Tricked by Hepatitis B!!!

 

"Your test is positive" But she already knew that because the envelop was unsealed. Now I was preparing myself for one of those long and delicate conversations. The context afterall, was delicate: pregnant lady with an acute Hepatitis B infection. Certainly, not a laughing matter.

I took a deep breath. But the lady spoke. First, she expressed her doubt about the results, which most people do anyways. The reason why she insisted on a lab error was because she had gotten tested twice for hepatitis B beforehand, and both tests had been negative. Since then, she had been sexually active with one man-her husband, who was himself uninfected. I asked her if she had ever received a blood transfussion or if she was a health care worker constantly exposed to blood products. She said no. And thats when I began truly listening. Either she was not entirely truthful with me or there was something missing.

Hepatitis B is an inflammative disease of the liver caused by the Hepatitis B virus, one of the five viruses (Hepatitis A, B, C, D and E) that can cause liver injury. Of these, the B and C viruses (HBV & HCV) are the most concerning because they can cause chronic liver changes, which eventually lead to cirrhosis then liver cancer. More importantly, all pregnant women are screened for Hepatitis B in the first trimester because of high rates of perinatal transmission from an infected mom to her baby. Moreover, the risk of developing chronic HBV infection is inversely proportional to the age at time of exposure. The risk is as high as 90 percent in those exposed at birth, while the risk is much lower (about 20 to 30 percent) in those exposed during childhood.

 hepatitis-B virus HBV "Dane particles", or virions (PHIL*)

Needless to say, I couldn't have this future mother roaming the streets without appropriate management, but at the same time, I had to put her preoccupation into consideration. What if the lab had indeed made a error, and she wasn't infected? The easy way out was to redo the test in another lab, Antigene HBs being the routine marker. And I added Antibody HBc just because with both, you can't go wrong. And guess what: both markers came back negative. She wasnt infected!!!

The first lab technician was obviously summoned, and after a so-called investigation, admitted to mistakenly swapping patient results. The details arent as important as the fact that I learnt a valuable lesson: always listen to the patient first.

*PHIL Public Health Image Library 

All on a silver plate (Part I)

So I was pretty much myself... on call at the clinic. It was one of those dreams where you can tell you're dreaming but everything feels so REAL!!!
This pregnant lady came in, and she was in labour. I did what I usually do (which was so weird because remember, this was a dream): took her to the maternity ward, examined her and etc. But what I specifically noted was the way I interacted with her. For no particular reason whatsoever, I was extremely nice to her (not that I'm usually mean to my patients), but whoever was controlling my dream wanted me to be aware of that.

So fast forward, my patient delivered her baby without any issues, and then was well on her way home. I walked her and the baby outside the hospital ,and that's when I realized there was a sweet ride waiting for her with a driver. Brand new. Leather seats. She was loaded!!! Well, I helped her in her car, and when they were ready to take off, she looked at her. Relief. I could tell she was glad it was over. And then she reached out and gave me a piece of paper. It was a check. A blank check!!! I definitely didn't understand. She said how grateful she was with the way I'd taken care of her, and that was just a small token of her appreciation. FYI, per medical ethics we can't accept gifts from our patients, but let's be real for a second. Dream or no dream, it was a freaking blank check!!! I'd first take the check then listen to what the lady had to say, won't you agree? That's when she said I could write any amount I wanted on the check then cash it. 

That's where my dilemma started. First, I chose a generous amount. Then thought about it. I didn't think I deserved that much for my services so I went down some. Still couldn't agree on an amount. I mean, all I'd done was take care of her, which was my job anyway so I shouldn't even be taking anything. But then again, she said any amount was mine to have. If someone makes that kind of statement they know what they're counting on. I continued battling it out until I rose from my long slumber. Need I say I was very perplexed? 

Now, tell me. What would you do???