Thursday, April 10, 2014
Dodging a Bullet with My Name on It.
Dodging a Bullet with My Name on It.
Disclaimer: This is quite a morbid post and better avoided by those with a queasy stomach. It contains graphic descriptions of diseases and deaths and is not recommended for everyone.
I woke up sometime around four this morning with my mind all alert of a sudden. For a few minutes I lay there trying to calm myself of the sudden wave of anxiety that had woke me up and trying to recall what it was that was troubling me so much. And then it crashed on me like a wave. Oh god, how could I miss it? It was so much like an HIV case. And then it all came back. Yesterday, being an unusually busy day with a long line of patients- each one crowding out the other like on an assembly line- I had seen a patient with certain unusual symptoms- a severe disease with no logical added reason like diabetes or some previous fevers or something which could explain the severity of her symptoms. And being such a busy morning with forty plus impatient patients waiting next-in-line I had asked her the mandatory questions, asked her to get the routine blood tests next time she came, did a minor procedure on her then and there and prescribed the usual medicines all the while functioning on my robo- doc mode.
I know that my being tired and distracted with all the noise and clamor of those patients surrounding me doesn’t excuse me from not suspecting something amiss right then and there. But, i suppose my ever present vigilance slipped for a minute and i decided to treat it for then and there and reserve further inquiry for the next visit in three days. But somehow, somewhere in the back of my mind my subconscious was not satisfied with the mystery is what I think now. It must have been plugging away at it all day until in the middle of the night it made the right connections and it woke me up. I was lying there in a cold sweat while thinking how careless i had been in handling an HIV patient. What if, god forbid, I had been exposed too? Was it already too late for me? Am I going to get AIDS and die? Believe me these are morbid thought to think in the middle of the damn night. They don’t make for much pleasant sleep the rest of the night.
When we are students we are taught repeatedly how to protect ourselves. There is a reason that we are taught to take precautions as if every single patient is an HIV patient because you never know who can be one. They might know that they are hiv positive but conceal it and lie to the doctor so they wouldn't be treated differently- with extra safety measures. Or the poor patients might not themselves have known about it. Any which way if only we, I, had followed the proper procedure of doubting everyone- I wouldn't be here in the middle of the night shivering with fear. But complacency they say can kill even the best of them and as i had started to think myself as wise as Yoda the Jedi master, I had let down my guard and been as foolish as the newest apprentice.
Of course the blame can also be shared by the authorities- they expect us doctors to do miracles with what we have while they support us only halfheartedly. If you want to give the best health care to the poor patients then you should be prepared to spend more money by hiring more doctors who can spend more time with each patient listening and diagnosing carefully. You can’t expect just a handful of doctors to cope with a hundred patients in five hours and still take a detailed look into everyone’s complaint and not make a single error. We are human too- a fact which the authorities conveniently forget all the time. I had been travelling all night that night, on a rickety government bus, perched on an uncomfortable seat trying to grab a few winks of sleep and as soon as I had landed in the city I had come straight to work after stopping to change at home. I was tired, sleepy and my alert levels were far below normal. Of course I made an error- but the bottom-line is I am in a profession where errors are inexcusable- they can either kill the patient or kill the doctor. No excuses allowed.
And to conclude this post, medicine is as a risky a profession (for doctors, I mean) as you can ever see in life. The chances of our errors killing us is almost as high for airline pilots - remember the Thai flight lost recently due to pilot error? Similarly, one mistake, one moment of carelessness and we doctors are dead- it’s an accepted hazard of the profession though no one talks about it much. If you think I am being paranoid let me explain that on a daily basis we doctors are exposed to far more life threatening diseases than anyone else - including those sick people who have that disease and only "that" disease. For example, I had spent a majority of last week at the fever ward- the place where severely infectious patients are admitted- because there has been a recent explosion of chicken pox cases in the city and everyone's been pitching in to help out to get over the staff shortages because of the summer hols.
I guess my blood by now is crawling with all sorts of viruses and bacteria after being exposed to the infectious diseases wards all week. I am a walking, talking bio-bomb, most likely. On the other hand the fact that I am still healthy and haven’t caught anything yet only points out the astonishing fact that my immune system is robust and copes with everything that’s thrown at it. Those little buggers, the white blood cells swimming down my arteries must be some helluva strong fellas right? And in the end - what doesn’t kill us only makes us stronger, in the immortal language of that awesomatic rapper 50-Cent. So, let’s see, my options are I can either keep worrying all day long about whether I have caught anything or just get on with life throwing it all to fate and that’s what I am prefer to do. Just get on with my life and hope for the best - like the light brigade- canons to the left of them, canons to the right, rode the six hundred and so will I.
P.S. Just now- this morning the patient has returned with her blood test results. She said she had been cured completely by whatever drugs I had given her earlier- all her symptoms had disappeared. And most importantly her blood test results came out clean- she was not HIV positive which means I was in no real danger whatsoever and had merely been frightened badly. I don’t know who was more relieved at the result - her or me. Somehow I seem to have dodged the bullet this time- but I have learnt my lesson. Eternal vigilance is the price to pay- to sleep well at night. No more excuses- of being tired or anything- nothing will be tolerated. I vow to keep awake, alert, all the time, so help me god. And I sincerely hope that the bullet which has my name on it will take some more time to arrive. I am not dying yet, I have work to do and a life to live and miles to go before I sleep.