leg.
“Before you do a procedure, any procedure,” I said, “you should do a time-out. Before you do something to a patient, no matter how trivial, you should bring someone else into the room.”
“Got it,” he said, writing that down. His copious copying reminded me of myself. But I doubted Carleton ever needed someone to tell him not to write on his hands. He probably already knew about the time-out. He was probably only taking notes to placate me.
I tilted my head at his notepad. “First, confirm that you have the correct patient. Then, double-check that you are, in fact, doing the appropriate procedure to the proper body part.”
I confirmed the information and plunged the needle into David’s thumb. He reflexively pulled his hand back an inch as blood flowed through the tubing and the vial filled.
“All done,” I said a moment later and held up the vial.
With my left hand I withdrew the needle from his thumb and with my right I reached for a Band-Aid. Blood oozed where the needle had been. Not wanting it to drip on the floor, I quickly moved the Band-Aid toward David’s thumb.
But the Band-Aid never reached its intended destination. My right hand’s path was intercepted by the butterfly needle, and in an instant I had impaled my index finger with the blood-filled needle. I dropped the needle and ripped off my glove. Blood dripped out of my hand as Carleton looked on, mouth agape. Hundreds of thousands of copies of the human immunodeficiency virus had just been injected into my bloodstream.
19
Darkness.
That is all I remember until I heard Carleton’s voice.
“Holy shit!” he was shouting, shaking me from a tranquil haze. I dropped to my knees and squeezed the finger, trying to expel the infected blood. My breathing was ragged. I squeezed so hard my finger turned white—I didn’t mind if it fell off. “No, don’t,” Carleton said, inching toward the door. “Don’t cause inflammation. It’ll draw white cells to the virus and—”
I stared at him blankly. He was an amorphous WASP blob. But he seemed like he knew what to do.
“Sink,” he said. “Sink! Wash it out!”
How did Carleton know what to do? Was this a scenario they covered in medical school? I contemplated putting the finger in my mouth. Could I suck the virus out? I looked down at my palm and licked my lips. In my peripheral vision, I caught a glimpse of David. Both of his hands were on his face like Macaulay Culkin in Home Alone.
“Wash it out!” Carleton implored.
I felt like I was going to pass out or vomit. Time was somehow simultaneously speeding up and slowing down. I was unable to move, trapped in quicksand just a few feet from the needle, from the blood, and from David. I wanted to scream but I had nothing to say. I wanted to run but I had nowhere to go.
Carleton turned on the faucet and guided my hand toward the stream. We looked at the finger, which was still oozing blood, and looked at each other. His placid face was without a single crease, without a single wrinkle. I wondered what he saw in mine.
I waved my hand under the icy water, and the cold snapped me back into the awful present. Bursting out of the room, I lunged toward a nearby conference room where a group of HIV doctors were known to have lunch. “I’m sorry,” I said, frantically throwing the door ajar as six gray heads turned to me. “I just stuck myself. With HIV. Drawing blood I stuck myself.”
Dr. Chanel popped up from her chair and gasped, “What?” I cradled my right hand in my left like it was Axel’s banana peel. She rushed over and put her hand on my shoulder as the others returned to their conversations. “Are you okay?” she asked slowly.
I wasn’t. I couldn’t speak. Staring at the finger, I wondered if a scab was forming, sealing the virus inside of me.
“You’re going to be okay, Matt,” she said deliberately. “You need to go to Employee Health. Okay?” She scanned my eyes to see if this had registered.
“Okay. Where, uh, is that?”
My teeth felt heavy; my lips were numb. I felt like a small child, wanting to run, to disappear, and unable to formulate words.
Chanel grabbed her purse. “Let’s go.” She put her hand on the small of my back and gave me a gentle nudge out of the conference room. We passed a sheet-white Carleton recounting the event to Ashley, who mouthed “What the?” as we proceeded toward the elevators.
“Who was it?” Dr. Chanel asked. “Which patient?”
The image of Macaulay Culkin’s face reentered my consciousness. “David,” I mumbled. “It was David.”
