KEVIN SPENT ALL MONDAY in clinic. At dusk, he went across the street to see inpatients where he ran into Gwen. She had been on call since Sunday morning.
“Last progress note,” she said, closing a chart. “I’m out of here.”
“Get any sleep?”
“I did! A whole, uninterrupted hour.”
She didn’t seem in a rush, so he brought up her post-residency plans, urging her again to apply for a general internal medicine attending position at City Hospital. Gwen said she had submitted the application and had also scheduled interviews at several public health clinics around the Bay Area.
“Stay here,” he pleaded. “The residents take care of the scut, and you’ll get to teach them. You might get woken by a phone call in the middle of night once a month, if that. It’ll be more fun than working in a public health clinic and way less time away from your family than this is.”
“Any job will be easier than this, Kevin. You know I’d love to be hired here. But they’re not making any promises. I need other options.”
He put a hand to his forehead and gnashed his teeth in an operatic imitation of despair. Gwen’s laughter stopped when her pager sounded.
“Damn!” she cried on seeing the number. “The ICU. Five more minutes, and I would have been signed out.”
“I’ll be there in a bit,” he said as she hurried off. “If it’s about Miller, I can take care of it.”
“You’re sweet,” she called back to him.
Miller’s sedation had been temporarily lightened that afternoon to look for signs of recovery. He became agitated and yanked out his intravenous line. A nurse attempted to re-insert a new one but had no success. Per hospital policy, a medicine resident had to take the next try. If that failed, a surgeon could be called in to dissect down to a vein.
Gwen found Miller motionless except for the periodic rise and fall of his chest each time the ventilator pumped air into his lungs. She scrubbed his forearm with iodine and alcohol, tied a rubber tourniquet above his elbow, opened an intravenous catheter kit, and donned a pair of sterile gloves. Using the tip of her gloved finger, Gwen stroked Miller’s skin, hunting for an engorged vein. Finding a promising bulge, she drove in a needle encased inside a white Teflon tube. Blood appeared. Satisfied she was in the right place, Gwen slid the white catheter off the needle into his vein. She was reaching backward to drop the needle in a sharps container when she felt wetness on her ankle. Turning her head, she saw blood dripping from the catheter onto her leg. Reaching back to pick up a piece of tubing, Gwen impaled the fleshy part of her left palm on the needle she was still gripping with her right hand.
Gwen stared at the needle for a numb moment before pulling it out. Eva crossed her mind. She’s only twelve years old, Gwen thought. Then all thinking was submerged by a flood of nausea and disbelief.
As Kevin entered the ICU, he saw Gwen leave Miller’s room. Her eyes were oddly glazed. She was wandering, not walking purposefully. This was beyond any post-call torpor. She passed him with no sign of recognition. Kevin followed her out the rear door into a resident sleeping room. She collapsed on a bed.
“What’s wrong?”
“Unbelievably stupid!” she sobbed. “I stuck myself.”
“When?…Miller?”
She nodded yes and began shaking. Kevin sat next to her.
“Let me see.”
Gwen opened her palm. A bead of blood covered the puncture wound.
“It went in deep.”
She finally looked at him. The apprehension she saw in his face registered.
“Unbelievably fucking stupid!” she screamed.
Kevin disappeared and returned seconds later with a basin of iodine solution. He plunged Gwen’s hand into the basin and held it down. The force of his hand on hers, pressing it to the bottom of the sterilizing bath, soothed her.
“Thank you,” she said, sniffling.
“Gwen, I know you’ve heard about IV drug users in New York with the syndrome. But think about it. A lot of immune deficiency patients have been hospitalized in the last two years, and not just here. Lots of hospital staff have had accidental needle sticks. Nobody has gotten sick.”
“Kevin, what about that nurse in Los Angeles who…”
He cut her short.
“Urban legend. The CDC has been searching hard and hasn’t been able to document a single case in a health care worker who didn’t have other risk factors—that’s code for being gay or injecting drugs. You don’t cruise bars in the Castro, do you? Been shooting heroin or speed with your buddies in the Haight lately?”
Gwen tried to smile.
“I’d be scared too, but think about facts. If whatever causes this disease can be transmitted by an accidental needle-stick, it hasn’t happened yet. Which means the risk has got to be very, very low.”
She looked at the basin and said, “Kevin, the only thing reassuring me is the smell of iodine.”
They lapsed into silence, hands immersed together for the next five minutes. Then she stood up.
“Think that’s long enough?”
“Probably. Go home, Gwen. I’ll take care of Miller.”
“No, I don’t want anyone else to know about this. If someone sees you putting in his IV, they’ll ask questions.”
“I’m not going to tell anyone. Come on, Gwen. You’ve been here for thirty-six hours. If I tell people you don’t feel well and I’m mopping up for you, they won’t start wondering if you stuck yourself. They might think you’re getting soft or maybe that I’m not really gay and have the hots for you.”
She didn’t smile.
“I need to go back to work and stop thinking about this.”
“Gwen, you need to go home. Get some sleep.”
She gave him a look of utter incredulity.
“You’ve got to be kidding.”
“OK. If you can’t sleep, at least get some rest.”
“Right,” she said, washing off the iodine.
“Talk to Rick. He’ll be there for you.”
She didn’t respond. Head bowed, Kevin followed her back into the ICU.