Tuesday, March 20, 2012

A Close Call

Well, it was bound to happen eventually. Last week I had accidentally cut my finger on a scalpel blade while in the morgue. It would have been fine if the scalpel blade was clean, but it was right in the middle of my organ dissection.

As I was cutting the organs on a raised table I needed to grab my long 'slicer'. This is the long knife that is typically used to section through or bread-loaf organs. I reached for the handle, but it was out of my sight (big mistake) and adjacent to the table. As I grasped the handle, I could feel a slight scratching motion run across the tip of my index finger, but it honestly didn't feel like a cut. Of course, I was wearing two layers of gloves, but it wasn't a feeling that one would normally feel while wearing gloves, so I took a look at my finger and I could see that the glove had a cut through it at the tip of my finger. I knew then that I was in trouble.

I unconsciously exclaimed an expletive and took off my gloves. Sure enough, a drop of blood formed at the tip of my finger. I was incredibly surprised because the pain was almost nonexistent. The cut was so smooth and clean I could hardly notice that my finger had just been cut. Looking back at my table, I could see how I had gotten cut.

It turns out I had unbeknownst placed a scalpel next to the slicer handle (or the slicer handle next to the scalpel) so that when I reached to grab the slicer handle, my finger inadvertently rubbed across the scalpel blade. It was a perfect cut.

The biggest danger of being exposed to blood from another person (even if they are dead) is the risk of the transmission of disease. There are three big diseases that you should be conscious of in an exposure incident. They are, HIV, Hep B and Hep C.

Hepatitis B vaccinations exist and that is why we students, upon matriculation into this program, are vaccinated for this virus before we start the program. I'm definitely glad I was already immune, so I didn't have to worry whether I was exposed to it or not.

No vaccination exists for HIV, but fortunately, due to the nature of the virus, it is not easily spread even if you are exposed to it. Also, the number of persons in the US infected with HIV is relatively low.

My biggest fear was hepatitis C. It is more transmissible than HIV and a larger percentage of people have hepatitis C than HIV. Like HIV, there is no vaccination available for Hep C.

I immediately washed my hands with anti-microbial soap and tried to force out as much blood as possible from my finger. The morgue technicians were kind enough to draw some more blood out of the cadaver for me to take to the employee health office to test for antibodies in the cadaver blood. (The cadaver was already pretty 'dry' and it was really difficult getting any more blood out of it.)

I handed the blood off at the employee health office and eagerly awaited their response. I was in limbo. What if the body really did contain hepatitis or HIV? What if I really did contract some disease? It was a definite possibility that my whole life could change. I'm the type of person who for better or for worse, always imagines the worst outcome possible, and the worst outcome possible was definitely a grave one. I began to think about how I should conduct my life if I were to become infected. Could I still get married? What if I gave this disease to my fiancee? I'd never be able to forgive myself. What about having children and a family? What if my children were born with these diseases? Perhaps I should give up on the idea of raising a family.

Strange thoughts like these go through your head while you are waiting. The next day, they called me but unfortunately couldn't get a satisfactory lab result. Hemolyzed blood is more difficult to test with (well, after all, it's from a cadaver) and they needed to send out the blood to an outside lab.

It was all out of my hands at that point. I waited as patiently as one possibly could. Friday. Saturday. Sunday. Monday. Finally, today, the results came back.

Negative for both HIV and Hep C.

It's a load off of my shoulders to finally know. I do feel guilty that the hospital had to spend a good amount of money to get those tests done. I'd imagine that it was at least a couple of hundred dollars. Someday, when I have more discretionary money, I'll need to pay back the favor.

Life continues on as normal but with one important change. When you're working with your tools, always look at where your hands go.

20 comments:

  1. wow what a story! Good thing everything turned out in your favor. Don't feel guilty about the hospital paying for your exams, you were working and they should take care of you.

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  2. Thanks for the kind words! It's a story that I hope to experience only once.

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  3. Glad that test results were negative!

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  4. Glad to Hear that you are okay man.
    I am in the same boat as you with expecting the worst outcome.

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  5. @Thatgirl - Thanks for dropping by! It's an experience that makes you think about a lot of different things.

    @Chris - Yeah, some people would say that we are pessimistic. But, I have found that if you are pessimistic, you are usually prepared for the worst and that is why we can usually predict the bad things that can happen and avoid them or fix them.

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  6. Don't be concerned about the testing, Forrest. It's a cost of doing business and the hospital knows that. I'm glad you're OK and that the viral screens were negative.

    Ed W.

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  7. Thanks Ed. I bet you're more than ready for spring break! I'm jealous!

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    1. You're more than welcome. I've never been this ready for spring break in my life. That said, I can't believe there's only one more month left in the spring semester.

      May the rest of your autopsy rotation be uneventful.

      Ed W.

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  8. Congrats on the negative results! Having to go through a cut on the job is never a good thing...

    I personally went through this THREE times (never during an autopsy though...only when cutting into surgical specimens in the grossing room).

    The first time I ever cut myself, it was a DOOZY. I was dissecting a gall bladder, the scalpel was covered in bile, I went to grab the scalpel, it slipped from my hands and I foolishly went to grab it as it was falling on my station. I grabbed it in such a way that the blade sliced into the palm of my hand perpendicularly. In other words, the tip of the blade went in and came out the other end of the skin! I have the battle scars to prove it :) (a sign of any great pathologist!) I take pride in something like that!

    My other two injuries were cutting into a fibroid uterus and then trying to pick up a knife in a tray. I actually should have sued the hospital for having really sharp knives just lying in a tray with their blades fully exposed. After that injury, they made sure to immediately buy a knife block for them! Bastards...I should have taken a picture of the tray and then sued them for a few thousand bucks.

