Some of the things we learn during our medical training are startlingly obvious, but only after we have learned them.
I was a first year family practice resident in Madison, Wisconsin. Generally healthy, I had always prided myself on never missing school or work for illness. It was a shock when I picked up a viral illness within a few days of starting my pediatric rotation. Then, just as I was beginning to feel better, I had a second. Then a third. And a fourth. Serial sickness. Sometimes I had a few days respite between bouts of illness, but sometimes they overlapped. I began to feel sorry for myself and worried that I would never feel well again.
Near the end of my four months of pediatrics, I mentioned to my attending, Dr. Paul Dvorak, between patients in his office at the Dean Clinic that it seemed as if I had embarked upon a project to see how many illnesses I could get. I asked him how long it had taken him to develop the immunity that so clearly protected him but not me.
“It isn’t immunity,” he said. “It’s germ theory, simple common sense, and basic hygiene.”
“But I wash my hands before and after each patient,” I protested. “And I wear short sleeve shirts to make sure I wash my whole hand and wrists, not just my finger tips.”
“Think about your pen,” was all he said. But it was all he needed to say. It was obvious and I understood at once.
I looked down at my shirt pocket. There was a small penlight, about a dozen index cards held together by a paper clip, and my ever-present two BIC pens:
They were cheap, easily available, and came in boxes of 20. And they were the problem
Every time I bent down and leaned forward to look in a sick child’s ear, her mouth was positioned only inches from my pocket. She had no choice but to breathe (cough and sneeze) on my pens. Since every patient encounter required a note in the chart, within moments of making the sick child breathe, cough and sneeze on my pen, I used my just washed hands to pull the pen out of my pocket and my mouth to remove and hold the contaminated plastic cap while I wrote. Just thinking about it now makes me shudder, but up until that moment I had been oblivious.
On the way home that day, I bought a Cross pen and that night I discarded all my BIC pens. I stopped being serially ill. And I share this story with patients who ask if there is something wrong with their immune system causing them to ‘catch everything that comes to town.’