Lightning Strikes Twice

Most healthcare workers will probably finish their careers without personally suffering a known exposure to HIV. Your humble narrator has scored a deuce.

It was less than a year after my first exposure, my residency training was almost complete, and I was about as comfortable as I could be.

Maybe I was too comfortable. Like my first accident, this one was easily preventable if I had taken proper precautions. But like my first accident, I didn't.

This gentleman had done some time in the pen, and he was older than most AIDS patients of his day, probably 50 or 60 if I recall correctly. He had CNS lymphoma (among his other problems) and that day he needed a spinal tap. I'm not one to wear eye protection routinely, and since a spinal tap is not the sort of procedure that typically is associated with airborne bodily fluids, I wore no mask or glasses.

Now for those of you who are familiar with the procedure, you are aware of the instruments in the LP tray, but for those who are not, I'll elaborate:

There is a long rigid plastic manometer (for measuring the pressure of the spinal fluid) which comes in two pieces that must be joined together before use, since the full-length apparatus is too long to fit in the tray. To this device, one connects a stopcock and a flexible short bit of tubing which is then connected to the spinal needle once it has been properly inserted. Many docs probably forgo this whole routine, simply obtaining the spinal fluid and getting the heck out of Dodge, but I always perform the procedure in its entirety. Click on the picture for a closer look at the instruments in the tray.

As before, the procedure itself went smoothly. Afterwards, as I was disconnecting the two pieces of the manometer before disposing of them, I used a twisting motion to separate them, which freakishly caused the flexible manometer tubing to catapult a droplet of HIV-infected cerebrospinal fluid directly into my right eye. Dagnabbit.

This time, I didn't even think about taking antiretrovirals; I just washed out my eye and went on to my next task. I've had a couple of careless needlesticks since then and I've been sprayed with blood and pus a few times, but after those first two experiences I just try to be cautious and I put my faith in a higher power these days. So far it's working out.