It's two steps forward and one step back, but that's still progress, albeit slow and impeded. I made it both up and down the stairs on my own today, and I was able to coax my aunt's moronic dog back inside with the help of the Fedex deliveryman when she decided she would rather go with him than stay inside my condo with a person who loves her so dearly [sarcasm font]. I spoke with one of my favorite friends on the phone today. He was very busy and didn't have to take the time to call me, yet he did. My mother is back, which is simultaneously good and bad. My sweet aunt convinced her, after a lengthy shopping trip, that this is the place she needs to be right now. My aunt even came with her. To be perfectly honest, it probably would have been even better if just my aunt had shown up here while sending my mother on her merry way elsewhere, but life doesn't always work out perfectly.
Speaking of life not always working out perfectly, such is the state of my medication. I've been so stoned and/or sick that I'm not even sure what I've shared. I'm taking post-operative prophylaxis fr occupational exposure to body fluids of someone who very likely does not have the human immunodeficiency virus. I'm not at liberty to share the circumstances surrounding my exposure. The hospital system with which my medical school is affiliated is concerned that the media would love the story and would be all over it, which would, in turn, bring on ambulance-chasing attorneys, in part because one person involved -- I shall not even state his or her position -- acted rashly and not in the best interest of a patient. Because of all of these political ramifications, I'm not at liberty to talk about something that very much involves me. I feel this is wrong, but what can I do about it? I want to finish medical school, and someone connected with the school may be aware of my blog.
It is not totally my choice to undergo the prophylaxis routine. If I wish to continue with clerkship rotations at least once my 4-week tests come back clear, and possibly until my 3- and 6-month checks come back clear, I am at the mercy of the school and must take the drugs. If a particular pharmaceutical cocktail is making me especially ill, which was what happened, I have some say in changing the particular drugs. Still, I'm relegated to a three-drug treatment, which is most effective if the virus is actually present. The part of my brain that thinks logically (though some would say that no part of my brain actually thinks logically) says if I'm going to do this at all, do it the right way; take the three-drug treatment. The half-@$$ed two-drug treatment is merely hedging bets, and it will still make me sick, though not quite so sick. There is wisdom in doing it right or not doing the treatment at all.
What bothers me most about this situation, in addition to the forced confidentiality (I'm probably going further than my superiors would prefer simply with the authorship of this blog) is that I am forced either to undergo this treatment or to place my participation in my medical school program on hold at least until my three-month-check. Doing such would not allow me to graduate with my cohort, and would also likely prevent me from obtaining a match and beginning my internship/residency in the summer of 2018.
What makes this all the harder to swallow is just how low is the risk of exposure from the patient from whom I was exposed. No one is zero risk, but let's just say for the sake of argument that Big Brother went crazy in the form of Obama Care going on steroids, metaphorically speaking. The government decided, in my analogy, that in order for our collective medical expenses to keep us from going under financially, that everyone in the U.S. had to have a needle partner, and an unrelated one at that, with whom he or she must share hypodermic needles. (The unrelated part would be because some people have no relatives, and we have to make it fair.) I know this sounds crazy, and it is, because I am on drugs right now, but please humor me and hang with me for just a moment.
So each of us has to find a person unrelated to us, and possibly even outside our social circles, with whom to share syringes, hypodermic needles, IVs, scalpels, and the works. The person whose body fluids were exposed to me is quite possibly the person I would choose. She's clean. The least safe thing about her is that she is an elementary school teacher. A kid may potentially spit at her or bite her someday. Otherwise, her health habits are beyond reproach. She has more to fear from me than I have from her.
So with such a low-risk subject, why am I being forced to undergo this treatment regimen? I can understand exercising extra caution with regard to what procedures I'm allowed to perform until my testing comes back clear. Frankly, prior to my HIV exposure, I had already performed multiple procedures that third-year residents are not supposed to undertake. I'm way ahead of the game at the moment. I can afford to step back and watch for a month or two or three as others take the lead in procedures.
The bottom line here is that I'm ordinarily a cautious person -- not so cautious that I would not have done what I did in the first place that caused the exposure -- as I reacted on impulse. Those of us who enter the profession I am entering should be doing so with the intent of saving and/or improving the quality of others' lives. If I had the opportunity for a do-over, I wouldn't change a thing. I did what I thought was right, and I still think it was the right thing to do. If another person whose identifying information shall be withheld had done the right thing as well, I might never have been in the position to have done what it was that I did, but that's really neither here nor there. My point, after all has been said and done, is that I think, even given all the information I have regarding the clean lifestyle maintained by my source of exposure, I still would have elected to undergo the post-exposure prophylaxis. My quarrel with the process is that it should have been my decision without the heavy threats having been hung over me.
Regarding the title of this post, I thought of it myself, though I was far from the first person to coin a similar expression. Its pertinence is to the effects of one of the new drugs I'm taking. I now not only have to worry about vomiting, fainting, dehydration, and low blood pressure: I now have the ghost of Montezuma haunting me.
Why is it that, in going through this treatment regime, I always feel best between 3:00 and 5:00 a.m? It's a time when it's probably least productive to feel at one's best. I suppose I should consider myself fortunate that there is any time at all in a given twenty-four-hour block that I don't feel like euthanizing myself. Count your blessings. Name them one by one. (It's a Mormon hymn, though fundie Protestants may use it as well.)