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I Quit: My MD, My Baby, My Nightmare

— HIV exposure had this doctor in "hiding"

Last Updated December 23, 2019
Ƶ MedicalToday

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This story is from the Anamnesis episode called I Quit and starts at 25:32 on the podcast. This story is told by Sapna Kudchadkar, MD, PhD, associate professor of anesthesiology and critical care medicine (ACCM), pediatrics, and physical medicine and rehabilitation at the Johns Hopkins University School of Medicine.

Every summer, my heart is heavy with memories of a time when even I, that upbeat, optimistic, always-with-a-smile-on-my-face gal, came close to leaving medicine -- a time when my career and the new journey of motherhood collided in the most untimely way, a time when I didn't ask for help.

On a warm August morning exactly 16 years to the day that it happened, I decided to tell that story on Twitter. I decided that if it helped just one person it would be absolutely worth it. Why an August day 16 years later?

We all know that July is a time when new physicians start their official forays into the world of medicine. July is orientation month. July is when everyone is watching, offering tips of the trade, giving you a tour of the hospital. But then August comes and we all get swallowed up in the hustle and bustle of heavy clinical loads.

August is when orientation ends and the real work actually begins, but it doesn't mean anything is easier. In fact, it's quite the opposite.

I had just finished peds residency and had decided I wanted to have a combined clinical practice in both pediatrics and anesthesiology, so it was time to start over as an anesthesia resident. The difference?

This time a new residency was complicated by the presence of a six-month-old bouncing baby boy. I had, however, just mastered how to pump while on service on the pediatric wards, where the best pump rooms were, how to time daycare pickup so that I could feed him as soon as I saw him and save a pumping session.

I had this mothering thing down.

Not "Short and Easy"

Then anesthesia residency started. It was a completely different world. The learning curve was steep for a newly minted pediatrician. My awesome well-baby exam skills and prowess with heart murmur auscultation weren't so immediately helpful.

Instead, surgeons were staring you down because your IV or arterial line was starting to take too long, feeling like you were never turning the room over fast enough, climbing under drapes to empty urine out of the Foley bag, or troubleshoot the blood pressure cuff.

July wasn't bad though because our preceptor was always there in the room with us, but then August came. August. Orientation was officially over and now we were deployed to do our first cases in the OR without an attending always in the room with us.

On my first day without constant in-room supervision, I was assigned to a room with "six short-and-easy cases," they said. I was really nervous about my inefficiencies, though, so I showed up at 4 a.m. to set up the room and draw up all of my meds.

Drawing up drugs quickly, correctly, and without splattering everywhere takes a lot of practice. On that first day setting up alone, I was running out of time. Racing to finish, I hastily cracked open the top of a glass fentanyl vial. It broke off completely jaggedly.

I cut my finger. It was a small cut. I tried in vain to find a Band-Aid, but it was 7:20 a.m., only 10 minutes to see my first patient. On-time starts are very important in the operating room, so I just washed my hands quickly.

Did I Just Contract HIV?

Four hours later, I'm doing OK. I had a couple tough IV starts and a missed intubation. No time to ask for a break to pump. It's pretty uncomfortable, but that's okay. Work comes first, right?

Induction for the next patient goes pretty smoothly, and I'm pretty happy. Take off my gloves to put clean ones back on, and in that moment, I look over and realize that I had set the stopcock up incorrectly.

My really awesome IV was now backflowing blood all over the floor. In a moment of sheer panic, my eyes darted around. I'm making a huge mess. I need to fix this ASAP before anyone notices. Instinctively reach out to grab the IV, forget that I never put a new set of gloves on, blood is now in my cut from the morning.

The patient is HIV-positive. My mind goes into action. There are no sinks in the OR, only hand sanitizer. I can't leave the patient unattended.

So, I wait until my attending finishes inducing next door to wash my hands. I'm told to go to occupational health immediately.

Life (Does Not) Go On

On the walk there, I try to think rationally. The risk of HIV transmission is extremely low, right, less than 1%. We learned about this. Begin one-month course of prophylactic Combivir the same afternoon. Told I cannot breastfeed anymore.

I go home to a baby who doesn't know what hit him. He won't take a bottle from me, screaming for the evening feeding with me that he expects. I really wish I'd enjoyed that last 3 a.m. feed more, but there's no time to wallow.

I need to preop with my attending for the next day. Life does go on, right? But it doesn't, really. I never tell anyone except my husband that I'm really scared; even with him, I underplay.

I still have to ask for pump breaks to relieve the pain. By the way, stopping breastfeeding cold turkey is very ill-advised. Cabbage leaves don't smell so good under scrubs. You can .

Every single day I go through the motions. I smile when I should. I take good care of patients. I'm really strong after all. No one would ever know that something was wrong.

Classic Doctor Mistake

Two weeks later, I have a very high fever. I'm convinced I'm seroconverting. That's what all of those hours of internet searching says, anyway.

Still, I talk to no one. Not my husband, not my mom, not my friends. There's despair and anger, but more despair. Six months go by in a fog, waiting for definitive testing.

I wonder what it's all for. I spend all my free time, baby in my arms, reading about my chances of contracting HIV.

I'm lost, but I talk to no one. This isn't a big deal, right? Wrong. I made a mistake too many of us in medicine do. I should have talked a lot.

I spent over six months of my life wondering if I should leave medicine, wondering if I had ruined my life. Were my fears rational? Likely not, but they were my fears and I should have asked for help.

I put my job ahead of my mental health and I almost got completely lost. Luckily, I was surrounded by colleagues, family, and friends who may not have known the depth of it, but unknowingly lifted me.

My team. Time and team healed, but they may not have.

I'll end with this. There is always someone to listen and help. You are never too strong for help. Don't ever put your work before your mental health. If it's impacting you, it's not irrational. It's real. It's your life.

Other stories from the I Quit episode include Dying for the Fifth Time and Why I Fled the Country.

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