Life Hazards, Or, How I Learned to Argue with Doctors

Yesterday at 1:22pm, after coming into the office from lunch I had to deal with someone at my syringe exchange and in the process I received a needle stick injury. I am not going to write about the details of how that happened, certainly not online, but enough people have heard about my injury that there’s little sense in not talking about it at all. I’ve known ever since working for this nonprofit that working in the exchange carried some risks, and I’m proud that after fifteen years in operation, this is the first accident in the program.

However, if I thought there was a readily accessible and understandable protocol for dealing with needle stick injuries that I could work through in the hours after the injury, when it is most critical to get care, I was sorely mistaken. For a town known to have a great number of medical personnel and a nursing program, I had to work through six different care organizations and several staff who were close to incompetent, who had poor patient listening skills, and little cultural competence. Here is what happened after I washed my wound out in my office rest room.

I called the health department, saying I had a needle stick event and needed to talk to the infectious disease nurse, who knows me professionally because of my position at the nonprofit. She told me that I needed to contact Occupational Health at the hospital beause those are the folks who deal with needle sticks that have occurred in the workplace. I pulled up their web page and called the number at 1:30pm, eight minutes after the event, and got a recording saying their normal working hours were 8:30am until noon and 1:00pm until 5:00pm, but I could leave a message and they would call me the next day. I hung up and called again. Same thing. I texted Susanne, knowing she would be in class until 2:20pm.

I drove to the emergency department, got a bracelet, and was ushered back to a bed by 1:50pm. I texted the president of my board who offered to join me. I accepted. The nurse on my case told me her computer said to send me to urgent care because they are associated with the occupational health department. She cut the bracelet off my wrist and I drove half a block to urgent care. My board president met me there. At 2:30pm they brought me back and a nurse took my vitals. She was concerned that my blood pressure was 148 over 90, but I said given the circumstances it wasn’t going to get much better. I tried to relax; but my BP readings were just borderline high, which is atypical for me.

The doctor came in and asked what happened. I told him I run a syringe exchange and that I received a needle stick injury through my rubber glove. He asked me the name of the “source patient,” science-speak for the owner/user of the syringe. I said I didn’t know his name as this is a confidential program. This began a strange discussion in which I outlined:

• This primary exchanger trades in needles for himself and several other people, none of whose names I know
• Sixty percent of injection drug users have hepatitis C, nationally
• These were not needles from diabetics or people with a health condition, but people at high risk for HCV and HIV, as well as other blood borne pathogens

He nodded, and left me and my board president to wait again. We talked about maybe calling people we knew who were doctors. Maybe I should call the doctor who sees my HIV-positive clients. We waited.

The urgent care doctor (where is occupational health, again, I wondered) came back in and said that because I didn’t know for sure if the needle had blood in it or the source patient had HIV, that this was not a high-risk event and I should just come back to get tested for some variety of diseases I could now be exposed to. I think my jaw dropped.

“I can’t think of a higher risk scenario in all of Walla Walla,” I said, “unless I got a needle in my thumb from one of my clients who has a high viral load. I need PEP (post-exposure prophylaxis).”

“I just don’t think you need that,” he said. He referred me to CDC protocol for needle stick injuries which indicate PEP if the source patient is known to have HIV. The protocol says nothing about syringe exchange programs (SEPs), but it did give some latitude for a “case by case” basis to administer PEP.

It was now 3:30pm. Two hours, eight minutes after exposure. I’d gone to two health organizations and couldn’t get this physician to understand what a syringe exchange program looked like, apparently. I manually kept myself from shaking. I texted the head of the North American Syringe Exchange Network and asked her if she knew of any CDC circular that mentioned dealing with needle stick injuries at SEPs. In five minutes she and her colleague had texted back two PDFs for me to show the doctor, who had left the room again, this time to call the CDC hotline. The doctor was trying to describe my situation to another physician who was either looking at a check list or making an educated guess, and in this way, he was an unwanted middleman in my process of getting critical drugs.

He came back in the room for the third time, and sighed as he sat on the chair. I was annoyed that he was annoyed. He told me, as if making a penultimate stab with his newfound knowledge of syringes and needles that hepatitis C dies after about nine hours outside the body. I snapped at him.

“You’re acting like these were just some syringes left in a sharps container at the hospital over the weekend. I don’t know when they were last used. It could have been five minutes, three hours, 90 minutes. They’re injection drug users who use often, multiple times a day. I wouldn’t be the slightest bit surprised if many of the needles in that container had been used within the last hour from when he came to my office.”

“There are a lot of side effects to these drugs. They’re not easy to take.”

“I know that! I manage more HIV-positive clients than anybody else in the county. I hear from them all the time about how difficult these drugs are to live with. Bad, vivid dreams, or insomnia. Or somnolence. Nausea, diarrhea, headaches, limb pain, rashes. I will live with it for one month. It’s a no brainer compared to the rest of my live with HIV. Will you give me the drugs or not?”

He told me he’d give me two prescriptions, the usual remedy as outlined by the CDC. I asked what happens next. He told me I’d need to get tested for HIV in a few months. I corrected him and said, “six weeks, three months, then six months.” He nodded. Motherf*cker, I thought, my civility dissipated. He tried to explain the difference to me between antibodies and antigens. I explained again:

“I also perform more HIV screens than anybody else in Walla Walla and Columbia Counties, so I know the freaking difference between antibodies and antigens, doctor. Come on.”

I thanked my board president he left because now it was time to go home and meet his family for supper.

