|This is not Glenn beck. It's Mr. Potato Head with his happy face.|
Today I actually begin my clerkship in internal medicine. I've spent three of the past four weeks officially participating in the internal medicine rotation by taking medical histories and documenting symptoms in the E. R., but that wasn't real internal medicine. It was the hospitals' and my program's very generous attempts to accommodate my situation. While my HIV exposure happened on the job, which made it somewhat their problem to find a way for me to participate in my program as much as possible as opposed to saying, "We'll see you in three months when your test results come back clean," my supervisors have gone far beyond what they were legally required to do in order to accommodate me. Other than one doctor who yelled at me when I passed out -- but then quickly apologized when he was made aware that I had not violated agreed-upon protocol -- no one has complained when I needed extra breaks or was required to leave early for health reasons. (Every moment I was there, they were probably just waiting for me to collapse to the floor in a heap, and it was likely a relief to them each time I made it official by leaving early.)
I don't think anyone expected much in the way of actual work from me since this debacle started. I promise to make it up to everyone involved and thus inconvenienced by working doubly hard in the upcoming months. I had my one-month blood draw yesterday (Sunday), and the results should be back by Tuesday, at which point I will be allowed at least to touch patients. Tomorrow and part of Tuesday will be a bit like the past three weeks have been, minus the frequent barf breaks, with regard to the "no-contact" rule.
It has not yet been determined when I'll be allowed to give injections, insert IV's, perform exams involving body cavities, and the like. The original word I was given indicated that wouldn't happen until my three-month clearance, but I've been told since that the embargo may end sooner. At the very latest, it should end when the patient who was my source of exposure receives a two-month clearance, which will be in one month .In terms of exams of body cavities, if I double-glove and if I have no broken skin on my hands and if I continue to keep my nails short, there's no risk. With regard to injections and insertions of IV lines, there's always been far more risk to the health-care provider than to the patient if even normal protocols are followed. At some arbitrary point in time after the lab results come back, I expect that I'll receive a memo lifting the ban on those procedures. The order in which my privileges are reinstated will likely follow no logical order. I'll go with the flow. Meanwhile, I'll consider myself lucky even to be able to palpate a patient's skin.
This entire experience, while largely a waste of my time and good health, has not been without value. As Jono said in the comments section of a previous blog, a doctor who has been a patient has much more empathy for what his or her patients experience. I've been sick and injured before -- more than a person should be -- but still, it does not take a person long after the cessation of feelings of pain, nausea, discomfort, or whatever symptom accompanied a particular illness or injury, for a person to forget all about those sensations and to no longer feel gratitude for the simple blessing of wellness. I hope to retain that feeling a bit longer this time than I have following previous instances of injury or illness. I wish to savor the good feelings this time, while understanding a bit better just what it is that a patient is feeling.
I'm also grateful for the expanded career options the negative HIV results will afford me. While either radiology or pathology might ultimately have been or might still be my specialty of choice, I won't be limited to those or to psychiatry by default because of an HIV+ diagnosis. The entire field of medicine is open to me, with the only restrictions being any physical or mental limitations I possess. That was the case from the very beginning of my pursuit of a career in the field of medicine. I just never really appreciated the whole concept before this recent scare.
As far as the "scare" goes, I understand why the professionals who handled my case had to present a worst-case scenario and a rather dire doomsday prediction. First, they couldn't have me taking unnecessary chances with patients or with anyone else had I been sexually active, which I was not and still am not, but they could not have known that to be the case for certain regardless of what I told them. Second, they needed to present a solid case to persuade me to go along with the post-exposure prophylaxis. I could have opted out (though I would have needed to opt out of my program as well for a minimum of two months) but it would not have been the safest choice for me to have made. Third, it's easier on everyone involved to give someone good news after the fact. Presenting nothing but a positive outlook, then hitting someone with a "Guess what? We were overly optimistic. You are HIV+ after all. Sorry!" would have been a lousy way to have handled this fiasco.
To those who have been a source of support with this issue as well as in regard to other matters, I cannot adequately thank you. To all of you online - Knotty, Jono, Donna, Jaci, OzDoc, Lil Gamble, Aunt Becky, Becca, Heather L., and anyone else I've forgotten -- who have offered words of encouragement, they helped more than you can know. Thanks to Judge Alex who spoke with me by phone, once even in the wee hours when I inadvertently butt-dialed him. To my possible source of exposure: you and I both know we would have done nothing differently, that it was for a very good cause, and that everything will be fine for both of us -- and thanks for being so accommodating where testing is concerned. To the doctors and faculty members who have been especially supportive, you know who you are if you read this blog, and you understand why I cannot use real names when I thank you. I will offer a shout-out to Professor Larry Bakman. Why you've been so nice to someone who was a bit of a pain in the butt during lectures is a mystery to me, but your kindness has not gone unnoticed. And to family members and the cohort mates who have become like family members, you've all gone out of your way far beyond what anyone could expect of his or her family and friends. Mom and Dad, I'm sorry for putting you through one more ordeal. You both owe almost every gray hair on your heads to me (Matthew gets credit for the remaining few). And to Matthew, thanks for what was no more fun for you than it was for me.
To anyone who thinks I'm being prematurely optimistic, all I can say is that there are some things a person just knows. Lab results will prove me right in due time.