Living in fear of dying

Published: December 1, 2011

The commonest mode of transmission of hepatitis C in healthcare workers is getting pricked by an infected needle.

I wait restlessly in the Sind laboratory for my test results, pacing back and forth. Palms sweaty, stomach churning, I walk nervously to the receptionist. She looks at me emphatically and asks me to wait ten more minutes. I scowl at her and curse her under my breath, wondering in disbelief how could she make go through this agonizing delay.

I sit down and stare at the clock completely transfixed, watching each second tick by. At every name that gets called, my heart catches, beating faster, almost synchronizing itself with the tick tock of the clock.

I just want to know now. I will come to terms with it, whatever it turns out to be, well at least that’s what I tell myself every time I come here. This is every three to six months. And that’s how it will be for me for the rest of my life. Unless, the test comes out positive, in which case, it will be the end of it – the end of my life…

Hepatitis C is a fatal disease. It’s a disease that is as dangerous as cancer. The unfortunate ones who acquire it are doomed to the most excruciating and depressing death. The most fearful part is how common and prevalent this disease has now become, with over 180 million people suffering from it today.

My mind drifts to how it all began…

About a year ago, I was working as an intern at the Civil Hospital in Karachi. As a new intern, I expected some form of guidance before I was set to draw blood from patients. Instead, I was handed  a piece of paper by a senior, ordering me what labs to run and on whom.

It was my first on-call duty. With jittery hands, I put on gloves and feigned a confident look.

The patients I was assigned mostly suffered from hepatitis B or C. After watching closely how my fellow interns worked, I set out to begin my task. I approached my first patient, and picked up the file that read ‘Hepatitis C +ve’ in bold on top. One look at him and fear gripped me. Lying there unconscious, was a man whose hands and feet were tied with a rope to the bed. After every few minutes, he would struggle violently, and utter a sting of profane words. This is how a patient with end-stage liver disease behaves, when he suffers mental impairment along with liver damage, medically known as hepatic encephalopathy.

I took in a deep breath and stepped forward. The patient’s attendant, recognizing the frozen look of terror on my face, told me not to worry. He said that he would hold the patient’s hand very still while I attempted to withdraw blood. I gave him a grateful look and ripped the syringe out of its wrapping. Finding a nice vein, I proceeded confidently. With the needle halfway in and blood filling nicely I felt victorious. But my victory was short-lived.

Suddenly, with all his strength, the patient jerked up violently and started abusing. The needle flew right out of his vein and as if in slow-motion, I watched with horror as it pricked me right in the finger.

I froze. Trying not to falter, I pulled it out and watched droplets of blood soak my hand. Panic-stricken, I rushed  to the senior doctor on-call.

With my voice quivering, I explained to him what had happened. However, I was taken aback to see how nonchalantly he reacted. He calmly told me how common this was amongst interns and very casually added that even he had been pricked four to five times.

Since hepatitis C is a chronic disease, the symptoms rarely ever present themselves before ten to fifteen years of having acquired the disease, and by that time, it usually has progressed quite far. Around 80% of those infected with hepatitis C go on to develop the chronic stage. Out of those, 20-30% develop cirrhosis.

All that I could do now, he told me, was to get myself tested every three to six months for the rest of my life, for symptoms can present at any given time. The worst part is that no vaccine exists for hepatitis C.

As I headed back later to check on my patients, I saw the same patient spit up a large amount of blood, red specks splattering everywhere.

Within a month of this incident, most of my friends had been pricked while running labs. This is especially common in government set-ups where no proper training is given and yet you are expected to get the job done. Sadly, there’s not much one can do as even if one is wearing gloves, the needle still pierces right through. This is the commonest mode of transmission of hepatitis C in healthcare workers.

My thoughts are distracted by a shrill voice calling out my name as I recall my first day of work.

“Ms Sanaa, your report is ready.”

I stand up, knees shaking. With butterflies in my stomach, I walk weakly. Could this be it? The image of that patient flashes before my eyes. That could be me, I thought. Holding my breath, I open the envelope and let out a sigh of relief.

That could really be me, but not today, not right now… I walk out relieved.

Six months later I am back here again and the same anxiety replays.

Sanaa.Siddiqui

Sanaa Siddiqui

A doctor who graduated from Dow Medical College, and is about to start her residency. Sanaa is also a music and poetry lover.

The views expressed by the writer and the reader comments do not necessarily reflect the views and policies of The Express Tribune.

  • Nandita.

    @Author – that’s bravery in the true sense. Helping others and in the process putting yourself at risk. Doctors across the globe need to be lauded for the work they do.Recommend

  • http://bakedsunshine.wordpress.com Shumaila

    Its kinda a job hazard – getting pricked, getting coughed on by TB patients, getting HIV+ blood spilled on you. Even trained people get pricked sometimes. You can’t dissociate the risk from the profession. Its like the risk of soldiers getting bombed, of drivers getting into road accidents.

    That being said, proper training obviously minimizes risks, as do precautions and proper equipment.

