The Blog I'm Not Writing

Content warning: Despite the date, and one or two moments of comic relief,  [1]   this is probably the most serious and personal blog post I have written.  No foolin.’

*   *   *

Department Of Worst April Fool’s Day Ever

The following took place a long time ago in a galaxy far, far away – twenty-one years ago today, April 1, 2001. Background info: MH and I and our offspring, K and Belle, were members of a local church.  [2]   Within the past seven weeks we’d celebrated K’s eighth birthday, and Belle’s fifth.

*   *   *

At approximately 12:20pm, Sunday, April 1, 2001, MH and I were in the ___ (church name)  Fellowship Hall’s kitchen, doing cleanup after coffee hour.  K and Belle were playing with other children outside, in the church’s courtyard.  Belle found a hypodermic syringe (“A shiny toy,” as she later described it to me) on the grass under the bushes next to a play-shed in the courtyard.  She picked up the syringe, which was capped, but the syringe’s needle — which was sticking out at an angle from under the side of the cap — poked her in her right thumb.  She dropped the syringe and walked away.

K had seen Belle pick up something and then quickly drop it.  He went over to where she had been, saw the syringe, and picked it up. He intended to take it upstairs to MH and I, to show us what Belle had touched…then he also got stuck by the needle (in his left thumb) when he picked up the syringe.

K came into the kitchen, holding the syringe.  He told us that he’d found “this thing on the grass” and that he’d accidentally stuck himself with it. Before K had finished his sentence MH whisked the syringe from K, and recapped it (K said he took the cap off *after* the needle stuck him, as he wanted us to see exactly what it was that had stuck him, but that the syringe had the cap ON when he picked it up).

I rushed K to the sink, quickly but thoroughly washed his thumb, and told MH to get Belle and meet us at the hospital.  We had our two cars with us; I wrapped the syringe in several paper towels and ran down the back stairs of the hall with K in tow, telling him that we were going to the Tuality Hospital ER (which is less than half a mile from the church).

At this time MH and I did *not* know that Belle had also – and first – been stuck by that same syringe’s needle.

MH found Belle standing in the entrance to the Fellowship Hall, crying and holding her thumb, which was bleeding.  MH asked another child, who was lying on a couch in the entrance, what was going on.   The kid glanced at Belle and casually replied, “Oh, she cut herself.”   MH asked Belle what happened; she said that “a knife” she found in the courtyard had cut her finger.

I’d parked on the street by the entrance to the Fellowship Hall. Just as I was about to pull away from the curb MH ran to my car, pounded on the window, opened the door and practically threw Belle in the back seat, next to K.  MH told me about Belle’s thumb as he strapped Belle into her car seat; we tried to get more out of her, but she was very upset.  She didn’t want to say that it was the needle which had cut her, but K said that it was, and then Belle confirmed this.

All of this — from the moment K came up to the kitchen with the syringe to MH running with Belle to the car — took place in less than two minutes.  I squeezed Belle’s thumb to get more blood out, gave her a tissue to hold over her thumb, and drove to the ER, with MH arriving in our other car about four minutes after the kids and I did.

The bad news:

…was what had happened.  Of particular concern was the fact that the syringe was from an “unknown source,” which is hospital jargon for, “We don’t have the syringe’s user to test.”  However, as the hospital personnel  [3]   – and our own instincts and experience told us – as far as what the syringe had been used for, we should assume the worst.  Translation: the syringe had been used to inject a person or persons with illegal drugs; it had not been left there by a diabetic who on the spur of the moment decided to adjust his blood sugar/insulin ratio in our church’s courtyard’s bushes. (Coincidentally, earlier that morning I’d been told by the church groundskeeper that the previous day, members of our church had done a cleanup of the church grounds, removing beer cans and trash from under and around the bushes in the courtyard, where the groundskeeper had occasionally found “vagrants and street people partying.”)

Hospital personnel told us the syringe was likely used to inject its user(s) with a certain kind of heroin (“Mexican brown”) and/or methamphetamine, which, for “street users,” were the injectable drugs of choice both the hospital and the police were seeing at that time.  Although we brought the syringe with us (and could detect a micro-microscopic drop of fluid inside of it), we were told that there was nothing the hospital could test it for.  In fact, it was hospital policy not to test it, for among other reasons, the false reassurance of any false negative results (which they would likely get, as there was no way to determine how long the syringe had been there).

