The Real Doctor Will See You Shortly

During his internship at Columbia University Medical Center in New York, while on his first week of infectious disease rotation, Matt McCarthy’s medical education got a little too personal. This experience, and many others, are described in his new book, The Real Doctor Will See You Shortly: A Physician’s First Year.

Infectious disease rounds took place around a conference table. Glazed donuts were passed as I spoke.
    “So,” I concluded, “the patient is doing really well. I actually think he’s ready to go home today.” David was thirty-four and had walked into our emergency room a few days earlier covered in painful purple and yellow abscesses. A simple staph infection was the cause, but his immune system, ravaged by HIV, was unable to fight it off. It was the third time in the past year that he had come to our hospital with these erupting, rancid skin lesions.
    Dr. Chanel ran her hand through her ponytail. “I agree,” she said, “but I’d like to get one more set of labs. I’d like to see how the liver is doing before we send him out in to the great unknown.”
    It was 10:15, and the morning labs had already been drawn; a phlebotomist would not be on the floor for six more hours. “I’ll just draw the labs myself,” I announced. I’d come a long way from those first few incompetent days in the CCU. I wasn’t ready to do a pericardiocentesis, but I could draw blood.
    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. I 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. Hundreds of thousands of copies of the human immunodeficiency virus had just been injected into my bloodstream.
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.  She rushed over and put her hand on my shoulder as the others returned to their conversations. I couldn’t speak.
    “You’re going to be okay, Matt,” she said deliberately.
    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.”
    When we arrived at Employee Health, Dr. Chanel 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 looed like a young Antonio Banderas. He began saying words, but I didn’t hear them. He became more animated as I stared at my hands, tracing the creases.
    “Matt,” he shouted. “This is important.” I snapped back, as if a train had unexpectedly passed through the opposite direction. “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. 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. He said it was impossible to prognosticate. I might be fine, but I might not.
    Out in the waiting room, Dr. Chanel was standing ramrod straight with her arms behind her back. “Matt,” she said, lowering her head, “I spoke to one of our experts. You’re going to need to come with me. Things are a bit more complicated than we realized.” Pure, unalloyed fear coursed through me. “Whatever you just got 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.”
My thoughts turned to the handful of facts I’d learned about HIV in medical school.  Needle sticks were rare, but they happened.
    I looked out 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 become sickly. I could die. And drawing David’s blood wasn’t even my responsibility. I had volunteered.
    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. 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 had 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 she got her diagnosis of HIV. I was thankful that a room full 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’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. 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.
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To read more, order The Real Doctor Will See You Shortly at Amazon.com.