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Joe Case Study (HIV)

Last updated over 1 year ago
5 questions
Joe was your typical 30 year old medical student, although his last 4 years were anything but typical. Being recently diagnosed with Human Immunodeficiency Virus (HIV), Joe reflected on his activities during his time in medical school. Because he was a medical student who was commonly in the emergency room, he has had experiences that the average person will never have in a lifetime. The following is his story:

"Although it was confirmed that I have HIV, I am not completely sure on how I got it. Exposure could have come from all different things I was exposed to. I will begin my story four years ago, when I started rotations in the emergency room. I lived the typical life of a medical student- little sleep, hard work, stress, and little time for fun. I had a girlfriend for a short period of time close to the beginning of these four years, and we did engage in unprotected sex once or twice (1 know, as a medical student I should have known better...). I did not think too much about it. I had known her for a long time, and to my knowledge, she did not have HIV (and to my knowledge, still does not have HIV).

"It was a fairly easy breakup, but it was on the drive home from this breakup that my life changed. I was driving fast, but I did not see the red light. I went right through it and blindsided a SUV at about 45 mph. I was immediately knocked unconscious, and I don't remember anything until I woke up in the hospital. My arm and hand (or, what I thought was my hand) was wrapped in a huge bandage and I had a cast on my leg. When the doctors came in, I was told that I had lost my hand in the accident, lost a great deal of blood and had to have a blood transfusion, broke my leg, received a concussion, and received other bumps and bruises. This was, of course, life changing news. As a medical student I knew that there was such a thing as a hand transplant (look it up- it is real!) and I might have a chance to receive one. If not, I knew I had no chance of actually becoming a surgeon one day. After a couple months on a waiting list, I received word that a donor hand was available and I needed to come in for the procedure. That was great news, and the procedure went as planned. I was not prepared for the recovery, it was long, and painful. In fact, it was so painful that my pain killing medication became a drug that I needed all the time. It began to lose its potency, and I moved onto stronger painkillers. These painkillers were intravenous (administered into a vein) and were not prescribed. I quickly became hooked, and was consumed with trying to buy and find these painkillers. Even at the time, I knew that intravenous drug use was highly risky, but I just didn't care. The battle with painkillers lasted nearly 5 months, but finally with the help of friends and family, I got off of them. That was the right move if I ever was going to finish medical school.
"Speaking of friends... I did meet a new girl during this time. Although it never became too serious, we shared some memories. That all came crashing down when I made my move", and gave her a kiss on the lips. She pushed me, and walked away, I felt pretty dumb at this point, but out of frustration and embarrassment, I let her go. When I called her the next day she informed me that two years ago she was diagnosed with HIV and she did not want a relationship because of it. I guess I respected that, but at the time, I was just frustrated with the news. To my knowledge, this was the first contact I ever had with someone who had HIV.

"So, I took a vacation. It was summer, and I love to camp and hike. I decided to go out on my own for a week-away from everyone else. Although the scenery was amazing, the mosquitoes were in full swing. I cannot count the number of mosquito bites I received, but it had to be over 100 within a week's time. I knew mosquitoes could carry some parasites in their saliva, but I thought that actually obtaining one of these infections would be unlikely. I wonder if mosquitoes can carry HIV?

"Either way, I was finally heading back to medical school after my long hiatus to get well after the accident.. I was excited to be back in an emergency room learning about what I loved. Although the first week back was fairly standard, the next was anything but normal. I remember that a mother and toddler came in, both were crying. Although I was not an attending doctor, I was still in the area watching and learning. The toddler had a large cut on his leg, and was bleeding profusely. Everyone involved was wearing appropriate protection (gloves, gowns, face masks, etc...), but the toddler was squirming all over the place, Tears and snot seemed to be flying everywhere, it was clear the toddler was in a good deal of pain. As I went in to help control the child, my arm got close to the toddler's face, and apparently he felt it was appropriate to bite my arm (I am not sure if I blame him in his situation). Although the bite was painful, no skin was broken. After the bleeding on the child's leg was controlled, we proceeded to clean up the blood spatters on the floor and linens. Before this clean up, I neglected to check my gloves. It was only after the cleanup that I noticed the hole in my glove. Although I cannot be sure, I am fairly certain the hole was there during part of the blood cleanup. I proceeded to thoroughly wash my hands and arms and made sure I had no open wounds on my hands. I did not find any cuts, and I went to discuss the event with the attending doctor. The doctor instructed me that both the toddler and the mother had HIV. Of course, the events of the day then replayed in my head- what about the bite? What about the glove? I did not discuss this with the doctor because all contact I might have had with HIV was because I was being neglectful.

As a medical student, my goal was to always look like I had it under control-so l moved on. I visited the mother and child while they were still in the ER; the mother thanked me, shook my hand and said goodbye. Of course, in the retrospect of being diagnosed with HIV two years later, I have many more questions about this event.
"Oh, I almost forgot to mention ... I finally went through with it... I got a tattoo. I was not sure if I was ever going to get one, but I finally convinced myself that as long as it is not easily visible then no one in my profession would even know. I got a caduceus on my shoulder-that ever so famous medical symbol of the two snakes wrapped around a winged staff. The place! I went to get it from seemed a little shady (it seemed clean, but just very odd people there), but It turned out well.

"The next couple months were fairly standard-hard work, long hours, stress, and another girlfriend. You might be thinking to yourself 'wow, not another girl.' Trust me, I was thinking the same. Either way, we met through mutual friends and started hanging out. One thing led to another and before I knew it I was in some sort of relationship. It became pretty serious and soon after she moved into my small apartment with me. We shared everything-a bathroom, my kitchenware, and even food. I had become wiser from previous relationships and tried to always have protection during sex (although I did forget once with her). One evening, I came home and she was gone. All of her stuff was moved out, and she left a note saying that she was 'done and wanted to move on.'

"Although this was a heartbreaking surprise, I just tried to forget about it. On top of trying to deal with that, I came down with the flu about 1 week later. This just made it worse. I don't ever remember having the flu this bad. I never received the swine flu vaccine, so I assumed that is what I had come down with. I stayed at home, and slowly recovered.
"It was six months later in mid-June when I noticed that there were posters around the hospital about National HIV Testing Day on the 27th of this month. I had never heard of this, but a group of us at the hospital thought it would be a good thing to do as an example to individuals in the hospital that were asking questions about the posters. I had some blood drawn from my arm, and went on with my day. It was to my surprise when I got the call that told me I was HIV positive. Of course my mind began to race as to how I actually got the infection and what it meant for my life. To this day I am not completely sure how I got HIV. Even though I was a 'brilliant' medical student, I made mistakes and had many chance happenings, but I will carry this virus with me for the rest of my life."
4

Joe could have come in contact with the HIV virus many different ways during these four years. Make a "ranked" list of the most likely ways Joe became infected (in order from most likely, to least likely).

4

Out of the most likely ways that Joe became infected, what did they all have in common?

4

If the last girl in the case study gave Joe HIV, do you believe that she should be legally held responsible?

4

What implications do you think this infection will have on Joe's life?

2

Did Joe have any symptoms of HIV?