The relatively good (or at least, less bad) news:

-Both kids’ immunizations were up to date, including for Hepatitis B.

-Although there were no vaccinations for Hepatitis C and the other rare strains (D, E, F), risk of transmission for those infections, in that kind of possible exposure, were negligible…  Also, those strains of hepatitis were rarely seen in Oregon at that time (Hepatitis A is not transmitted via needle sticks).

-The syringe had a small gauge needle; thus, the possibility of a significant “viral load” transmission was small.

-HIV, the big fear factor at the time, is a very fragile virus.  Despite its many mutations it can survive only a few hours (if that) outside a host body.

The children were seen by P.A. ____, who examined them and then spoke with us about what happened.  Over the next three-plus hours, the P.A. consulted via telephone with Drs. E___ and L___ at Emmanuel Hospital’s Infectious Disease and Pediatrics Infectious Disease departments, with our pediatrician’s on call group, and with other physicians at the CDC.  [4]

We were told (by the P.A. and a Tuality ER physician) that HIV prophylaxis treatment was something we should consider, for both K and Belle.  We did, and decided against it, with the following information in mind:

– None of the doctors consulted would strongly recommend that we start either K or Belle on prophylactic treatment for possible HIV exposure, given the parameters of the particular accident/incident, nor was such treatment the recommended protocol for that kind of possible exposure.

– MMR (Morbidity & Mortality Report) statistics showed no transmission of disease had been recorded to have occurred in “this kind of injury,” in Oregon.

– Risk of transmission of HIV was estimated to be less than 1%; risk of side effects from AZT or other prophylactic HIV treatments definitely exceeded 1%.

K and Belle had blood drawn at the hospital for baseline HIV and Hepatitis titers, and we were given scripts to have the tests repeated at intervals of two, four, and six months.  The P.A. suggested, for our own peace of mine, that we do another test at twelve months (although that was not the official recommendation).

******************************

Department Of The Aftermath

At one point, sitting in the ER exam room with MH and the kids, I remembered noting the date and thinking, “If only this were an April Fool’s joke….”

The above was the Dragnet (“Just the facts, ma’am”) version of the incident, which I sent to family, and wrote for our own records.  I left out the emotions experienced by K, Belle, MH, and myself, which you can probably imagine (and which took me months to forget).

We were at that ER for hours.  We waited, while the P.A. consulted with various specialists and/or waited for them to return his calls and periodically came into the exam room we occupied, to update us.  All the adults were (trying to be) calm.  The ER seemed understaffed, to me (a hospital staff member later told me it was unexpectedly busy “for a Sunday afternoon”).  Even so and speaking of the afternoon, I wish one of the staff would have thought to offer our kids some food.  It was lunch time when the accident happened, and a little after 4 pm when we got out of there.  MH and I were too adrenalized to be hungry and, in our state of shock and with possible scenarios and outcomes running through our minds, we forgot that the kids, of course, were hungry  [5] ). I finally had the presence of mind to realize this, and got someone to bring them some sugary drinks, which made them both happy.

Waiting, waiting, waiting….  We bummed drawing supplies (paper and pens) from a nurse, to keep the kids amused or at least distracted, while hospital staff checked with one another and called various experts.  We shut the door to the exam room we were in and talked loudly to the kids when an accident victim with a fractured femur was brought into the ER (we were mostly successful in muffling the victim’s cries of pain, which echoed down the ER hallway).

MH’s cousin is a pediatrician and her husband an epidemiologist; MH used some of the waiting time to call her (she lived on the East coast).  She was very reassuring.  She told us that, to her knowledge and after checking her sources, there were no cases of someone “sero-converting” – i.e., going from a negative HIV test to a positive – after having “that kind” of accident (being stuck with a needle which had likely been used and discarded several hours before the stick-accident).

Okay; yes; this is good.   But, if this is common knowledge, why is this taking so long?
Why all the consults – are they preparing detailed information for us,
for a prognosis we don’t want to hear?

We had plenty of time, sitting/waiting/pacing in that exam room, to imagine the worst.  I had worked for nine years in the women’s reproductive health care field but been away from the medical world for almost as many years and hadn’t kept up with “things.”  HIV, despite its ability to mutate rapidly, was – or had been – a very fragile virus. Perhaps new strains had developed, which I was unaware of – new mutations which could survive hours outside a host body? I thought that unlikely, thus; actually, my main concern was not HIV.

