The Doctor’s View: The Drug Battle

By Denise Kavuma, Uganda:

And now, we shall talk about something more frightening and a million times more personal than what I've been talking about so far. This happened at the beginning of internship and frightened me more than I thought was possible. The hazards of medical care far outweigh those of many professions; even if you were a dragon-fighter, all you'd have to worry about is death (yours or the dragon's). Not things like getting sued by the dragon for invading its home and having the entire town hate you for angering the dragon. Yes, they hired you and you explained that there are some dragons that just do not die but hey, it's your fault for attempting to help them anyway.

Obviously my love for the more dramatic patients has worn thin and I just want to put itching powder in their underwear but that wasn't the case with this lady.

I was rotating on the Obs/Gynae ward and anyone who's ever been there can tell you the fatigue, despair, yelling, and endless odor of the perineum that haunt those halls. I am not kidding; the female perineum has a smell so distinct, your brain will set aside a certain section just so you can never forget it. I'd done a full 2 months and a half in the department and so there I was, hallucinating that particular odor even when I was in restaurants, waiting for my meals. Even when I slept, I'd never get any peace; I'd dream of pregnant women having all sorts of issues and women bleeding as well as needing surgeries; it was exhausting, to say the least.

And I loved it.

I loved taking care of pregnant ladies especially; I would see a gravid abdomen and most of the time, I just would just start fan-girling and squealing like I'd just seen the cutest thing in the world. What, did you honestly assume that somebody as stressed out as I was wouldn't have some sort of creepy obsession? Welcome to the real world, my dear. Of course now I am all about them eyes because I decided Ophthalmology is my calling but back then, Obstetrics was my shit!

It was under such a frame of mind that I found myself with a long list of Caesarean Sections to perform. It had been a long day; I'd had a 6 hour long ward round and by 3pm, I could barely understand a word people were saying. So I did what any self-loving person would do: I ran away…for lunch. After that, I went back to the ward only to find that 2 mothers had not yet been worked on. They were electives (google that if you know not the meaning) and not emergencies, so we really didn't have to rush anything. But it was 4pm and this was the ward I was in charge of. Care at the hospital is not cheap and I couldn't leave them there overnight simply because I was too tired; what was I, a banker?

With quite a bit of will power involved, I managed to get my full stomach up and squeeze it into theatre scrubs. I delivered the first lady with a colleague and we decided to do the same for the second one. She is a HIV positive lady on ARVs and things were going well until the baby was delivered, then all hell broke loose.

We had quite a tussle trying to stop the bleeding and the fibroids she had were not helping matters. Granted, there were only two small baby fibroids but man, those things can bleed if you've never dealt with them before and yep, you guessed it, I had never seen one up close let alone trying to cut it out. So what should have been a 30-minute operation took twice that time but finally, I was doing the final suturing on the skin and subcutaneous tissue.

Then I pricked myself.

On the last stitch.

The last freaking stitch.

I was in shock; so were all the people in the theatre. All the complaining and whining about me taking so long had stopped to leave complete silence in the theatre and it wasn't helping my rising panic. I finished up the operation, took off the gloves and then dutifully followed the head-nurse as she took me to the HIV counseling unit. All the while, she was trying to console me with stories about how she herself had ever pricked her finger with a needle having the blood of an HIV positive person, but I was not interested. All I was thinking about was WHAT THE HELL AM I GONNA DO?!

Yes, I know I am a doctor and we have protocols set in place should any of these things ever happen but all the nurses and counselors were fawning over me and telling me to calm down as I stared at them listlessly. I wanted to cry; to scream and blame the lady and her baby but not a single word or tear came out. If anything, I vowed to never speak again because I was sure only a blood-curdling scream would come out instead.

As it were, they tested my blood and started me on Post Exposure Prophylaxis (PEP.) These are drugs you have to take at most 72 hours after initial exposure to HIV to reduce your risk of contracting the virus. It all sounds like fun and games but PEP is a big deal and has a wide spectrum of side-effects. The ones I had to face were hallucinations, nightmares, excessive nausea and vomiting, possible liver and kidney failure, and severe body weakness. In order to reduce them, I had to stop eating junk and get at least 7 hours of sleep per night, and drink water like a fish. This, for somebody who was on call 3 times a week and would barely get 2 hours of sleep on those nights. Obs/Gynae was only my first rotation and the very methods of failing it were now in my way; how on earth was I expected to carry on with working when I felt sicker than an overly-full child on a roller-coaster?

That very evening, I had practically the whole hospital apologizing to me and offering their condolences as if I was already a dead writer. The worst thing though, was how my supervisor kept asking me why I was taking the drugs. He'd then go on to narrate various stories about how he had pricked himself numerous times, never taken PEP but was still alive and virus free. He insisted that God knew what he was doing and wouldn't let us, the people who risk our lives for our patients, die from some of these diseases but I knew that to be false. I hated that talkative man at that time; there I was, not 100% sure I would not contract the virus even with PEP and he was looking at me like a fool.

Everywhere I went, the hospital staff would look at me with eyes of pity and I finally couldn't take it any more: I stopped taking the drugs 8 days in. It might seem weak but put into thought that I was heavily nauseated every second of every day, weak from the drugs and yet having to attend ward rounds and theatre every day for 9 hours at the very least. On top of that, I have to do 3 night calls a week which meant 36 hours of no sleep per call-night. It's starting to look like I'm much stronger than you thought, eh? 8 whole days!

I then proceeded to forget about the whole thing until 3 months after the fact. Ideally, after PEP, you're supposed to repeat the HIV test 3 months later. I was terrified, so scared in fact that I got some sort of flu and then my fear went through the roof. When one is sero-converting from negative to positive, there's a flu-like illness they get. At that point in time, I was making all sorts of ridiculous deals with God. 5 months later, I finally tested and found myself negative. Repeated the test a few months later and it was the same result.

Pheeeewww!!

The moral of this story? Don't become a doctor.

Seriously, just don't.