Sunday, March 05, 2006

The Bugaloos: They're in the air and everywhere.

(Inspired by the PGY2 resident who now refers to me as "Bugaloo", a nickname I find simultaneously charming and disturbing.)

I am not fanatical about bugs.

Yeah, I scrub my countertops and cutting boards with hot water and soap after I cut meat on 'em, and I wash my hands about forty times a day at work. But when it comes to hugging a patient with HIV, or touching a person on their skin with my bare, clean hand (provided they don't have any open areas, of course), I don't flip out.

Which is why I got so irritated with a couple of coworkers this week.

One of 'em asked me if it was safe to let a newly-diagnosed HIV+ patient to use her pen. For her, not for him.

Once I was done goggling, I said yes. That coworker's trepidation might've stemmed from the fact that this poor guy had herpes lesions *all over* his skin, a result of being undiagnosed for a year or more after infection. Note to the wise: if you end up with a huge skin rash that defies dermatologists, go 'head and get an HIV test. It can't hurt.

Anyway, this guy was quite pleasant, dealing pretty well with the shock of having just been told he was poz. But the HSV lesions presented a problem, one which I dealt with by wearing an isolation gown any time I had to get up close and personal with acreage of his bare skin.

Why? Two reasons:

First, even though herpes is not a tough virus in the sense that molluscum or smallpox is, there's the offchance that a virus or three might survive on my scrubs. I could then conceivably shed that virus elsewhere.

Second, and much more important in this case, my patient has a combination of open sores on his skin and a compromised immune system. Since he hadn't begun any sort of treatment yet, it's a rational step to reverse-isolate with him, especially since I had another patient with Clostridium difficile infection. Bacterial bugs are much more robust than viral particles, and I didn't particularly want to expose Mister T-Cell Count at 2 to any sort of bacterial veneer I might be wearing.

Then came the coworker who commented, as I was briefing a couple of students on the HIV+ patient over lunch, that she'd moved out of her dorm room in college because her roommate had contracted herpes.

God love the nursing students . They all looked carefully blank as I explained to cow-irker that, unless she and the roommate were sharing toilet seats in a way as yet undiscovered by Hustler magazine, she had nothing to worry about.

That sort of thing drives me absolutely up the wall. Even with modern education, I *still* run into nurses who are unwilling to touch HIV positive patients, even as they wander in and out of isolation rooms whistling, not wearing gowns. I *still* run into nurses who haven't the faintest idea how things like Chlamydia, mononucleosis, pinkeye, and hepatitises are transmitted, or who get it all wrong.

Maybe I'm oversensitive, having spent a good deal of time in the past with people who had varying degrees of infectious disease (ooooh, I like that rhyme!). Maybe I'm peevish because I don't like to see people isolated from touch and contact because they have a Highly Publicized Infection That Still Carries A Huge Social Stigma. Maybe I'm grumpy because I wonder what on earth these people were doing in class while I was absorbing information about how and why to keep my patients and myself safe.

The single most important thing we can do for our patients is to touch them without hurting them. Most people they see in the hospital, us included, do many unpleasant things to them. They can go an entire day without being touched in such a way that doesn't cause pain. That's why it's important for us to hug, or squeeze a hand, or stroke somebody's hair: without painless, pleasurable touch, the human soul starts to die.

So yeah, I 'm not fanatical about bugs. I cover my mouth when I cough, I wash my hands, I use standards when dealing with blood and body fluids and nasty oozy things.

But once in a while you have to take off the gloves and be human.

1 comment:

may said...

i totally agree. sometimes, ignorance kills other people faster than their disease.