I was more troubled to think that the kids might have been infected by one of the new strains of hepatitis that seemed to be cropping up left and right. When I’d worked at Planned Parenthood, just before MH and I moved up to Oregon, I’d had a needle stick accident, [6]  and had to go through the routines of initial HIV/hepatitis blood tests, getting the Hep B vaccine series,   [7]   then follow-up HIV and hepatitis tests at two, four, and six month intervals.

Meanwhile, back in the ER….  Finally, a little before 4 pm, the ER staff attending to our case had documented it to their satisfaction. We needed the kids to each have their blood drawn for the first round of tests, and then we could go home.  MH and I and the hospital personnel tried to be as straightforward – and as nonchalant – with the kids as possible.  “Everything is going to be all right, we just have to do one test (which…er, yeah…will involve another needle stick)….”

K tried to be brave.  He was old enough that we could explain the hospital procedures to him, how they’d need to draw a small amount of blood for a test.  Did he think he could cooperate?  His lower lip trembled as he nodded yes.  He sat in my lap, I hugged him, and he hid his head under my arm when they drew his blood sample.  For each of the subsequent, follow-up blood draws (at two, four and six months after the incident), K got better at handling the needle poke (he even watched the last one, instead of turning his head to the side!).

Belle’s reaction was…almost feral.

What a difference three years makes, especially for younger children, in terms of experience and comprehension. Looking back, I realize that Belle was also being brave, in a different way – in defense of herself.  She did not understand why she had essentially been held captive for hours; she did not understand the need for the tests the adults were trying to explain to her.  She understood that she had already been injured by one needle, and she was determined not to let that happen again.

The hospital personnel were kind and patient with her, but despite their assurances that they would use the tiniest needle possible (“The size we use on preemies,” a nurse told me) Belle became unhinged. Even her beloved daddy could not get her to cooperate, nor could he restrain her.  Finally, in order to safely draw her blood, the hospital staff put her in what I can only describe as a full body straitjacket.  It was a device/garment I’d never seen before,   [8]   and it provided me with one brief moment of levity in that dreary afternoon (I had to leave the exam room for a moment, to stifle my giggles).

The follow-up blood draws were, for Belle, not much better (although full body restraints were not necessary).  For years after that ER visit Belle maintained a visceral fear of needles.  Routine vaccinations were…stressful, to put it mildly, for Belle, her parents, and her pediatrician.

Despite Belle’s fear of needles (which had not been present before the trip to the ER), neither she nor K seemed to carry any long-term trauma from the needle stick accident.  They also barely displayed any short-term distress.  By the morning after they seemed to have accepted what the adults had told them (it was an accident; everything is going to be fine), and it was almost as if the accident hadn’t happened.

The night we came home from the ER they both fell asleep even quicker than usual (fatigued from the excitement, was my guess).  Oh, to have that short term memory dump capability, I remember thinking.  Meanwhile, as our children dozed in blissful ignorance, MH and I sat upright in our bed, eyes abuzz from our respective adrenaline overdoses.

“What just happened?” I said to MH.  “I feel like – like I should attack something.  I’m all geared up for battle, but there’s no one to fight.”

*   *   *

When the option for prophylactic HIV treatment had been offered to us, I thought:

Is this the day our lives change forever?

I hoped the medical personnel were going to advise *against* such treatment; instead, they’d presented the pros and cons, and left the decision to us.

I’d already decided that, unless there were compelling evidence to do so, no way was I going to agree to poison my kids to play the odds.  During some of the down time in the ER exam room I’d chatted with the kindly if seriously-demeanored P.A., and discovered that he too was a parent.  After he and a hospital physician had presented the HIV treatment option to MH and I, I waited until the physician left the room, then asked the PA,

“What would *you* do, if this had happened to *your* children?”

He paused, and I continued.

“I know you’re not supposed to answer that kind of question, but please?”

The P.A. nodded at me, in a way I can only describe as respectful, and I saw the brief flicker of a smile cross his eyes for the first time since he’d met us.  No, he said, if they were his children, he would not opt for the HIV prophylaxis.

*   *   *

Thanks to the merciful element known as “the passing of Time,” the distress of that day has morphed, for me, into having an impassive remembrance of what happened without having to relive how it “felt.”  Years will pass without me thinking about the accident, and then something will remind me.