“Okay,” she said, “I’ll have to…I’ll need to make a few phone calls.”
A moment later we squeezed into an elevator full of patients and doctors.
“Matisyahu!” a cadre of interns in the back howled, referring to the Jewish rapper and a nickname I had received at a karaoke orientation event. I held up my scut list and shook my head. We were on the ninth floor. Every button had been pressed. On eight I felt a wave of heat rush over me; on seven I got chills. I was going to shit myself.
“You’re okay,” Chanel whispered.
“Yep.” Like a vampire I covered my mouth with the bend of my arm and quietly retched. Sweat gathered around every orifice. The crowd edged away, giving me space to dry-heave.
“Almost there,” she said, as the elevator gradually thinned out.
When we arrived at Employee Health, Dr. Chanel removed her hand from my back and spoke to the clinic administrator. The only words I heard were “can’t wait,” and a moment later I was in a doctor’s office, sitting across from a physician from South America who looked like a young Antonio Banderas. Why did everyone at work remind me of an actor? Perhaps it was because hospital life often took on a cinematic quality and I was subconsciously casting a film—one that had just transitioned from drama to tragedy.
Banderas’s broad smile and well-coiffed black hair projected an air of genial confidence; he looked like he could be Diego’s older brother. He began saying words, but I didn’t hear them. There were lots of nods and smiles. I considered his hair gel. He became more animated as I stared at my hands, tracing the creases. Eventually isolated, vexing words from Banderas began to register:
hazard, unfortunate, change, feel, sleepless, fine, support, prophylaxis
It was a new experience to flip back and forth between such unwelcome extremes. One moment I was wholly and vividly present; in the next I was rendered senseless, lost in a fog. I squeezed the finger over and over. First it was to match my surprisingly sluggish heart rate, and then it was to the beat of an eighties song I couldn’t get out of my head—“Your Love” by the Outfield. Banderas put a hand on my shoulder and lyrics breezed through my head.
Josie’s on a vacation far away…
“Matt,” he said.
What was the Outfield up to now? I wondered. And who was this man before me and where did he go to medical school? Could I trust him? Was his life, like mine, a series of flashbacks to movies and sitcoms? Did he have hobbies? A mixed martial arts enthusiast, perhaps? Someone who might wear a blouse to a nightclub?
“Matt!” he shouted. “This is important.”
I snapped back, as if a train had unexpectedly passed going the opposite direction. “Yes. Yes. What?”
“Matt, do you know if the patient has hep C?”
I shook my head. “I’m sure we c
hecked, but I’m not positive.”
Why was he bringing up hepatitis?
“This isn’t meant to alarm you.” He motioned to a chart on the wall. “But I want you to have all of the information.” The chart showed a large syringe with a stream of statistics. Hepatitis C was an order of magnitude more contagious than HIV via needle stick.
“I don’t know about the hepatitis,” I said. “I’ll find out, obviously.”
“In addition, Matt, I highly recommend you take the postexposure prophylaxis.”
He stepped out and returned a moment later with pills, the same medications I’d spent the morning reciting to myself on the subway, trying to drill their confusing names into my head to impress Ashley. Truvada. Lopinavir. Ritonavir. They sounded like villains in a comic book, each with a bright color and a unique shape. The conversation with Banderas concluded a few minutes later and we shook hands, agreeing to follow up later in the week. He said it was impossible to prognosticate; I might be fine, but I might not. But I didn’t want to leave until I had an answer. How could I?
As I stepped out of his office, I imagined the virus frantically swimming like a legion of sperm toward the lymph nodes in my armpits, and from there, racing to my neck and groin. Was HIV starting to replicate inside me? Or was my immune system destroying it? And how would I be able to tell what was happening in my body a day, week, or month from now? Banderas had said there was no way to know; I just had to take the pills and wait. Blood tests with an answer were more than a month away.
