I always knew that as a pediatrician, I would bring home a few germs. Kids are crawling with them and crawling all over me. I’m currently in the middle of an antibiotic course after a Pertussis exposure at work last week, and I’m sure it won’t be the last one. Occupational Health and I became friends years ago when I got HIV in my eye. Yes, I said HIV in my eye. Let me start from the beginning.
It was October of my intern year and I was feverishly trying to prove myself as a legitimate doctor. I felt especially confident with a bisexual teenager who came in for his yearly physical, as I had experience working and doing research at the Mazzoni Center, a Philadelphia LGBT health and wellness center. After this teen confided that he had unprotected oral sex with men and had recently been bothered by a persistent cough and sore throat, I decided to culture him for gonococcal pharyngitis, in addition to a number of other sexually transmitted infections. My supervising attending witnessed as the throat swab gagged him and he coughed a large wad of mucus into my eye. Eww. My attending though seemed unimpressed, as if teens were coughing mucus into the eyes of pediatricians everywhere, and being an eager and naive intern I wiped away the mucus with a wet paper towel and continued on.
By the next morning, I had forgotten about the grossness of this event and almost completely put it out of my mind with the exception that my eye was bright red. I, along with my coworkers, believed that I must have picked up pink eye, until four days later when I was on call and received a page from the Virology Lab technician. He reported that Patient X had a viral load so high he needed me to order additional tests. Wait, Patient X. He’s the one who coughed in my eye. “Do you remember this patient?” he asked me. I was weak with the news and all I could say back was, “my eye.”
An infectious disease doctor, who has known me since I was a medical student, tried to reassure me between my sobs by quoting the medical literature’s risk of HIV transmission from this type of exposure. He informed me in an upbeat tone, it was 1 in 100,000. WHAT?! I had hoped the denominator would be more like a zillion, because I can’t imagine what a zillion looks like, but I can picture 100,000. That’s the number of seats in a large football stadium, the population of Erie, Pennsylvania, or the number of people at a U2 concert.
Reflecting on this experience now raises many mixed emotions. I am relieved that after 1 month of antiretroviral therapy, 6 months of testing, and 180 days of worrying, I am HIV negative. Phew. I feel angry that my attending didn’t guide me more appropriately and guilty that I didn’t advocate for myself. I am grateful that I was on call with a senior resident who made one of the worst nights of my life more bearable and that my co-interns surrounded me with love and support. I am proud that the first diagnosis I made as a real doctor was one that may have saved a teen’s life.
So even though I received my Tdap booster and I should be immune to Pertussis, I’m still dutifully taking my Z-pak because I have learned not to take chances that would compromise my and my family’s health and this is the example that I want to set for the interns I teach and the son I am raising.