The nurse came in to take my blood and get a baseline on a host of health indicators and pathogens before they administered my first hepatitis B vaccine dose. I sighed. Look, I said, I’m transgender so some of these indicators may come back out of normal range. Red blood cell count, for one, is often off from both the male and female range.

She nodded, trying to be professional.

“Do you use male or female pronouns,” she asked.

“What the fuck do you think I use,” I said, pointing to my goatee.

“Well, I had to ask,” she said, apologetically.

“No, you didn’t. Just use male. It’s right there on my patient file.

She drew two vials of blood and then told me to make an appointment to get my liver checked in two weeks, because the HCV and the HIV prevention drugs could tax it and they wanted to monitor it. I walked to the counter and waited for the staff member to get off the phone so I could make my appointment. As I was standing there with my order in my hands, itching to get to the pharmacy, another employee sat down at her desk. Almost immediately a woman behind me walked past and asked her to help her make an appointment.

“Oh, I think you were behind me,” I said. Frontal lobe somewhere inside me said, no, Everett, stop. Actually it was more of a whisper. Not that frontal lobes have vocal chords. Whatever.

“My sister is in labor,” she declared, a big smile on her face.

“Oh. Oh your sister is in labor,” I said.

She continued to smile as the employee looked at the urgent care calendar. Because we all love making appointments with urgent care.

“It’s not you in labor, it’s your sister.”

“I could show you the texts,” she said to the employee, who clearly didn’t give a crap what was on this woman’s phone.

“Because you don’t know, maybe I’m in a hurry, too. Maybe I’m in a minute-by-minute race over something critical not to my sister, but to me. But you wouldn’t necessarily know that because I’m not announcing it and cutting in line over it.”

“Could you do November 12,” asked the employee.

The woman looked at her phone.

“I mean, she can’t be like almost about to deliver because you wouldn’t take time out of that to make an appointment, right? But by all means, cut in front of me.”

She walked away, her appointment date in hand, looking very confused. The employee apologized to me, and the staff member I’d been waiting for finished her phone call. She gave me dagger eyes, but I no longer cared.

“I see you have an appointment on November 12th for physical therapy. I could make this appointment the same day if that’s more convenient,” she said, giving me a time in the afternoon.

“My physical therapy is at 8:30am that day. How would this be convenient? I would just need to leave work twice to come over here.”

“Okay, well I can squeeze you in on November 11.”

“Let’s do that.” At 5:10pm, I finally left urgent care.

My usual pharmacy didn’t have the drugs but could get them the next morning. I thanked my favorite pharmacist in the world but said I had to start them that night. I know I had 72 hours to start the drugs to be effective in stopping HIV replication, but the sooner I got started the better it would be for me. She called another pharmacy and they said they had both in stock. I got back in the car and drove to pharmacy #2.

The pharmacist took my information and came back from the stock of pills frowning.

“We only have the Truvada,” she said.

The other pharmacy just called here fifteen minutes ago to see if you had both pills.

“Do you know who she spoke to?”

“Does it matter?”

“Uh, I guess not.”

“I need you to find a pharmacy that has both of these pills,” I said.

“Well let me just help the gentleman behind you,” she said.

“No. You may not make me wait here to help someone else. I stood in line, it’s my turn to get assistance now.”

Frontal lobe: OFFLINE. PLEASE CALL ADMINISTRATOR.

“Uh, I don’t know who would have them.”

I had picked the pharmacy that four of my clients use, but the second HIV med is in uncommon use, as it’s an integrase inhibitor that gets used when a first-line class of drugs no longer works against an individual’s HIV. So I picked the next in-town pharmacy my clients use and asked her to call there.

They had both Truvada and Isentress. I said, “Please call them now and transfer this to them. I need to start these meds as soon as possible.” She said she would.

I drove across town again, to pharmacy #3. Sure, they had those medications, but they didn’t have the order from pharmacy #2. She was just itching to serve that guy behind me, I guessed.

“Please call them,” I said.

“Okay, said the employee. What’s your phone number?”

“Why do you need my phone number?”

“So I can call you later after I’ve gotten the prescription transferred.” She looked at me like I had ten heads.

“Oh, I’m not going anywhere until you give me those medications. I’m going to wait right here. I need them now. And I mean NOW.” I put my fist on the counter.

FRONTAL LOBE: WHERE IS THAT ADMINISTRATOR?????

“I have had to deal with SIXTEEN FUCKING INCOMPETENT PEOPLE TODAY and now I can finally get my medication so that any HIV that may be in my body RIGHT NOW can be shut down before I CONTRACT HIV. Do you understand? I need you call pharmacy #2 this very instant, and I thank you in advance.”

Frontal lobe threw in the thank you as a last-ditch effort.

The pharmacist standing next to her stopped what he was doing.

“Sir, are you all right?”

It was the first time any health care worker had asked me that that day.

“No, I’m really not all right. I got exposed to I don’t even know what at work today and I just want to go home.”

“I’m going to call them right now and get your meds. There are a couple of people ahead of you, okay?”

“Okay.”

I walked into the aisle that had Nyquil in it and cried and texted Susanne a whole host of angry, sorrowful notes.

Another pharmacist asked me if I knew what the pills were for.

“Why, do you need me to explain it to you?” I walked away from her confused face and drove home.

I took the night dose in my bathroom and ate tacos at the dinner table with my kids and my in laws and Susanne, and I slept mostly soundly. I know it will be all right. But our health care system in Walla Walla needs a lot of work.