I tried to think of something else—anything else—but I couldn’t. I imagined a priest reading me my last rites as I writhed in bed. Then an artist’s rendering of the human immunodeficiency virus from a textbook appeared. Soon, pill bottles and syringes were dancing across my mind. But the thing that mattered—the scientific realities of viral transmission—remained elusive. The enzymes, the blood cells, the biochemical reactions…all of that suddenly seemed hazy. Why couldn’t I remember what I needed to remember? I craved clarity but the only thing I could easily picture was a giant question mark blinking atop my head.
Out in the waiting room, Dr. Chanel was standing ramrod straight with her arms behind her back.
“You didn’t have to wait for me,” I said, touched and relieved that she had.
“Matt,” she said, lowering her head, “I spoke to a few people.”
“You look worried,” I said abruptly. “I mean more worried. What’s happening?”
“I spoke to one of our experts. You’re going to need to come with me. We can talk on the way.”
“I’m sorry?”
She put her hand on my shoulder and her fingernails inadvertently scratched my skin. The tactile sensation cut through my fog. I started to feel uncomfortably present again. “You are going to be okay, but things are a bit more complicated than we realized.” Pure, unalloyed fear coursed through me. “Whatever he just gave you for postexposure HIV prophylaxis is insufficient. David has such a highly resistant strain of HIV that you’re going to need an extensive regimen of medications.”
Her lips went on moving, but I heard nothing. My thoughts turned to the handful of facts I’d learned about HIV in medical school. Needle sticks were rare, but they happened. Someone did a study and found that of six thousand pricks with HIV-positive blood, the virus was transmitted twenty times. Those were decent odds, but far from perfect. I thought of myself as number twenty-one, which was my old baseball number. I pictured a jersey, a scarlet letter of sorts, with the virus on the front and my name on the back, announcing to the world that I’d contracted a deadly disease through my own incompetence.
I wasn’t sure how long Dr. Chanel spoke or how far we walked, but my sensorium cleared when we hit the waiting room of the Columbia outpatient HIV clinic. A handful of men and women were reading magazines and chatting on cell phones, not unlike any ordinary waiting room. What I knew about this patient population had largely come from more senior residents. Based on their salacious anecdotes, I had expected the AIDS clinic waiting room to look like something out of a zombie movie, with drug addicts and the mentally ill shouting and spitting at one another. But these were just regular people—people with families and jobs and pets and credit card bills—who were trying to coexist with a virus. And I was now possibly one of them.
“Come to my office,” Dr. Chanel said. “This way.”
As we walked down that interminable hallway, time slowed down, just as Baio had said it did for Michael Jordan when he was in the zone. But this felt like the Twilight Zone.
“Take a seat,” Dr. Chanel said.
I looked out of her office window. A storm was gathering. My body tingled as the enormity of the moment finally set in. I might have just given myself HIV. Because of a mistake. A second’s carelessness and I had possibly altered the trajectory of my life. I might have to travel with pill bottles. I might become sickly. I could die. And drawing David’s blood wasn’t even my responsibility. I had volunteered.
Suddenly I was on fire. Rage rippled through my entire body like a shock wave. I looked into Dr. Chanel’s aqua eyes and screamed, “Fuck!”
She stared right back at me, unflinchingly holding my gaze.
“I can’t fucking believe this! Fuck!” I wanted to hit something as a slew of compound, unimaginative curse words rushed out of me. I wanted to flip over Chanel’s desk and break a window. I wanted to channel all of my rage into something else, some other object that was not me. If I broke a window, the shards of glass would also be implicated in this ordeal. I would have something else to blame, something other than my own incompetence. I screamed again. It sounded like a bullhorn, low-pitched and distorted. I imagined the sound waves smacking into the concrete walls of her small office.
Never could I have imagined behaving this way in front of a senior physician, but here I was, scared and unhinged. I felt like I’d just climbed up ten flights of stairs and been kicked in the face. Eventually I paused to catch my breath, aware that I had rather successfully transitioned from the first stage of grief (denial) to the second (anger). Chanel, to her credit, was unfazed. A few hours ago she had been the teacher and I the student. Now she was the doctor; I was the patient.