One such reminder came via a local public television show I saw a few years ago, which featured an interview with an activist who “represented” an encampment which homeless people had been setting up in a Portland neighborhood.  The encampment was in an area which had been designated as a wildlife corridor; homeowners living near the corridor were disgusted and alarmed by the encampment’s accumulating trash, habitat destruction, and crime.  The activist/representative said that the camp occupants were policing themselves – she looked directly into the camera and declared that they had a strict, no drugs/no alcohol policy.

Local news reported that within days of authorities evicting the campers, the encampment resembled an EPA-declared toxic waste dump. City employees and volunteers who cleared out the hundreds of pounds of garbage the campers had left behind had to wear special gloves and protective garments, as the trash included  – surprise, “self-policing” activist/representative! – drug paraphernalia, including contaminated syringes and needles.

When I read that follow-up story I was right back to that day – back to the moment when MH ran up to my car, carrying our frightened five-year-old in his arms; back to the moment when I realized that *both* of our children had been stuck by a hypodermic needle; back to the moment when, as surely as I could sense my own pulse hammering in my carotid artery, I felt as if my “spirit” were draining out of my skull, down through my chest and gut and legs, and exiting my body through the soles of my feet.  And no, this is not a florid way of saying I peed my pants (which I didn’t).  The sensation was so vivid, I later checked my car’s floormat for…something (I didn’t really know what I was looking for).

Several months passed before the needle stick accident wasn’t the first and last thing I thought of every day.  Some mornings with stoic acceptance and some nights with fierce, Samuel L. Jackson-style defiance (“C’mon, just try and hurt us again, you needle-discarding, muthaF#&%?! ass#@&%* !”), I’d contemplate the fact that there are so many things out of a parent’s control.  Seemingly apropos of nothing, I would find myself ruminating on the plethora of shit, be it circumstantial, biological, genetic, or whatever, that I could neither anticipate nor control, but which could harm K and Belle.

I eventually made peace with the reality that generations of parents before me had recognized:

Your life can change in an instant;
your love for your children may be river deep and mountain high,
but it cannot protect them from everything that might harm them….
including random fate and their and other peoples’ (and your own) mistakes.

One day, several months after the NS accident and after things had returned to the proverbial normal, I was out running errands with Belle.  We were at a crafty-type store, getting supplies for her preschool project, and she had to pee.  The store’s restroom was a fairly large, handicapped access room. After Belle flushed the toilet and began to move to the sink to wash up, she exclaimed, “Look!” and reached for a shiny object lying on the floor, to the side of the toilet.

I had my first ever out-of-body experience: I watched as a hand (that was apparently my own) reached out with lightning speed and slapped Belle’s hand just before she touched the object; I heard a banshee’s voice from the bowels of the hells I don’t believe in bellow from my mouth:

” NO NO NO NO NO !!!
Don’t EVER pick up ANYTHING when you don’t know what it is –
didn’t you learn ANYTHING from the accident ?!?!? “

It took a stunned two seconds for first Belle and then me to burst into tears, and a nanosecond after that for me to apologize to her.

*   *   *

May you never have a similar story to tell;
May you make peace with life’s realities but do your damnedest anyway;
May you remember to ask for something to eat and drink when
you’re stuck in an ER room for hours;
…and may the hijinks ensue.

Thanks for stopping by.  Au Vendredi!

*   *   *

[1] Thank you for the inspiration, Samuel L. Jackson.

[2] One of the more (if not most) liberal of the Protestant denominations.  Yes, this foulmouthed  expressive atheist and her family were active church members.

[3] The P.A., doctors, and nurses we saw during our ER stay.

[4] He had also spoken with at least two other Tuality hospital physicians, one of whom, along with the P.A., presented the HIV prophylactic treatment option to us.  We also had several nurses (in and out of the exam room where we and the kids waited) who never introduced themselves.

[5] Although, oddly enough, neither of them said anything to us about it…which I attribute to them being intimidated by the surroundings.

[6]  This happened as I was doing a finger poke blood draw from a high-risk (multiple sexual partners; IV drug user) patient: I poked myself with the same lancet I’d just used on the patient, as I was transferring the lancet to the sharpie container.  It was a move I’d done a hundred times, only that time I somehow managed to stick myself as I grabbed the sharpie container.  To this day, I’m not sure how it happened, but I’ll never forget how the patient looked at me and said, “Uh oh.” 

[7] Which I should have had anyway…but I’d kept putting off for time/scheduling reasons.

[8] Then a few months later, in a veterinary setting, I saw a similar garment used to restrain a fractious cat!