    Some strains of Hep C are curable though, so even if diagnosed patients have some chance of being treated and cured.

    All in all, I’m sorry you had to find yourself in such a situation. I hope in future you don’t allow your juniors to be in a similar position at any point. And that your HepC reports always come out negative :)Recommend

  • http://natashasuleman.wordpress.com Natasha S.

    I have lost a loved one to this terrible disease. Another loved one fought it bravely and will probably have to go through this painful test procedure every few months to know if there’s a relapse for the rest of her life. One got infected during a blood transfusion , the other one during a surgery. That’s hospitals for you today!

    Stay strong Sana. Recommend

  • Anique

    Hey sad to hear about your story.
    it is a very depressing situation indeed.
    jst wanted to ask. instead of gettin tests done every 6 months to see if the disease is active did you get your ELISA and PCR tests done to see if you’re actually infected in the first place?
    As far as i think your gettin the surface antigen test done which only comes positive if the disease is activeRecommend

  • Hindu Indian

    We gotta salute you noble souls, who risk your lives for the betterment of Humanity, Recommend

  • Sanaa

    Thanks nandita and all the others for liking it. Recommend

  • Steven Maimes

    Hepatitis C is NOT a fatal disease for the majority of people with hepatitis C. Most people will have no serious complications during their lifetime. Hepatitis C is dangerous and can be fatal for some people. There are many things one can do to protect the liver and prolong life.Recommend

  • KK

    Very well written Doc.I felt it, literally!!Recommend

  • Najwa

    very well written.may God keep you and all friends safe from this painful disease.Amen!Recommend

  • sars

    Hepatitis C isfatal in those who are not screened diagnosed in time or treated.You would not be in this population.The seroconversion for hep c is about 3% (worse than hep b which has a vaccine and better than HIV)
    so looking at the figures there is a 97% chance you will be fine IA.These figures helped me as an intern in your situation and may help youRecommend

  • Sanaa

    Thanku everyone for appreciating the article and for your concern. I wrote this not to just talk about my fears but to voice on what alot of the interns face.
    Even if just a class is conducted before we start our housejob of what to do and what to expect when interns find themselves in such situations would be helpful so that they don’t panic. Pointing out that it requires concentration as usually interns have so many labs to run they are just in a hurry to get it done forgetting that you could end up being in a hazardous situation.
    And yes the chances for someone who has gone through a similar experience is rare but it is there.
    Doctors just shouldn’t forget to be cautious. Recommend

  • http://www.lucindaporterrn.com Lucinda Porter

    Powerful and brave writing. Thank you.Recommend

  • Mahwish

    My heart goes out to you, going through this regularly is stressful to say the least and I understand how unbearable the anxiety must be. Hope you stay well, safe and strong. Recommend

  • Amjad

    @sars: I think no matter how well prepared you think you are, an intern or a house officer is bound to come across such situations. I came across the same thing as a resident (house officer) in the United States. Performing tests on HIV positive and Hepatitis C positive patients is a right of passage that all doctors in training go through. I can’t remember how many times I have been afraid of contaminated blood and body fluid exposure. I can distinctly recall the crying that some of my colleagues went through after being pricked by an HIV positive needle. The trepidation of drawing baseline tests and repeating tests in 6 months. Recommend

  • HCV patient

    About 15-20% of people who are exposed to HCV successfully clear the virus on their own. These people do not need to be tested every 3-6 months for the rest of their lives. If you are among the lucky 15-20%, then you will not need to be tested for the rest of your life, either.

    It doesn’t sound as though you are being tested with the appropriate tests. You should be able to find out fairly quickly whether you cleared the infection or not. If you clear the infection, you will no longer test postive for HCV RNA. If you didn’t spontaneously clear the infection and develop chronic disease, then you still have the option to treat the disease. You can also treat the disease while it is in the active phase. If your treatment is successful, you won’t need to test for the rest of your life. You will be “cured”.

    As a patient with advanced HCV who has been through several unsuccessful rounds of treatment and who has watched loved ones die from liver failure, I can most certainly sympathize with your fears but it seems as if some of them may be a bit exaggerated. Most people die with this disease… not from HCV.Recommend

  • Khalida

    It makes me sad to read the conditions of our government institutions. As an intern you should have been supervised, and in the case of a mentally unstable person, you should have had more than one assistant knowing the patients unstability. Having a cousin studying at DOW, i now feel scared that she might have to go through the same situations. That little prick has given you a lifetime of anxiety which could have been prevented with by a well organized institution. What appaled me was nonchalant attitude of your supervisor. Wish you the best of luck.Recommend

  • Jawwad Jafri

    You have made each one of us live that moment and made us realize what you guys go through. We often hear the horrific stories coming out of government hospitals but rarely this well articulated. I hope you continue to bring this issues to light and may God protect you, This was a brilliant piece and expect to see a lot more from you.Recommend

  • Summaiya dowite 2009

    Welldone sana , very well written, literally i wanted to read the last part before the starting part, love it ! thank God u are saved :D ! Allah bless U .Recommend