Penicillin desensitization

I spent Friday morning in the ICU for a penicillin desensitization. Sounds exciting, being in the ICU, but it was actually a lot of sitting around, doing nothing but talking to the patient. It takes place in the ICU so everything is there in case the patient has an allergic reaction (which is kinda expected; the reason why he needs to be desensitized is because he had a reaction in the past). Fortunately, he didn't this time. Like most things in medicine, boring is good.

Penicillin desensitization isn't something that's done all that much anymore, because there are so many other antibiotics that can be used for infections; however, for some infections, such as syphilis, penicillin is by far the best choice, so if you have a patient with a penicillin allergy, you desensitize them in the ICU and give them penicillin.

The way desensitization works is that after everything is set up in the ICU (EpiPen in the room, etc), you start with a very, very small dose, and then if everything goes well, there are eight more injections with increasing doses, separated by twenty minutes. The whole thing takes almost three hours (160 minutes), and then you keep the patient in the ICU for another hour or two after the last dose (which is a full treatment-sized dose) to continue to monitor for allergic reactions. So there's something to do (which takes two minutes) every twenty minutes, and the rest of the time is spent waiting and watching and chatting with the patient (and watching ESPN, because that's what people do during March Madness).

We spent most of the time talking about careers, of all things. The patient is a lieutenant in Navy intelligence, working in MTAC (yes, the real MTAC... it is not a fictional creation of NCIS). His orders are up in January 2011, so we talked about what he wants to do next. Since he's going to be up for promotion to lieutenant commander by then, he wants to deploy to Iraq or Afghanistan (outside of the medical corps, there are boxes that need to be checked for promotions); the problem is, he's HIV positive and therefore not sea-worthy (we say 'non-deployable' in the Army). You can remain on active duty with HIV, and like all medical information, that status is classified medical information, but when it's time for promotion boards, the question does get raised about lack of overseas duty. Fortunately for the patient, he did deploy and have sea time before he became HIV positive, so that shouldn't be an issue for this promotion board, but he does know that he won't make commander, so he's planning on getting out at his twenty-year mark, which is in seven years.

In all, chatting with a patient while doing absolutely nothing isn't a bad way to have to spend a morning. And then I spent the afternoon being enrolled as a healthy control in an asthma study, so it was a very low-key Friday. The hardest part about the whole day was getting skin tested for allergies (I'm apparently allergic to birch and cottonwood pollen; who knew?). As my surgeon friends tell me, this shouldn't even be allowed to be considered an internship, because I hardly ever have to do any work.