In 2016, the most dangerous job in the US was that of logger. According to Time Magazine, loggers suffer 135.9 deaths per 100,000 workers. I don’t know all the particulars, but I would assume that big trees fall on people during the course of this job. I haven’t ruled out Yeti attacks, given that many loggers work in Yeti territory, deep in the northern woods. However the Yeti is rarely seen, and we’re talking about large numbers of injuries and death.
Other deadly professions include fishermen, airline pilots, and roofers. This leads me to our next issue, which is statistics. There are actually more deaths of roofers than loggers, but there are fewer loggers overall, so the rate is higher, due to the lower denominator. Please refer to eighth grade algebra.
I was surprised to read that pilots have a high rate of death at work. It turns out that major airlines, the ones most of us use to travel, are very safe. However, smaller planes, used by air taxis and bush pilots, are much more dangerous. Another interesting fact, about a fifth of the deadly accidents occur in Alaska. Flying is much more common there, a place where everything is so remote from everything else.
Speaking of flying accidents, it’s kind of a terrible stereotype for a doctor with a plane to be killed. Common wisdom attributes this to overconfidence and lack of care. This willingness to make snap decisions serves physicians well on the ground; not so well a few miles up in the sky. There is even a single-engine plane, the Beech Bonanza, that has been called the “fork-tailed doctor killer,” due to the high number of accidents in this airplane.
I am personally not worried about airplanes, because I don’t fly. If I did fly, I would be very careful, and hopefully safer than most. But, it just takes one moment of unfocus to result in a disaster.
That moment happens to doctors, nurses, and techs in healthcare in the form of a needle stick. This happens when a solid (suturing) or hollow (hypodermic) needle that has been used on a patient then punctures the skin of a provider. Most people working in surgery or even a less invasive field have at least one story about this happening to them.
My story happened when I was working in Nebraska, about a year after finishing training. I was performing a lumbar puncture, commonly known as a spinal tap, on a patient. Radiologists are commonly asked to perform these procedures when a primary doctor, who might be an emergency physician or neurologist, is unable to perform the LP without imaging guidance. This has become more and more common over the last few years. I think that this is probably due to patient size as well as the prevalence of spinal surgeries.
When I was in medical school, we commonly performed LPs at the bedside. A patient would lie on his side, and we would feel the back, counting up from the pelvic bones to find an appropriate spot to shove a needle into his spinal canal. But when a patient weighs 400 lb, this is nearly impossible. You cannot accurately feel any of the bones. So you need xrays to find them.
This is true for postop patients as well. When somebody has metal in his spine or little blobs of transplanted bone material in random places around the spine, you can’t get the needle where it needs to go. So, you call the radiologist.
I was performing one of these procedures, and it went well, and I was nearly finished. I had sterilized the skin with betadine, and numbed the skin and deeper subcutaneous tissues with 1% buffered lidocaine. Once your needle is down past the most superficial tissues, patients don’t have much discomfort until you poke a bone. Then they jump.
I removed the solid stylet from the center of the spinal needle, and placed it on a paper drape laying over the patient’s back. While reaching for my needle, I accidentally poked my finger on the sharp tip of the stylet. It didn’t hurt, and I was wearing surgical gloves, so for a split second, I was hopeful that I was okay. I stared at the tip of my index finger, stomach sinking as a drop of blood welled up on my finger. I had broken the skin.
It’s hard to describe the rush of thoughts and emotion that crosses your mind when this happens. What is the fear? Well, the big one is HIV. Then you have Hep C, Hep B (not really a problem, as I have been immunized). You worry about bacteria, fungi, viruses, prion disease. You know how dirty people are, and you are terrified that your patient has just sentenced you to a slow death.
What do you do first? You finish the procedure. I still had a 6-inch needle protruding from this guy’s back. I obtained the fluid, pulled the needle out, and my tech cleaned him up and placed a little bandaid over the tiny hole in his back.
Next, you stare a hole through the patient. What are his characteristics? Does he look like a needle drug user? Is he from another country, where he might have some horrible third-world disease like malaria or the plague? Of course, I know that heterosexuals contract HIV as well, but gay and bisexual men still carry the bulk of the disease. Does this man look like he might be gay or homosexual? I hope this does not come across as pejorative or discriminating. I’m just calculating my odds.
No, he does not “look” gay. He looks like a 250-lb farmer. He is about fifty years old, with the healthy skin of someone who does not drink or smoke. He is not from a third-world country. I relax, but just a little. After all, I don’t know what’s going on at these farms. Maybe they’re having be gay heroin parties. I excuse myself and go wash my hands about a hundred times.
The procedure from here is set, with written instructions at every hospital. First, blood is drawn from the patient, with the understanding that if he is negative for all the major pathogens, it will be unnecessary to draw my blood. If he’s positive, my blood will be drawn now, and on a regular basis for a year or so. I sweat, thinking about what it would mean to me and my family if I were HIV+. Then I stop thinking about it, because I have to get back to work. In the time I’ve been messing with this LP, 20 CT scans have piled up.
Fortunately for us, the farmer already had his blood drawn today, as part of his yearly exam. The tests are run and in two hours, we are all in the clear. I breathe a sigh of relief and think hard about what I’m going to do differently. Since then, I never leave the stylet or any other sharp object (referred to in the medical community as “sharps.” Doctors and their jargon!) on or near the patient. I put all sharps back in the same location on my tray. In fact, most trays have a little piece of foam for us to stick used needles into, sort of a pincushion of disease.
It really all comes down to being careful. Slowing down, going through the same steps every time. I don’t know if that will keep loggers from being crushed by falling trees or fishing boats capsizing, but it makes my job a lot less dangerous. If I can just stay out of small airplanes, I should be okay.