The next day I was back on infectious disease rounds, presenting a patient to the team. In contrast to cardiac care unit rounds, this discussion took place around a conference table. Glazed donuts were passed as I spoke.
“So,” I concluded, “the patient is doing really well. I actually think he’s ready to go home today.” David was thirty-four and had walked into our emergency room a few days earlier covered in painful purple and yellow abscesses. A simple staph infection was the cause, but his immune system, ravaged by HIV, was unable to fight it off. It was the third time in the past year that he had come to our hospital with these erupting, rancid skin lesions.
Dr. Chanel ran her hand through her ponytail. “I agree,” she said, “but I’d like to get one more set of labs. I’d like to see how the liver is doing before we send him out into the great unknown.”
It was 10:15, and morning labs had already been drawn; a phlebotomist would not be on the floor for six more hours. “I’ll just draw the labs myself,” I announced. I’d come a long way from those first few incompetent days in the CCU. I wasn’t ready to do a pericardiocentesis, but I could draw blood.
“Can I join you?” Carleton asked.
“Make it quick,” Ashley said, “we’ve got two waiting for us down in the ED.”
I slipped on my white coat, put the dark green stethoscope around my neck, and walked with Carleton across the hall to David’s room.
“So exciting,” Carleton said. He was far better at faking enthusiasm than I would ever be, which irritated me. My colleagues could sense my hesitancy the moment I walked into the hospital’s lobby. But Carleton was the kind of kid who could adapt, who could play the role that was required of him. He was a medical school chameleon; if he needed to be passive—like during psychiatry, where more of the time was spent listening—he could, and if he was called on to be assertive, perhaps during the surgery rotation, he could do that, too. He was the student who would breeze through medical school and residency free from torment, free from anguish. A few years from now he would summer with other beautiful, carefree people in the Hamptons, tossing back cocktails on a private beach.
I tapped on David’s door as I pulled it open. A large man with thinning brown hair, he mock-cringed when he saw me.
“Not you again,” David said. He shook his head and reached for a magazine.
“Me again,” I said cheerily. “This time I have company. I’ve brought along a medical student, if that’s okay.”
“This guy tortured me yesterday!” David said with a smile to Carleton. He put the back of his hand to his forehead and added, “I don’t know if I’ll ever recover.”
A day earlier, I’d spent hours lancing every one of his abscesses with a small scalpel and even more time scooping up the pus with gauze. In college, even in medical school, the sight and smell of those abscesses would’ve made me nauseated, but not anymore. I had been told that every doctor eventually discovers which bodily fluid he or she finds most disturbing, and this realization helps guide the choice of a subspecialty. I didn’t mind blood, spit, piss, or pus. I did mind diarrhea, which meant I wasn’t destined to become a gastroenterologist.
“Antibiotics weren’t going to work,” I said. “You know that. I had to open those things up.”
“I know, I know,” David said, waving his hand dismissively, “you had to do it. But why the CAT scan? That took up my whole afternoon!”
I flashed to Gladstone and shook my head. I was now ordering potentially unnecessary head scans several times a week and neurosurgical consults nearly as frequently. “The good news is you’re getting better. The CAT scan was normal and you’re going home soon.” Even though I suspected that Gladstone was going to be okay, his image haunted me. Whenever I felt like I was starting to get the hang of things, like I was starting to become a real doctor, I was reminded of him and my colossal oversight. More than anything, I was reminded that I needed supervision. Fortunately, Columbia had a structure in place that provided it. But what would happen when I was the supervisor? It was okay to practice defensive medicine for now—I had people like Ashley to tell me when I was being overly cautious—but eventually I’d need to cut the safety net.
“Thank God,” David said.
“I’m proud of you for starting the HIV medications. Your numbers were through the roof.” I set down the equipment for the blood draw and turned to Carleton.
“You know, it’s actually better today to have HIV than diabetes.”
“But I have diabetes,” David said.
I frowned. “Let’s get started.”
I knelt down by the side of the bed and again turned to Carleton. “The key to drawing blood is finding a vein. Help yourself out by using a tourniquet.” He quickly scribbled on a notepad as I spoke. “Sometimes one isn’t available, so I just tie a latex glove around the patient’s arm.”
“Technically they’re latex-free gloves,” Carleton said. “Because so many people have latex allergies.”
“Right.” Fastening the glove, I felt for veins. “His veins aren’t great,” I said as David wrinkled his brow and looked at his arm. “Have you ever heard of the intern’s vein?”
Carleton shook his head. “What’s that?”
“It runs along the thumb. Works every time.”
Enjoying my new role as teacher, I took out an alcohol swab and wiped down the vein as David looked away. I uncapped the butterfly needle and attached it to a thin plastic tube. The tube was fastened to a small vial and placed in a bucket next to the patient’s right leg.
“Before you do a procedure, any procedure,” I said, “you should do a time-out. Before you do something to a patient, no matter how trivial, you should bring someone else into the room.”
“Got it,” he said, writing that down. His copious copying reminded me of myself. But I doubted Carleton ever needed someone to tell him not to write on his hands. He probably already knew about the time-out. He was probably only taking notes to placate me.
I tilted my head at his notepad. “First, confirm that you have the correct patient. Then, double-check that you are, in fact, doing the appropriate procedure to the proper body part.”
I confirmed the information and plunged the needle into David’s thumb. He reflexively pulled his hand back an inch as blood flowed through the tubing and the vial filled.
“All done,” I said a moment later and held up the vial.
With my left hand I withdrew the needle from his thumb and with my right I reached for a Band-Aid. Blood oozed where the needle had been. Not wanting it to drip on the floor, I quickly moved the Band-Aid toward David’s thumb.
But the Band-Aid never reached its intended destination. My right hand’s path was intercepted by the butterfly needle, and in an instant I had impaled my index finger with the blood-filled needle. I dropped the needle and ripped off my glove. Blood dripped out of my hand as Carleton looked on, mouth agape. Hundreds of thousands of copies of the human immunodeficiency virus had just been injected into my bloodstream.