There is a fear that every Health-care worker has. Tonight that fear jumped up and slapped me in the face.
Second job of the shift, we were called to “50 year old male – collapsed in street”. Normally this is someone who is drunk – but we rushed to the scene anyway, just in case it isn't (we rush to everything it's the only way to be sure you aren't caught out). We reach the scene and see the male laying on the floor talking gibberish. He is bleeding from a cut on his face and possible from his jaw. Bystanders tell us that he “just dropped”. He then starts to vomit, and because it's dark we get him on our trolley and into the back of the ambulance.
Our basic assessment finds that he has no muscular tone on his right side, although all his obs are within normal limits. Decided against hanging around – we start transport to hospital. Halfway to hospital he starts to vomit and cough – part of this vomitus/blood flies unerringly across the width of the ambulance…
…right into my open mouth.
Pretty disgusting – but what can you do? The patient then starts to come around – now able to move all limbs and to talk. This is good – it means I'm able to get some history from him. So I get his name, date of birth, address. Then I ask this 50 year old if he is normally fit and well.
“No”, he says, “I have AIDS”.
I've never had anything from a patient in my mouth before (apart from the odd chocolate when I was a nurse) – so of course the first time is with a HIV+ patient.
My crewmate looks in the rear view mirror, and _that_ look passes between us. Ambulance people will know what I mean – it's the “Oh shit” look that you give/get when something goes horribly wrong.
We get to the hospital and the patient is looking a lot better, fully orientated, full strength and starting to feel the pain from a probably busted jaw. So I get to hand over to the nurse, which turned into a bit of a comedy moment…
Me:“Patient witnessed collapse, had right-sided hemiparesis, now resolved. Previous history includes AIDS”.
Charge Nurse:“You can't say that”
Charge Nurse:“You can't say AIDS – People will be prejudiced against him”
Me:“Well they shouldn't be, and this is medical stuff. It's a syndrome like any other”
Charge Nurse:“You have to call it something else”
Me:“I don't really care for political correctness – besides I'm a patient as well as I swallowed some of his blood”
Charge Nurse:“Oh…Well lets get you sorted out then”
I then went through the rigmarole of having blood taken, then I asked to be put on PEP, which the Charge nurse agreed I should be put on.
PEP is “Post Exposure Prophylaxis”, basically a cocktail of antiretroviral drugs that taken over a four week period will hopefully reduce any live virus to non-infective amounts. Common side effects include…
Nausea, vomiting, headache, diarrhoea, cough, abdominal pain/cramps, muscle pain, tiredness, flu-like symptoms, difficulty in sleeping, rash and (I love this one) flatulence.
Other more uncommon side effects are – Pancreatitis, anaemia, neutropenia, peripheral neuropathy, and other “metabolic effects”.
I'm in for a barrel of laughs for these next four weeks…
The Charge nurse looked really sympathetic when he offered me stuff to look after the side effects – He used to work in a HIV clinic so I guess he knows better than me what I'm in for…
Then we talked about rates of infection, which is why I'm feeling kinda relaxed here. HIV is a tough virus to catch (compared to Hepatitis which is the one that worries me) If I were to stab myself with a needle after drawing HIV positive blood I would have a 0.004% chance of catching the virus. Swallowing a bit of blood/vomitus is less risky than that – especially as I have no mouth/stomach ulcers. With the PEP my chances of “seroconverting” are as close to zero as you can get. I knew all this before I set foot in the hospital – which probably explained why I wasn't a quivering wreck.
So far “only” two medical workers have sero-converted after needle-stick injuries. I greatly doubt that I'll be the third.
So “The Plan” is that I go to see occupational health on Monday, and they will advise me on what happens next. I've been told already that I'll have to avoid sexual contact for the next three months (not a hardship – I've managed “no sexual contact” for two years before now), and that I'll probably need to take four weeks off work due to me feeling too ill from the side effects of the anti-retrovirals.
We'll see about that… I don't “do” ill.
Anyway if I do need to take time off it'll give me a chance to read some books I've got sitting on my shelf – and complete “Zelda – Windwaker”.
Gotta go now, I feel flatulent already…