Are? Or Are Not?

When Meredith returns to her seat she and Derek suspend the topic until they’re back in the car. They are sufficiently well known at the café for a sotto voce cheek-to-cheek discussion to be presumed romantic rather than highly confidential medical talk, but they can’t talk across the table without the risk of being overheard.

Back in the car, Meredith asks about their talk this morning. “You knew about Mark last night, was that why you were so weird this morning?”

“I tried to concentrate on what you had to say, but all I could think about was how this mess started, Addison sleeping with Mark. I don’t remember what I said, but I won’t be surprised if I was a jerk or made no sense. I’m sorry if it upset you. I wanted to talk to Mark before I told you. I had questions, I knew you’d have questions, I wanted to be able to answer them.”

“I wasn’t upset, it was just weird. But I’m glad I wondered about that all day rather than what I’ll wonder all night.”

“I’m glad you’re glad. I didn’t know what was the right thing to do.”

“What did you do last night after Addison called? You look really tired, did you get any sleep?”

“I spent most of the night on the computer.” Overnight Derek researched tests for HIV, the progression of HIV infection, and statistics for healthcare workers, especially surgeons, transmitting HIV to patients. HIV infection occurs in three distinct stages before it compromises the immune system and causes AIDS. In the first two weeks the virus reproduces itself quickly in the blood, and can be detected directly, by looking for the RNA of the virus. In the second phase many infected people have symptoms like those of mononucleosis or flu, and during this phase they develop antibodies to HIV, enough antibodies to detect about three months after infection. In the third phase, which normally lasts about 10 years, but can last up to 20 years, the virus is active in the lymph nodes, killing off the immune system and building up the amount of virus in the blood. Mark’s low viral load may mean he was infected recently, after Derek and Addison split up. It could also mean that Mark is more resistant than average to the virus.

If Addison was HIV positive while she was with Derek, Derek’s last exposure was about a year ago, so he will have antibodies if he is HIV positive. Derek and Meredith will take the Rapid HIV Antibody Test, which returns definitive results in under an hour. It’s expensive, but worth it.

“If I have to get tested, I don’t want to know the odds until I have the result.”

“My mind refuses to think about the odds. It just won’t do it.”

“Did you find anything about hospital staff transmitting HIV to patients?”

“It’s very, very rare. There are no documented cases of surgeons transmitting HIV. There’s one case of a surgeon and a patient who are both HIV positive, but the patient is believed to have been HIV positive before the surgery. Nurses, phlebotomists, jobs like that are more likely to become infected than to pass on an infection. HIV is far less transmittable than Hepatitis B.”

“Can genetic testing show who infected whom?”

“I think it can establish that two people have the same virus, I think there are time constraints though.”

“How was Mark? Were you so mad you were mean to him?”

“He was a basket case. He called Addison last night, met Richard and the Chief Nursing Officer this morning, and I cornered him before lunch. He looked like he’d pulled a 48-hour shift in less than 12 hours. No, I wasn’t mean to him. I can’t guarantee I won’t be mean to him if I test positive. It will be worse if I’ve infected you.”

“Does he know what the Chiefs are planning to do?”

“As of this morning they were thinking of a year-long clinical study of all staff at risk for needle sticks and other forms of patient-to-staff contamination. This kind of study is not out of the ordinary, but it will take a couple of days to get all the test kits and a plausible protocol in place. Margaret is dealing privately with the women who really have cause for concern.” Margaret Spellinger is the Chief Nursing Officer. “The study will provide cover to the women he’s slept with and probably uncover other people who are HIV positive. The CDC estimates about 25 of infected people don’t know they’re infected.”

“No wonder she gave Mark hell. What an awful thing to have to do.”

“If Mark tells them they’ll focus on the personal aspect, not the medical. The rumor mill will start grinding and ruin the hospital. The general public doesn’t know – hell, I didn’t know – how extremely rare transmission is in a hospital. People remember the dentist with AIDS who infected people in the early 90’s.”

“So the hospital and patients aren’t really at risk?”

“Not real risk, but perceived risk hurts just as much as real risk.”

“Just think, if you’d been Chief of Surgery this could have been your problem.”

“That’s a fun thought. Let’s go to bed.”

“Do you think you’ll sleep?”

“Might as well try.”

Meredith and Derek spend a restless night, dozing, dreaming, waking, dozing again. Neither dreams of HIV tests, they dream their standard bad dreams. In the morning the alarm wakes them, they dress silently and set off for the lab where they’ll find out if they are, or are not.

AN: Grey’s is far from a reality show, but with respect to all medical issues in “Has This Ship Sailed” I’ve tried to be accurate. Every fact in this chapter comes from one of the following sources. I’ve similarly annotated Chapter 8 (Doc and the Dock) to explain medically what happened to Meredith in the water; it absolutely cannot be construed a suicide.

Here are factual sources (this editor won’t accept html so I replaced . with (dot)

en(dot)wikipedia(dot)org/wiki/HIV#Theclinicalcourseofinfection

cdc(dot)gov/hiv/topics/testing/resources/journalarticle/pdf/rapidreview.pdf

gateway(dot)nlm(dot)nih(dot)gov/MeetingAbstracts/ma?f102199555.html

www(dot)annals(dot)org/cgi/content/full/124/2/277-b

www(dot)annals(dot)org/cgi/content/full/122/9/653