    But yeah, the good Dr. D. has had his experiences, that's for sure! And I'm not even 30 yet! I just can't wait until I get that M.D. and take my boards as a pathologist. Untouchable won't even be the word to describe me.

    Oh, and all tests were negative :-)

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  9. @Dr. D. - I'll do my best to avoid those mishaps, especially that one that went through your hand! I'm glad that everything in the end was ok for you though. I wonder if there are any purple hearts for people injured on the battlefield of pathology.

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    1. Hahahah probably not, but we still get a few hearts anyway :-)

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  10. Do they provide you with slash proof (cut resistant) gloves? When I was doing necropsies we would wear nitrile gloves, our slash proofs, and then another layer of nitriles over everything. They really do prevent the smaller nicks and cuts caused by incidental contact with scalpels and blades and I recommend them. The only downside is that with all those layers of gloves, you lose some flexibility in your fingers and have to fight the cramps and aches after hours of fine dissection. However, your hands do eventually grow stronger and these aches and pains subside. Our greatest danger was contracting Herpes B and if you are at all familiar with this virus, you would agree that any additional layer of protection is welllll worth it.

    Here is a link to the style of glove we used:
    http://www.google.com/products/catalog?q=slash+proof+gloves&oe=utf-8&rls=org.mozilla:en-US:official&client=firefox-a&um=1&ie=UTF-8&tbm=shop&cid=16771817736957497913&sa=X&ei=O358T4fKB8K8iwKAzZz6DQ&ved=0CIYBEPMCMAM

    P.S. I have been a reader of your blog for several months now, and as a future PA program applicant, I just wanted to say thank you for taking the time to document your experiences in such detail. I look forward to hearing more about your PA adventures and wish you all the best.

    James

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  11. Hi James, I'm glad that you've found this blog helpful. If there's anything I can answer for you just let me know!

    I have seen chain gloves in the gross room, but I haven't seen them used in the morgue.

    That glove you linked to looks like a great deal! I might just have to buy one myself. It looks like it has a kind of fine wire mesh. Hepatitis B is certainly not something you want to contract, but thankfully there is a vaccine for it. My antibody levels were tested recently and were still doing good, so that's a relief.

    I look forward to your future comments!

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    1. Forrest, an old "supervisor" of mine forced me to wear cut-resistant (CR) gloves after I cut myself dissecting a uterus a few years back. Those gloves are ANNOYING! They're white and mesh-like...very stiff when you try to put them on, and they're horrible for people who have long fingers (like myself).

      Also, you can still get nicked with a scalpel even if you wear a pair of latex/nitrile gloves underneath the cut-resistant pair. Silly me never wore an extra pair on top of the CR ones (like James mentioned doing). That's exactly what you have to do; otherwise, the CR gloves get soiled. Still, I would never wear 3 pairs of gloves like that at all (even if I was dissecting an HIV autopsy). Two or 3 pairs of nitrile gloves do the job for me in that case.

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    2. Thank you Forrest, as application time approaches, I am sure I will seek you out for questions and advise.

      The gloves that I linked you to are actually more flexible than the chain gloves. Wearing proper PPE is of course a trade off. It is up to the person performing the procedure to weigh out the pros of safety and protection vs. the cons of discomfort and annoyance. That's just how it goes and maybe in the future we will see some new glove material that is light weight and 'cheap' as well as protective. Until then, I will layer up.

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  12. Hi Forrest! Just stumbled upon your blog and I love it. I used "kevlar" cut resistant gloves that James is talking about for 5 years when I worked on cadaver donors to remove tissue for donation purposes. As Dr D said, you do loose some finger dexterity with them and the older they get, the more stretched out they get which isn't good for your fingers because you can't really feel with your fingertips with all that extra material there (more chances to hurt yourself). So I could only use one pair about 5 times, something happened when they got sterilized and they would just seem to stretch out. It was mandatory that we used them; we wore surgical gloves, then the kevlars then another pair of surgical gloves. Dr D is right, those gloves do nothing for when you poke yourself, and we were more likely to poke ourselveson the job rather than slice ourselves. One of the coroners offices we worked with had the techs use the gloves but I never saw any of the pathologists use them.
    I then moved to a job grossing tu/nl tissue from cancer patients and none of the pathology assistants used kevlars and neither did I. I don't see how I could have.
    I am fortunate I never sliced/poked myself with a scalpel but it would happen to my coworkers and luckily no one ever contracted anything. I can't imagine what you went thru while you waited for the results. Hoping you never have to go thru that feeling again.

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  13. Thanks for the comment Anna! I'll definitely have to check out those gloves and take your advice.

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  14. The same thing happened to my sister-in-law today. She is now waiting on tests to come back. I pray for her that it'll be okay. I know she is worried about it, but just hope tests come back negative

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  15. Hi Anonymous,

    Waiting is difficult, but there's nothing that anyone can do in the meantime. I'm keeping my fingers crossed for your sister-in-law.

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  16. I cut myself with my scalpel just today. I was dissecting a corpse for Anatomy (getting rid of fat), put my scalpel away in its case, and put the case in my bag thinking, "I've had enough time with my scalpel for today." But no. No. My scalpel didn't have enough time with me. Because, you know what? My scalpel is a fucking asshole. When I searched my bag for the keys to my apartment, I felt my finger being sliced. I quickly took my finger out, examined it, and saw that a lot of blood oozed out of it. When I got to my room, I then realized that the scalpel fell out of its case. And now I probably should get my blood tested. If I tell anybody, "I'm 18 years old and have Hepatitis C (or something like that)," do you know what they're going to think? Do you KNOW what they're going to think? I'll tell you what they're not going to think: "Hmm, I bet she got that from dissecting corpses." Actually, never mind. Maybe it's best if they don't think that.

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