Biohazard MY

I’m surprised Dr. Wilson hasn’t banned me from his ward after today. I couldn’t have been more hazardous to his health even if I had been trying to destroy him on purpose. Early in the morning, I was drawing blood from an ISS patient and Dr. Wilson was acting as my assistant, opening the tube tops for me. “You know, you really should be wearing gloves,” I remarked. “It’s ok,” he replied. “The gloves are too big for me.” Just as he said that, he pulled the tube away without my noticing, and I ended up spilling HIV-positive blood all over his fingers. “Oh my God, I’m so sorry!!” “It’s all right, I have an intact skin barrier,” he told me while soaking his hand in iodine. I then squeezed half my bottle of hand gel onto his infected hand. He then used his other hand, still ungloved, to collect the rest of the blood into the last test tube. “You’re still not wearing gloves!” I almost screamed at him. “Some people never learn,” he replied with a sheepish smile.

Later that day, we had to get a biopsy on a patient with suspected KS from the male ID ward. “Can I do the biopsy?” I asked. “Of course,” Dr. Wilson replied. As we set up for the biopsy, I realized that just like everything else around here, this biopsy was going to be carried out with the most basic of instruments. I wiped off the lesion with iodine-soaked cotton balls. Then I put on my sterile gloves and used the wrapper from my sterile gloves as my sterile “tray”. Dr. Wilson dropped a syringe and needle onto my sterile tray. I placed the needle on the syringe and then took out 5mL of Lidocaine from the bottle that Dr. Wilson held for me. I proceeded to inject the area all around the lesion with Lidocaine. After waiting a few minutes, I checked the area with the needle tip and the patient felt no sharp sensation. We were ready to begin!

I took the needle off the syringe and stuck it into the patient’s mattress to prevent needlestick injuries. “Where’s the needle?” Dr. Wilson asked. I pointed to it. “Oh no, you need to keep that, because it will serve as your forceps.” “Are you serious?” I asked. “Welcome to bush surgery,” he informed me with a wide smile. He opened another syringe/needle pack for me and I grabbed the needle. He then opened a surgical blade pack for me. There was no scalpel blade holder, so I had to hold the blade directly with my hand. There I was, needle in left hand, surgical blade in right hand, ready to embark upon my first biopsy, bush-style. I stuck the needle into the lesion, parallel to the skin surface, and cut around it with the blade. Once the specimen had been removed, I placed it into an empty medication bottle (it previously contained Ampicillin) that we had pre-filled with formalin. Then, Dr. Wilson opened up the suture for me. Obviously, there was no needle driver, so I held the suture needle directly with my hand. As I pulled the needle and suture out of the pack, the end of the suture fell outside of my sterile tray. “Oh no! What do we do?” I stared at Dr. Wilson. “We’ll still have to use this,” Dr. Wilson informed me. Blood was gushing out of the wound, and Dr. Wilson used an iodine-soaked cotton ball to wipe the blood out of the way. But as soon as he wiped, more blood gushed out, and he wiped at it again. I was terribly afraid of giving him a needle-stick injury, so I told him to just leave it. Then I proceeded to put a stitch across the wound with blood covering my surgical field. This process is also a lot more difficult without a needle driver. But I succeeded in putting in a pretty decent stitch. I threw down 4 knots. Then I put in another stitch, and held an iodine-soaked cotton ball over the wound, pressing down fairly hard to achieve hemostasis. I lifted up the cotton ball – no blood was coming out of the wound. Yes! A successful bush surgery, or should I say, bush procedure!

I cleaned up, throwing away all the used instruments. However, as I had a bit of cotton stuck onto my glove, when I tried to throw the suture needle away, the suture stuck to the cotton on my glove. Dr. Wilson had torn off a bit of plaster for me to bandage the wound with. I turned towards Dr. Wilson and reached out to grab the plaster, and sent the suture needle tagged onto the end of my glove flying in his direction. He withdrew his hand just in the nick of time. “Oh my God!! I’m so sorry!! You should stay away from me. I’m totally going to infect you with HIV!! I’m so so very very sorry!!” I apologized profusely. “Don’t worry, you won’t infect me,” he replied with the confidence that comes with years of experience in dealing with under-experienced medical students. I really hope he’s right. That his experience can overcome me – Biohazard MY.