I have never told this story to anyone.
It all started one night about ten years ago, three months into my internship. I was on call, having just admitted a man with a possible meningitis.
He now lay curled up in fetal position on the bed in front of me, looking thin and ill. Preparing to administer a lumbar puncture (a diagnostic test that involves removing fluid from the spinal canal), I gently pushed his head further down towards his legs.
He told me that he knew he was dying. AIDS had been ravaging his body for years. He wondered aloud whether this was a punishment for his previous lifestyle--especially the drugs. Everyone he'd cared for had either died or left him.
As I listened, I placed the spinal needle into the curvature of his back. I thought about dignity--something he hadn't experienced much of in the last few years. He seemed so close to death; I wondered briefly whether making a diagnosis of meningitis would be of any real help to him--whether we had anything to offer him in the last stages of this terrible disease. Then I thrust the needle into his spinal column.
I used too much force. The patient jerked, waking me from my reverie and bouncing the needle out of my right hand and into my left index finger. Then the needle dropped to the floor.
"Shit!" Running to the bathroom, I swiftly inspected the small puncture wound in my glove, then tore it off and glared at my finger. No blood! Was that good or bad? How deep was the puncture? Did I feel any pain? I quickly turned on the hot water and vigorously scrubbed my hand with soap.
I dried my hands. It was 3:00 am, and I felt tired and afraid. I knew that there was a hospital protocol for dealing with needlesticks--but feeling alone in a new city, without a soul to confide in, I panicked.
Instead of calling my senior resident for help, I did what seemed the easiest thing: I walked back to the patient, finished his lumbar puncture and didn't tell anyone what had happened.
I also did my best not to think about it again. When it did cross my mind, I felt terrified. What if I developed AIDS and died? What if getting a fingerstick so early in my internship meant that I was incompetent--that I would never be a good physician? I pushed these thoughts aside.
Shortly after this incident, the patient died from complications of cryptococcal meningitis. He died alone. We were unable to locate any next-of-kin.
About a year later, my wife got sick for two weeks. I couldn't figure out why. She had recently found a new job and moved into town to join me. She was losing weight, running fevers and feeling horribly fatigued. A visit to her doctor was fruitless. Her physical exam and blood tests were all normal, and the doctor couldn't explain why my wife had had to stop to rest twice on her way up the stairs to his office.
He assured us that she probably had a virus, and that it would pass. With a start, I felt myself mentally transported back a year to that night. I thought about the needlestick--and about what it might mean. If I got sick that was one thing, but my wife? And of course her doctor hadn't tested her for HIV; he'd had no reason to suspect it.
That night, the call room was dark, lit only by a small lamp on the nightstand; the window shades were drawn. I sat on a bed and listened. The din of the hospital had finally faded away. Everything was quiet.
As I looked down at the tourniquet, I knew that what I was about to do might change everything--my job, my health, my sanity.
Such simple objects--a needle, a syringe.
I hesitated for a second. Ethically, I knew I was on shaky ground. I knew that I hadn't thought through all of the possible consequences of tampering with a patient's medical records. I also knew that I couldn't wait until the next day, when I could get a doctor's appointment: I needed to know now.
So I took the plunge.
It was easy to find a label for the vial of blood. In the space where the doctor's signature should go, I scratched an unintelligible scrawl. Then I walked gingerly down the hall to the lab, waited for the desk person to step away for a moment, and left the sample in the drop box.
Back in my call room, I heaved a sigh of relief, cleaned up the wrappers and disposed of the used needle and syringe. My fate, and my wife's, would soon be revealed.
That morning, the attending physician strode toward the nursing station where, with my fellow residents, I waited for him to begin morning rounds.
"Which one of you dumbasses ordered an HIV test on Mr. Jones?" he asked. "Hardly indicated for an 85-year-old man with heart failure."
We all looked at him blankly for a minute. Then I mustered up my courage.
"So when should I start the cocktail of HIV meds?" I asked.
The attending smirked. "Funny. It was negative, of course!"
A week later, my wife developed a sore throat. This time, her blood tests showed mono. It would be twelve months before she felt normal again.
Now, ten years having passed, I've thought a lot about what happened and have gained some perspective. Among other things, these events have given me particular empathy for my patients who suffer from chronic illness and the worries and fears they must face on a daily basis.
The training to become a physician is a strange mix of loneliness, fatigue and utter desperation, side by side with the triumphs and achievements of learning to be a healer. The overwhelming stress I felt during my internship altered the way I made decisions.
Now I can see that I was too traumatized by fear and sadness in those early days of residency to find my emotional and professional bearings--and that, as a result, I didn't think clearly or act sensibly. It has taken me years to fully understand that my actions could have had devastating consequences. I could have falsely labeled a patient with HIV. I could have been discovered and dismissed from my residency program.
I realize now that I should have spoken up the minute things started to go wrong--the minute I stuck myself. Most critically, I should have confided in my wife immediately. At the time, I was unable to do this. Looking back, I realize that, for some reason, the process of becoming a doctor created a terrible, unbridgeable divide between me and my non-physician loved ones. I felt that they wouldn't understand my actions and feelings because they hadn't shared my training experiences.
Although I am not proud of my actions--that I didn't confide in my loved ones, that I didn't ask for help--I have forgiven myself. If I were ever faced with such terrifying circumstances again, I hope that the person I have become would think more clearly and act differently this time around, and would realize that I don't need to feel alone.
About the author:
Ken Gordon (a pseudonym) is an aspiring writer, a husband and the father of two beautiful children. He practices "old-fashioned" internal medicine in the suburbs. His poetry has appeared in The Annals of Internal Medicine, The Journal of General Internal Medicine and The Pharos. This is his first published story.