Real risks facing healthcare workers
November 12, 2019
By Geoff Frost, UBC Physiatry Resident
When I was a kid I used to wonder if doctors and nurses got sick. They were around sick people all the time, surely they were bound to catch a cold, maybe a nasty virus, and succumb to the illnesses they themselves were trying to treat. Once I got into medical school the idea of getting sick myself vaguely passed through my brain, but I cannot say I took the threat seriously. It often only came to mind when I was forced to wear Personal Protective Equipment – those lovely off-yellow gowns you see in hospitals all over the place – as I was about to see a patient. This again? This is such a hassle… Am I really at risk of getting MRSA from Ms. Jones? Is this really necessary?
The short answer to both questions is yes. And so I trundled through my medical career not really thinking much about my chances of getting ill at work, and frankly, not really caring.
O’ the blissful summer of youth. How sweet it seems in retrospect. I am now an emergency room visit, many phone calls, three bottles of pills and a trip to a specialist HIV clinic away from those halcyon times. Let me take you back to the day where it all changed.
It was a Monday morning, which I always particularly despise. I’m not an early riser, and Monday is Monday. I was a minute or two late for work, which had me on edge right from the start. My first patient of the day was a recovering addict. They were positive for a bunch of scary blood-borne illnesses. They rolled into the room with a sibling, who came equipped with a folder full of information.
As the patient talked, the sibling would furiously flip through the pages of the folder and then jump in with corrections. “Ah, actually, it seems like that surgery was in 2008, not 2010. And the medication you mentioned? I think you’ve mixed it up with this other one.” I like to think of myself as patient, but interactions that create a communication barrier between myself and the patient always infuriate me. Whether it’s language, decaying memory, or in this case a broken mind, I always get a bit irked. One of the most important things I do is talk to patients. Whenever there is a barrier to communication, a little part of me balks. Sadly, this encounter was no exception.
I was Monday morning unhappy and communication barrier grouchy. So I was not as careful as I usually am. I was plowing through the history and physical exam with a firm “let’s just get this done” attitude. During the physical exam, I was testing the patient’s sensation to sharp touch. I used a needle, which happened to break the patient’s skin. I will divert from the main plot for a moment to emphatically state this was not due to my poor attitude. This sadly happens all the time with the elderly or patients who have friable skin for one reason or another. So now there is blood on the needle. Of course, this should heighten my spidey senses and make me extra cautious, but this change to my operating reality does not penetrate my sour mood. I go on testing away, and at one point, hit a particularly sore spot. The patient jerked, jarring my needle hand, sending the sharp right through my skin.
And in that moment I let out an internal howl that would have impressed a wolf pack. I was now at risk of contracting all those scary blood-borne illnesses. I was now marked by Apollo. And for what? To see if their dorsal ulnar cutaneous sensory dermatome was intact? What an absurd risk to take on for such unimportant information.
I spent a half-second in that moment deciding how I would handle it. I quickly assessed the situation: a hollow bore needle, minimal blood on both sides of the equation. My chances of contracting a disease were objectively minimal. The patient had come with their sibling in the hopes of getting an answer to their problem. My new problem was not the focus of this visit. Time to solider on and answer the patient’s question. I did take stock in the moment and realized an attitude adjustment was in order. I took a deep breath, finished my physical exam before washing my wound, and then completed my assessment.
The last fifteen minutes of the appointment were excruciating. Especially as I explained the diagnosis, which turned out to be trivial. Why, I wondered, are we spending ten minutes discussing a trivial nerve problem when I could have an incurable virus worming its way into my body’s cells.
As the patient left, I turned to my supervisor and mentioned what had happened. She was immediately apologetic, told me to head to the emergency department, and quickly grabbed our patient. She asked the patient kindly if they would not mind getting some extra blood work done to help make sure I had not caught one of their deadly diseases. To the patient’s eternal credit, they agreed to take time out of their day to get some extra blood work done. I have to commend them for that. It was certainly optional for them, but definitely took a load off my mind.
The next few days passed in a blur. I was on medication to avoid contracting HIV, a scary thought. The side effects were meant to be serious, but thankfully I managed to dodge the worst of them. What surprised me the most was the questions other health care providers asked me. Was my patient still using? Was I sure they were no longer an intravenous drug user? I was taken aback. I get these questions, scientifically they are sound. But as I am sitting at home on the couch wondering whether I have HIV, I now have to play detective and question my patient’s motives. Were they lying to me when they said they were clean? Could they have possibly been hiding a double life? It was a bridge too far for me. I am no sleuth. Just a humble resident with an alarm clock problem. I wanted to rewind time for a few days and just be more present, more focused in that moment, and avoid that damn needle. I did not want to question the motives of someone I met once for an hour.
But so it went. Blood tests, doctors visits, difficult discussions with my partner about her own risk and how we would manage it. Life trundles on. Eventually, a big wig infectious disease doctor gave me the benediction sign and declared me all clear. I was not to contract an incurable disease after all.
I always knew my risk was low. The exact exposure was technically low risk. But it forced me to think. In BC, healthcare workers make up the second-largest group of employment insurance claims. In 2018 we made up 14% of all claims, trailing only Construction which came in at 15%. In practice what that means is that I do not get to have a grouchy Monday morning off where I am not completely present. I do not get to float through the day wondering where that sharp needle tip has gotten itself. I work in an industry with real risk.
I certainly do not work in a war zone, but I do not work in a sleek office either. Part of prevention is incumbent on me. I have to be present, respect dangers within the workplace, and operate with the intent of avoiding injury rather than treating it after it happens. Sometimes, despite our best efforts, we do get sick. I find it ironic that seven-year-old me would ponder the realities of health care employment risk, only to twenty-five years later encounter that risk in a very tangible way. What goes around…
Geoff is a fourth-year Physiatry resident at UBC. He currently serves as the Director of Communications at the Resident Doctors of BC and is the host of the Pulse Podcast. Geoff is a professional engineer in Ontario, and prior to entering medicine, he worked as a biomedical engineering entrepreneur.