My first day in the morgue was a shock to the system — the smell of death, the sight of rigor mortis and the comfort of everyone around me with the task at hand. I thought my prior health care experience prepared me for this, but it clearly did not.
As the days passed, I began to settle into my role as a part of the team. In turn, my responsibilities grew. The team became comfortable asking me to fingerprint the body and suture the chest wall closed. I came to enjoy these opportunities to contribute. With each chance I was given, I practiced my technique. From holding the double curved postmortem needle in my hand to spacing my sutures equidistant from each other, I worked with the hope that this would contribute to my ability to save patients from the very fate I was currently facing — at least for a few decades.
The responsibilities also came with added difficulties. On one of my hardest days in the morgue, I was tasked with cleaning and preparing a young man — no older than myself — for whom life was so painful that he decided the only escape was to remove himself from it. There is no better reminder of memento mori than holding death in your own two hands. Cleaning the blood away from the dime sized hole in his skull is a moment that will remain with me forever.
The days became weeks and I found myself slipping into the same familiarity with death that I saw in my colleagues on my first day. It was a comfort I found disturbing, and I quickly jolted myself back to the reality of what I was encountering every day.
It was a Tuesday, and I was finishing the case of a homeless man who had passed of unknown causes. I threaded the double curved needle like I had practiced dozens of times through the skin and superficial fascia to close the abdomen and chest wall. This time, however, as I passed the needle through I felt a small pain in the edge of my pointer finger.
Unsure of what just happened, and not wanting to cause a scene for the physicians and staff around me, I finished my sutures and tied them off. I told myself that it was probably nothing as I closed the body bag and finished the case.
As the morning came to a close, I took off my gown and the two pairs of gloves I always wore and there it was, a minuscule speck of blood on my pointer finger where I had felt the pain. Even though I knew what I was supposed to do, I didn’t do it. In my shock and embarrassment, I quickly washed my hands, changed my clothes and ran out to my car, as if the quicker I moved, the faster this situation would somehow disappear.
However, my efforts to forget what just happened fell short. As soon as I arrived home, I jumped on my laptop to research the risks of infection. My rapid research yielded a 0.3% risk of HIV, 1.8% risk of hepatitis C and up to 30% risk of hepatitis B transmission with a needle stick exposure from a positive patient. I was immediately grateful for my hepatitis B vaccination.
As my emotions settled, I knew I had to report the incident. This resulted in a trip to occupational health, phlebotomy, the morgue and the lab in order to gain samples of both the patient and my own blood. Then I waited.
As I anticipated the phone call, life continued. I had a research meeting to attend, studying to be done and household chores that needed to be accomplished. I finished some tasks and headed off to my research meeting where I was welcomed by our team. The meeting had commenced by the time my phone rang.
I excused myself and stepped out of the room. My nervous voice echoed through the phone as I said hello to the voice on the other line. The lab tech said there was good and bad news, and I joked that was a poor way to start the conversation. I was trying my best to maintain my sanity. She told me that the patient was negative for HIV and hepatitis C, but positive for hepatitis B. I was again grateful for my hepatitis B vaccination.
Then came the bad news. Although I was vaccinated for hepatitis B in the past, my antibody titer was much lower than expected. I was asked to immediately come back to the hospital for a booster vaccine. I flashed back to my prior research of a 30% transmission rate for hepatitis B. I took a deep breath, said thank you and hung up the phone.
I tried to tie myself back together before I entered back into my research meeting.
“Everything okay, Caleb?” my supervisor said.
“Oh yes, just fine,” I replied. As the minutes passed, I did my best to focus on the task at hand, learn new skills, understand the research protocol. My colleagues and I were shoulder to shoulder, but they were completely unaware of my internal turmoil. I was doing my absolute best to stay calm, but I was barely holding it together.
A few moments later, my phone rang. I apologized and excused myself again. As I answered the call, a familiar, but now excited voice greeted me. It was the lab tech. This time she had only good news, “We ran the patient’s specimen again, and it turns out that the initial test result was a false positive. The patient was negative for everything.” I was safe.