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Dr. Adam Marshall is a highly respected surgeon at Uptown General Hospital. He has been on staff for over 20 years with a spotless record. He is well-known in the community for work he does for a variety of charities and medical mission trips he has made. Dr. Marshall goes with a local group of physicians to Zambia twice a year to provide medical care and take much-needed medical supplies. Many of the Zambian patients treated on these mission trips have acquired immune deficiency syndrome (AIDS). Of course, all of the physicians take necessary precautions when treating these patients.

   During a recent mission trip, Dr. Marshall took a break to do some sightseeing. While he was out, he collapsed due to heat and dehydration and suffered a significant laceration on his arm. A local woman aided Dr. Marshall, treated his wound temporarily, and took him to the hospital for further treatment. What Dr. Marshall did not know was that the woman who assisted him had full-blown AIDS. He was so concerned about his injury that he paid no attention to the woman's hands and forearms, which had ulcerated areas that were oozing.

   The following week, the woman who treated Dr. Marshall was brought into the mission clinic for AIDS treatment. Dr. Marshall did not think much of it because there was minimal contact when the woman helped him. However, three weeks later, Dr. Marshall developed some mild flu-like symptoms and thought the worst case scenario. He confided in Dr. Singh, one of his colleagues working at the mission clinic, and explained how the woman had treated his open wound and that he was concerned about exposure. Dr. Singh did human immunodeficiency virus (HIV) testing, which confirmed that Dr. Marshall had indeed contracted the disease from the woman who had helped him.

   Dr. Marshall and Dr. Singh were close friends from their days in medical school. Because testing was done outside of the United States, the physicians did not make an official report. They had a gentleman's agreement that the incident would not be discussed in their hometown, especially at the hospital, to maintain Dr. Marshall's respected status.

   About a year later, Dr. Marshall had reported to work in the surgery department at Uptown General on a day that he had waken up not feeling well. It was not a major illness, but Dr. Marshall was experiencing some lightheadedness, so he decided it was not necessary to reschedule his cases for the day. All went well most of the morning until Dr. Marshall experienced his first ever surgical mishap. He experienced a brief period of blacking out, during which his hand slipped with the scalpel, cutting through his gloves and making a large laceration that immediately bled profusely into the patient's surgical site. The scalpel did not cause any accidental lacerations for the patient. Dr. Singh had been called in to assist by finishing the procedure and closing the patient because Dr. Marshall was taken to rest, and the remainder of his cases were rescheduled because of his feelings of illness that day.

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