In her own words: A nurse discovers she has HIV
After six months, she hears the dreaded news
[Editor's note: Lynda Marie Arnold, RN, had barely begun her nursing career when she sustained an HIV-contaminated needlestick from an AIDS patient in September 1992. (See related story on the cover of this issue.) She had used universal precautions and was wearing latex gloves while installing an intravenous line on a terminal AIDS patient in the intensive care unit. As she withdrew the catheter from the patient's vein, the patient suddenly moved his arm, plunging the needle she held in her right hand into her left palm.
Hospital Employee Health presents this narrative, in Arnold's own words, of the events following the needlestick. The narrative begins immediately after the needlestick and continues to the time when she received the results of her six-month HIV test from the employee health nurse at her hospital, and what happened to her career as a result.]
I went over to the sink, took off my gloves, and saw that I had definitely been punctured; there was blood from me and blood in the catheter. I washed my hands and went out to tell my supervisor I had been stuck, and ask what I should do. I didn't know what to do -- it was my first stick.
The evening shift supervisor and the nursing supervisor both helped me fill out the paperwork to document the incident. Then they sent me to the emergency department because it was after hours [and employee health was closed].
The physician there filled out more paperwork and asked me if I wanted my blood drawn for an HIV test. I said yes. He explained the risks to me. At that point I found out that the [source] patient was a known AIDS patient. He was in the end stages and died a few weeks after the incident. I remembered that when the aide had brought in the patient [to the ICU], she had told me to use blood and body fluid precautions, which we would have done anyway, but I think to this day it was her way of gently, politely suggesting that he had HIV or another bloodborne illness. She didn't want to say it right in front of him.
I had to follow up with employee health the next day. That was when the conversation about AZT occurred. At that time, our hospital wasn't using it as prophylaxis. It was discussed but it was felt there were no real proven benefits.
At three weeks I developed symptoms of sore throat, fever, swollen glands, and a rash. Employee health sent me to a family doctor who told me there was no AIDS rash and that I shouldn't be concerned, so I wasn't.
At six weeks I was admitted for what they thought was appendicitis, with symptoms of general malaise, low-grade fever, nausea, vomiting and stomach pain. They took out my appendix and found I didn't have appendicitis, but I had severe lymphadenopathy in my abdominal region. That's when they did another HIV test. It was negative.
At three months, I had another test, and I was negative. I felt fine and thought it was all behind me.
Then it was time for my six-month test. All along, when I had gotten my results, the employee health nurse had called me a couple of days later and told me I was fine; my tests were negative. This time she didn't call. I called her, trying to get my results. For a week, every time I called she was busy or at a meeting, and I couldn't get her. It was really unnerving. Finally I got a phone call asking me if I could stop by the office on my way to work. I found that very unnerving, too, because every other time they had given me my results over the phone.
As I was walking into the hospital that day from the parking lot, I met my evening supervisor, and I just casually said, "I'll be up in a minute. I just have to get my HIV results." He said, "If you're not back in 15 minutes, we'll know what happened." But it was like a joke. I went into the employee health office feeling much better, thinking I was just being ridiculous about this; she probably had been in meetings.
I no sooner opened the door to employee health, took one look at the nurse's face, and knew. She had tears in her eyes. The secretary had tears in her eyes. It was awful. It was devastating. I can't remember exactly what occurred in the hours following that. All I remember is saying, "What about Tony [her then-fiance, now her husband]?" All I could think of was, "Is he going to leave me? Is he infected?"
She was trying to talk to me about how the hospital was going to stand behind me and take care of me, how my job was going to be guaranteed. I just kept thinking. "What about my fiance? What about my life?" She says I just kept saying, "It can't be. It can't be." A lot of that is blurry for me. I was in shock at the time.
They called the chaplain. He came down. I was able to call my best friend. She came over. She primarily did all the talking to employee health; I just sat there and cried. I was in no position to listen to anything and would not have remembered anything they told me.
I never returned to the intensive care unit after that day. They gave me some time off work so they could have committee meetings and evaluate. They had procedures in place on what to do if a health care worker becomes HIV-positive, but it had never happened before. They ruled that I could go back to work in the intensive care unit if that's what I chose to do, and that they would evaluate it on a six-month basis.
I was sent to an infectious disease specialist who began the lymphocyte panel subset analysis of my T-cells, and they did an anergy panel. My anergy panel was negative; I wasn't responding to anything, and my T-cells were already below 500. They were going to start me on AZT right away.
At that point I decided I didn't want to work in intensive care because of my own risk of catching diseases, primarily tuberculosis, not only for myself, but because I didn't want to bring something home to anyone else. They gave me a job in quality assurance doing chart review. It was a nursing position, but I was really unfulfilled and dissatisfied with it. We talked about other areas of patient care I could go into, but I was having severe adverse reactions to the AZT and wasn't able to work.
Finally, in about a year, with the stress on top of everything else, I left on complete workers' compensation disability in April 1994. My husband remains HIV-negative; the baby doesn't have it. We're just trying to live life with this.
(Editor's note: Today, Arnold, 26, is using her experience to campaign for use of safer needle devices in hospitals, hoping to protect others from occupational exposure to HIV. She also has since been married, and she and her husband have adopted a baby boy.) *
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