“Okay, Matt,” she said calmly, “you’re going to need to be on several medications. Some are once a day, some are twice a day, and one is three times a day. One needs to be refrigerated. I will write you the prescriptions after we go over the side effects, which can be significant.”
I had heard her say these very words to the young woman on rounds, the patient who sobbed after Ariel gave her the new diagnosis of HIV. I was thankful that a roomful of medical students and young doctors wasn’t here to watch me. I wasn’t handling this well. I wanted privacy. I wanted to disappear. I couldn’t imagine dealing with this in front of a roomful of strangers. “I’m ready,” I said. I wasn’t ready. But there was nothing else to say.
I’d often wondered, Why don’t HIV patients just take their damn meds? It was something we encountered surprisingly often, and it didn’t make sense to me. Even if the side effects were awful, taking the pills was still better than the lethal alternative. Most patients understood the consequences of going off their meds, but many did anyway, and I rarely got a straight answer when I asked why. To skip even one dose seemed incomprehensible to me. Why even think about avoiding something that could save your life?
I was about to find out.
20
After leaving Dr. Chanel’s office, I walked out in front of the hospital and took a seat on an unoccupied bench. The thick air was hot and sticky; it was about to rain. I put my head in my hands and began trying to process everything that had just happened. My throbbing eyes were moist, but not from tears. It was as if all of the tiny blood vessels in my eyes had popped and were now slowly leaking onto my eyelids. Dried saliva was caked on the sides of my mouth, and my hair felt like it was standing on end. If anyone had looked like a zombie in the AIDS clinic waiting room, it was me.
&n
bsp; I thought of Heather. What would she say? Intuition told me it would be something supportive, although this scenario was so unusual I couldn’t be sure. I knew she was asleep, recovering from a thirty-hour shift in the ICU, so I opted not to call her. This conversation would need to be had in person. I looked down at my forearms and imagined the skin covered in abscesses, just like David’s. I pulled out my cell phone and scrolled through my contacts. Who should I call? Was this something I could mass-text?
Crazy needle stick at work. HIV scare. I’ll be fine. LOL
Probably not. I was suddenly hungry but the thought of actual food made me queasy. I wanted privacy but I didn’t. I wanted to blame someone but I couldn’t. I closed my phone and my eyes and tried to drown my fear in more facts from medical school. Needle sticks really weren’t that uncommon; there had been close to a million in the United States alone, and the people who jabbed themselves tended to be unlucky, not incompetent. My episode with David was an accident, a hazard of the job. A blip. A, dare I say, rite of passage? Maybe something similar had happened to the Badass.
I stood up and made my way toward the falafel cart.
A light rain began to fall as I placed my order. While the vendor drizzled white sauce and hot sauce on the cubes of chicken, my sense of comfort ebbed. There might be a lot of needle sticks, sure, but they were rarely with HIV-positive blood and they were rarely in patients with such a large amount of the virus swimming through their blood vessels. David’s blood had hundreds of thousands of copies of HIV in every drop, and for that reason Banderas had classified my stick as high-risk. So it wasn’t fair to compare my situation to the average jab, and it wasn’t fair to suggest that the Badass had gone through something similar—he was probably an intern before AIDS was even a thing.
I ate half of my falafel and threw out the rest. Part of me was anxious to return to the infectious disease wing—my unexpected absence would put a strain on my fellow interns—but Dr. Chanel had forbidden it. She was coordinating my treatment regimen with the pharmacy and said she’d text-page me as soon as the pills were ready. I took shelter under an awning and waited. Again I pulled out my phone, but I knew I wasn’t going to use it. I squeezed it in my right hand as I wiped my eyes with my left, inadvertently introducing hot sauce into my cornea. An occasional gust of wind blew the warm rain onto my skin, like a backyard sprinkler. As the drops of water accumulated on my hands and on my arms, I again envisioned the droplets transforming into hundreds and then thousands of tiny purple pus bubbles. I reached into my back pocket, pulled out the rumpled toilet paper the devastated young woman had waved away, and dabbed my moist eyes.
The Real Doctor Will See You Shortly Page 12
