We found him lying on the sidewalk, mumbling and semi-conscious.
Was he drunk or diabetic? Sometimes it’s hard to tell; sometimes they are both. We picked him up, put him on the stretcher and lifted him into the truck. A few tests later and we had a treatment plan.
Turns out he hadn’t taken his insulin, had a few drinks with his friends on the corner and then had a few more. When he became incoherent, his friends left him. We didn’t. Homeless alcoholics depend on us. They have far more problems than the obvious.
While establishing an IV he took a swing at me, and the needle ended up in my hand, just below my thumb.
My partner held him down while I sat on the bench, looking absently at my hand. I pulled the needle out, and wiped my blood with an alcohol swab. Then I put my hand on the guy’s chest, held him with one hand and drove a fresh catheter home with the other. We ran some D-50 and a few minutes later things returned to normal.
Lack of sleep leads to mistakes
I was nearly as unconscious as the patient.
The call came in at the end of a 38-hour shift, and near the end of a 23-year career. I was too tired to care about much of anything. So I went home, tried to forget about the needlestick and hoped for the best. But all the hoping in the world will never take away the nagging doubt that haunts me to this day, “am I a walking time bomb?”
There isn’t much to do once the damage is done, so if at all possible, don’t let it happen. Take care of yourselves first, and get enough sleep; otherwise you may do something you regret.
While the money that comes with overtime is great, but lack of sleep makes you a little crazy, which is the only way I can explain my lack of follow-up after the needlestick incident. Had I been alert, it never would have happened. I may have been stuck by the dirty needle, but I most definitely would have followed up with proper documentation and treatment.
And it’s not just me my poor judgment affected.
When I woke up some hours later, at home and in my own bed, I had to face the very real possibility that my irresponsible actions had the potential to touch the very people I was working to provide for. A dirty needle comes with all kinds of problems – HIV/AIDS and Hepititis topping the list. The problem flows downhill; the patient has a disease, the provider sticks himself with an infected needle and becomes diseased, the diseased provider brings the disease home and potentially infects those he is closest to.
Post-exposure prophylaxis (PEP) with antiretroviral medications against human immunodeficiency virus (HIV) are indicated, but are not mandatory. At the very minimum proper documentation should have been done. In the unlikely chance that I develop HIV it would have been nice to point to a probable source.
There is no room for poor judgment when lives are at stake. Exhausted people make poor decisions, and there is absolutely no excuse for medics to be practicing without proper rest. I did it for years, and now I have years to regret doing so. Time spent in the streets ends abruptly, and there is the rest of your life to live when it’s done.
Or not.
It is up to each and every one of us to know our limits, and how best to not exceed them. When overtime is available, try to think of how you felt after the last one, and decide whether or not it was worth it.
