One of my worst fears realized (updated 8/19/2013)

What's that alarm that's going off?  Is it time to wake up?  No, that can't be it as I'm always up by 8AM.  Is it some event that I wanted to attend?  No, I don't schedule things that early in the morning.  Is it a television show that I wanted to watch?  No, if I wanted to watch something at a particular time I would just add it to the DVR schedule.

Oh yeah, it's the alarm reminding me that it's time to take my medicine.  It's time to take my Combivir tablet.

If you haven't heard of Combivir it's a particularly nasty drug with many detrimental side effects.  These side effects include such mundane things as headache, chills, fever, sore throat, tiredness, weakness, abdominal pain, muscle tenderness pain and numbness, nausea and yellowing eyes and skin.  More severe side effects can include trouble breathing, lactic acidosis, and liver failure.

You see, Combivir is a combination drug that has both Lamivudine and Zidovudine.  Ziduvudine is generically known as azidothymidine or often shortened down to AZT.  Lamivudine is generically known as 2',3'-dideoxy-3'-thiacytidine, often shortened to 3TC.  Both of these drugs are nucleoside analog reverse transcriptase inhibitors.

 When used together they're often referred to as 'the cocktail'.

The HIV cocktail.

So to put it plainly, I am taking a drug that will hopefully prevent myself from being infected with HIV.

I knew this was a risk of nursing in general.  Let's face it, my job is to interact and help people that are sick.  Often they have infections diseases that the best way to prevent spreading is to stay away from.  That risk goes up when you are dealing with people's blood.  You see, one of my jobs is to do 'Lab Draws'.  Inmates come into the health center, I grab up several vials and a vacuseal needle, insert the needle into the inmate's arm and fill up the vials with their blood.  This blood is then sent off to the lab where the doctor, physicians assistant, or nurse practitioner will get information about what's going on inside of the inmate.

Most of the tests are benign.  Blood counts, liver enzymes, heart enzymes, particular drug levels, blood sugar... stuff like that.  But even a benign test involves taking the blood from an inmate and getting it into that little vial.    As a nurse I take all the precautions available.  I wear gloves, I handle the needles safely, and as soon as the needle is out of the inmate it goes into a 'sharps' container where it can't get stuck into someone else.

There is that moment though, where the risks are fairly high and there is no safety measure.  Once the needle is out of the inmate, it has their blood on it.  The needle is very close to my own hand and no latex glove on earth will stop it from pressing into my own flesh.

Yesterday that very thing happened.  While pulling the needle from the arm of an inmate after successfully getting a vial of his precious bodily fluid, I and/or he jerked a bit and the needle moved smoothly out of his arm and directly into my finger.  My left pinky finger, just under the nail bed to be specific.  I kept my calm as to not worry the inmate, put a cotton swab over his puncture area and grabbed up another cotton swab for my own finger.  I placed the needle into the sharps container, put a bandaid on his cotton ball and sent him on his way.  I then immediatly went over to the sink, removed my glove and cotton swab and washed the blood off of my finger.  I then watched with an intensity I've never experienced to see if some of my blood came up to the surface.

You see, at this point I wasn't sure that the needle had punctured my skin.  There was blood both on my glove and finger, but the needle already had the inmates blood on it.  That blood could easily color my glove and finger without breaking my own skin.  My finger did sting, but that could just be from the needle pressing against my finger without pressing through it.  So there I stood, huddled over a sink watching my finger for that tell tale red bubble to form.

It did.

My own blood came out of the tiny little hole that I had created.

Now in most cases this is bad but not anything to really worry about.  In the hospital the nurse has to get a blood draw himself and be tested for the major blood borne illnesses.  But unless the patient is known to have HIV, Hepatitis B, Hepatitis C, or some other exotic blood borne disease, no other action is required.  But I don't work in a hospital.  I work in a prison.  Any and all prisons have a substantially higher incidence of HIV,and Hepatitis infected 'patients' (along with Tuberculosis and MRSA).  So the standard treatment is to not only get the tests done, but also to go onto a prophylactic dose of Combivir.

As scary as all of that sounds, the chances of me getting infected with HIV are slim to none.  For one thing, the inmate does not have a diagnosis of HIV.  While the incidence of HIV in prisons is higher than the outside world, it still isn't 100%.  Sure, he may have been infected since he was last tested, but even if he IS infected, I'm on the Combivir.  This has been proven fairly effective at preventing an exposure to HIV from becoming a full blown infection.

But the difference between having no chance of infection and having a slim chance is night and day.

I should add that as a healthcare provider in a prison I'm required to have the Hepatitis B vaccine, so I have very little worry about getting that.  I'm nor worried about being infected with Tuberculosis as it's only rarely been shown to spread through blood (and that research is spotty).  I'm not even worried about MRSA as the chances of this inmate having MRSA and not showing any symptoms is minuscule.


The one I guess that really worries me is Hepatitis C.  There is no prophylactic drug to help prevent it.  It is highly contagious through blood and there is also no cure.

--------- Update August 19, 2013 --------- 

I just wanted to offer a quick update.  First, as I was reminded, Hepatitis C does actually have a cure, it's just not something that works for everyone.  So if worst comes to worst, I would still have a good chance of not permanently having that disease.  

Second... damn that Combivir is putting me on my ass.  I had of course read about the side effects, but as many sites reminded me I'm taking this for a very serious reason and should consider that when weighting any of these side effects.   That being considered, the side effects didn't sound to bad.  The worst ones (redistribution of fat, long term kidney and liver problems, exasperation of previous medical condition, being more susceptible to infection) are only apparent after long term use.  The shorter term more immediate side effects though sounded like ones that they have to put on almost any drug.  Headache, nausea, weakness, tiredness.  

I was cocky thinking that I didn't have to worry about any of these.  I have headaches so often that I can't imagine them really bothering me.  I have an iron gut and no drug has ever given me nausea.  And weakness and tiredness?  Bah... that won't happen to me. 

Well now entering my fourth day of this drug I can attest that these side effects are true and are not anything that I was prepared for.  The headache caused by this drug is different than any I've ever experienced.  It's not as intense as my regular headaches, but I can't knock this headache out.  I have had a constant low level headache for going on four days now.  The nausea is worst in the morning and prevents me from eating anything for breakfast which makes it all the harder to get any energy up for the day.  Weakness?  Well I can honestly say that I haven't experienced that, but the tiredness... wow. 

You know that feeling about five minutes after you crawl out of bed?  Like your thoughts are running in slow motion and any new stimulation seems to take an eternity to process?  Yeah... that's me.   Coffee, caffeinated soda, even adrenaline don't seem to chip away at this bone deep tired feeling I have all day long.  Saturday night I slept for 10 hours and still felt tired all day long.  I did go to work on Sunday (hey... I can't afford to lose out on any money!), but thankfully I'm still orienting.  There is another RN there that is showing me the ropes and was able to take the bulk of our work. 

I'm not sure whether I'll be going into work today or not.  I'll still have an orienting nurse there, but Monday is a lot different than Sunday and I doubt that I'll be able to keep up or really learn anything.  Plus I have to get a lot of things in order.  I have to call the hospital and get my test results forwarded to my own doctor.  I have to get an appointment with my doctor to get more of this damnable drug.  I have to contact work to see how long it will be before the man I was getting blood from get's his own test results back, and I have to contact my employer (remember, I'm working for a temp agency AT the prison, not FOR the prison) to see how this workers comp will work out.  I may have more money than I'm used to, but without insurance a month's worth of Combivir can cost upwards of $600. 

Hopefully the test results are in for the inmate I was getting blood from.  If he tests negative across the board I can safely stop taking this medicine.