Lyla hustled her way across the crowded corridors from the male to the female surgical ward to draw blood from the patients, a part of her everyday job as an intern. Interns are unanimously exploited, forming the bottom rung of the ubiquitous hierarchy in the medical profession. Not only are they answerable to professors and associate professors, but also the resident surgeons, who are just one step above them in the hierarchal ladder.
Blood draws, filling in forms, shifting patients from one end of the hospital to the other, scrubbing in, but only to retract tissues to clear the surgeons field, were just some of the measly jobs entrusted to them. However unimportant their work seemed, it was still critical in the broader scheme of things.
Lyla, unlike her compatriots, willingly performed her duties.During a twenty four hour emergency duty on a fateful Monday, Lyla was just going about her business, until a spate of trauma cases trickled in through the narrow door leading to the spacious emergency surgical services. There were patients with broken jaws, bleeding foreheads, fractured legs and the like. All these patients had been part of a four car pile-up on a the expressway connecting two neighbouring cities, aptly referred to as the death bed for motorists.
Three of the resident doctors were scrubbed in to operate on patients inside the operating complex. The two resident doctors who remained outside, were the junior most resident doctors, who seemed overwhelmed with the situation.
Lyla, who was edging towards the end of her three month rotation in the surgical services, picked up the mantle to stabilise the injured patients. Having mastered the art of triaging patients, she waltzed around the emergency surgical services ward with the acumen of a seasoned clinician. Tending to the unconscious patients, placing a cervical collar, checking their parameters, placing a venous catheter to resuscitate them, and calling in the radiology resident to perform a screening ultrasound to rule out any abdominal injuries. After ensuring that none of these patients had a falling blood pressure or a rising pulse, she moved on to the more conscious patients with fractures. Using a cardboard and strings available by default in the ward, she immobilised their fractures and prescribed other investigations.
The radiology resident had arrived by this time and confirmed that one of those patients had fractured ribs and a collapsed lung with air having accumulated in the chest cavity and the other one had some fluid in the abdomen (indicative of a severe injury that had caused one of the abdominal organs to rupture). The others were cleared to get their CT scan’s done.
Lyla immediately organised an intercostal drainage kit for the patient with the fractured ribs and collapsed lung and informed the residents who were scrubbed in. Patient 2 with the abdominal trauma was shifted to the operating room under the care of the senior residents and patient 1 was positioned for the placement of a tube into his chest cavity to drain the accumulated air.
Junior resident 1 placed the chest tube and junior resident 2 rushed to the operating room. Lyla’s colleague, overwhelmed and under slept, took on the measly job of shifting the unconscious patients for the CT scan, having realised Lyla’s presence in the emergency ward in these desperate times was mandatory.
At last, an exhausted Lyla proceeded to the patients with the least serious injuries, the last of which was a wound over the forehead, requiring four to five sutures to stop the bleeding. The first suture was placed uneventfully, then the second and the third. Lyla was accustomed to this, having entered the final week of her three month stint. Her experience and skills allowed her to suture in a preposterously inconvenient position. The patient lay down on a bench and Lyla bent over in a most un-ergonomic manner. She was surrounded by other patients and caretakers of those patients, but was just too exhausted to ask them to leave.
While placing the fourth and what seemed to be the final suture, she received an inadvertent shove in the back from one of the other patients. She lost control over her instruments and the needle that had pierced one end of the laceration (a wound that requires suturing) pierced one finger of her other hand. Her glove tore and blood trickled down the sides of her finger.
Lyla halted, her bookish knowledge suddenly surfaced from a part of her cerebral cortex. “Wash the wound in running water with soap, and rush to the nearest ART centre.”
She did exactly that. Washed her finger with soap and water, sent a blood sample from the patient to rule out any infectious diseases spread via blood (HIV, Hepatitis B and C) and asked her seniors for permission to go to the ART centre in the hospital.
The anti-retroviral therapy given to exposed patients within 72 hours of exposure is meant to prevent these patients from contracting the infection.
The patients blood sample was positive for HIV. Notwithstanding the low incidence of contracting the infection (0.3%) from a needle prick, Lyla was shattered. She knew she had had a deeper prick. She knew that her chances of contracting the infection were higher. She started her course of prophylactic anti-retroviral therapy (drugs effective against HIV) and pinned her hopes on a false positive result.
The confirmatory results on the patients sample came in a week later. The patient indeed harboured the virus and Lyla would have to continue the drugs for 28 days and bear with the intense nausea, bloating, belching and burning sensation the drugs caused in her tummy. She wouldn’t know whether or not she was infected till at least 3-6 months later.
Lyla didn’t lose hope. She continued her internship as planned. 6 months remained and she wouldn’t let a stray incident affect her.
She went through her OB-GYN postings learning how to deliver babies and suture cuts made to the birth canal in the process, learnt new techniques to secure intravenous access in the paediatric age groups, assisted neonatal resuscitations and managed out-patient departments successfully in the rural outposts.
6 months hence, Lyla had moved on. She had put the incident behind her, deciding against approaching the ART centre to repeat her blood test.
A week before her convocation, Lyla was approached by the ART centre. They wanted to test her for the virus. Lyla was skeptical initially, but acceded eventually. Her samples were collected and Lyla was to be informed only after absolute confirmation.
On the day of her convocation ceremony, after receiving her doctorate, Lyla was summoned to the ART centre. The chief called her into the cabin.
“Lyla, the reports just came in today.” Lyla’s gaze was fixed downwards. She had an inkling, but she needed to know.
“You have tested positive.” Lyla maintained her poise.
“This isn’t the end, Lyla. You know that we can start you on ART and keep you on regular follow-up. You can still practice medicine and lead a life that may be as normal as most around you. Just be careful when it comes to………………..”
Lyla had zoned out. The bookish knowledge re-surfaced. She faced a normal life with a regular career pathway. But the books didn’t take into consideration her emotional state. She didn’t smoke, was a teetotaller, had never even tried drugs, was a virgin, never had a medical or surgical illness, and lived a regular healthy life. Yet, here she was, infected with a deadly virus, known to affect those who had been transfused with blood or those that lived their life on a edge.
She sat through the counselling session, exchanged pleasantries, promised to follow up and take care of herself.
Lyla was the unfortunate intern, amongst the thousands of fortunate interns and residents who come in contact with blood and other body fluids in dangerous circumstances every single day.
In spite of being utterly cautious, in every sphere, the odd mistake or mishap does occur. In other occupations, one pays with financial instability, loss of a job or at worse loss of limbs or injuries to body parts. Healthcare workers, however, face the daunting occupational hazard of illnesses, both physical and mental. Safety for oneself must take priority over everything else. Only then can healthcare workers adequately care for and nurture their patients back to health.
Lyla sailed into obscurity, daunted by the long and winding road she faced ahead.