Egoism makes you bleed...

GAH, what a frustrating day.

At some time during your residency you start to get more comfortable with your everyday tasks and procedures. First it's the little things such as presenting vitals and physical exams on rounds (no, medical school really doesn't prepare you for everything). Then it's smaller procedures such as drawing CSF, starting arterial lines... then before you know it you're throwing in central venous catheters and ventricular catheters (that yes, go into the brain), like it was tying your shoes. Well, admittedly I don't believe I'm quite at the point where I can do an EVD (external ventricular drain - entails drilling a hole into a patient's skull at bedside and placing a catheter, more or less blindly using anatomic landmarks, into his brain, aiming for the ventricles, in order to drain cerebrospinal fluid [CSF] in the setting of increased intracranial pressure from bleeding, tumors, etc) like I tie my shoes, but I've gotten fairly adept at it. But this isn't about the advanced techniques, but rather the simpler ones we become overconfident in.

I was setting up to place an arterial line today, and as my last few had gone swimmingly, so I told the family I'd be done in 20 minutes. "Twenty minutes?" the nurse asked. "Yes," I responded, "no problem." It wasn't really due to arrogance, but maybe there was some underlying overconfidence there. Well in any case you can probably see where this is going. The line placement was a disaster. The patient kept flexing his wrists and arm like he was arm wrestling me despite the local anesthetic, boluses of propofol, and IV morphine and versed we gave him. I even achieved arterial flow, but his clonic movements made it impossible to thread the guide wire. At this point I should have stopped, but my claim that I could do it in 20 minutes (and the goading of the timer on the wall... cursed competitiveness) drove me on. His arm started looking like a pin cushion. Just as I was about to call it quits, my patient got his vengeance and curiously the needle turned in my hand and stabbed my other hand as I was trying to put it away. Did it break skin? No I don't think so... but then there it was, the faint tint of blood with the wrong color... the color of it being on the inside of the powdered latex. GAH.

I broke scrub (got out of sterile attire) and washed my hands. You win sir, this time. We sent the routine labs for HIV, Hep C, Hep B... I'm not too anxious as his family denied him having any history of these diseases, but I'm still somewhat apprehensive. It was a hollow needle, with a large bore: the kind of needle that has a greater chance of ruining your life.

Moral of the story: don't get cocky. Arrogance leads to bloodshed... and not infrequently your own.