It was just a small cut, sliced by the jagged edge of a glass fentanyl vial that was opened in a rush. But mixed with the backflowing IV of an HIV-positive patient, it led Sapna Kudchadkar, MD, PhD -- the mother of a six-month-old as she was starting an anesthesiology residency -- to spend months considering whether she would stay in medicine.
Kudchadkar last week, hoping it might help other young medical professionals, especially new mothers who are suddenly facing the conflicting demands of medicine and motherhood.
The thread is powerful, studded with spot-on animations that lighten a heavy topic. She said she drafted it slowly, over several months, first for herself before deciding to go public.
"Just writing it out brought me personal closure, but I never hit 'send,'" Kudchadkar told 51˶. "Then, August came, a time that we don't fully acknowledge in medicine as the time when the real clinical experience begins for interns," which was when her story began, more than a decade ago.
"I felt especially unsure of how to deal with it at the time because I didn't know the people around me, and they didn't know me," she said. "I remember thinking as a trainee that all my attendings had it so together. It never really occurred to me that they likely had challenges and stories to share about their past experiences that are the fabric of who they are today."
"So I wanted to share just one of mine in case it helped anyone else," she said.
Kudchadkar's experience occurred at a time when she was "very vulnerable emotionally. I had already finished three years of residency training and had committed five more years to peds anesthesia and critical care training. Juggling a new baby with those aspirations was incredibly hard, as so many parents in medicine have experienced. It felt like I was never doing anything well enough -- job, motherhood, marriage."
"The thought that there was even a tiny chance I may have changed the trajectory of my life and my family's life in one second due to a stupid mistake -- while in pursuit of my own career aspirations -- was overwhelming," she told MedPage Today, acknowledging that while her fear wasn't rational, it was consuming.
Her Twitter thread begins: "Every summer my heart is heavy with memories of a time when I came close to leaving medicine -- when career and motherhood collided and I didn't ask for help."
On her first day without an attending's constant in-room supervision, Kudchadkar showed up early to set up the OR and draw up the needed medications. In a rush to crack open a glass fentanyl bottle, it broke off jaggedly and she cut her finger.
It was a small cut and she couldn't find a Band-Aid. There was no time to search; she had to see her first patient in just a few minutes.
She washed her hands and went to work.
By mid-day, after some tough IV starts and a missed intubation, Kudchadkar still hadn't had a chance to pump, causing swelling and pain, but she soldiered on.
Her next IV insertion seemed to be a success -- until she noticed the blood streaming to the floor because of an incorrect stopcock setup.
"First thought: 'I'm making a mess, need to fix this ASAP,'" she tweeted. "I instinctively reach out to grab the IV -- forget I don't have gloves on. Blood is now in my cut from the morning. Patient is HIV+."
There were no sinks in the OR, and she couldn't leave her patient unattended, so she waited for a colleague to stand-in so she could wash her hands.
Next stop, the occupational health department. She was instructed to start a course of prophylactic zidovudine/lamivudine that afternoon, and had to stop breastfeeding immediately.
But she carried on. Kudchadkar showed up for work every day and downplayed the pain. She didn't even convey the full extent of her fears to her husband.
"I smile when I should. I take good care of patients. I'm strong after all."
Even though she knew her chances of contracting HIV were slim, a high fever two weeks after her exposure made her worry that she was seroconverting.
"I wonder what it is all for. I spend my free time, baby in arms, reading about my chances. I'm lost. But I talk to no one."
It took six months until definitive testing could confirm that she didn't have the disease.
Looking back on that time, Kudchadkar tweeted that she "made a mistake too many of us in medicine do. I should have talked. A lot. I spent over 6 months of my life wondering if I should leave medicine. Wondering if I had ruined my life."
"Were my fears rational? Likely not."
"But they were MY FEARS. And I should have asked for help."
Her advice to others in a similar situation: "Don't ever put work before your mental health."
"If it's impacting you -- it's not irrational -- it's real. It's your life."
Dozens of healthcare professionals responded to the thread, thanking Kudchadkar for sharing her story. Many said the current system doesn't do enough to support mothers in medicine.
Nick Gowen, MD, associate program director (APD) for the internal medicine residency program at the University of Arkansas for Medical Sciences, called it a "deeply real and touching story."
"As an APD I know residencies have to do more to care for our residents, especially new moms," Gowen tweeted. "I'll try to remember your story every day as I interact with our smiling residents."
Kudchadkar -- now associate professor and associate vice chair for research in anesthesiology and critical care medicine at Johns Hopkins Medicine, with appointments in pediatrics and rehab medicine as well -- said there's "no question" she's relieved that she was able to get through that time and stay in medicine.
"It is a true honor to mentor and work alongside the next generation of clinicians," she said, "and I want to be a resource as they navigate the work-life integration that is so central to satisfaction and fulfillment in medicine."