Saturday, February 05, 2005

The Saga of Patient X (cont'd)

For those of you who've been following the story of "X", my patient with alcoholic hepatitis, this is an update, of sorts. For those new to this site, you may wish to refer to several earlier posts, namely "Exhaustion" and "Recovery".

Last Monday morning, I paid a visit to X, who was, as I surmised he would be, hanging out at the bar which is his ersatz home, as it were, apart from his apartment which I've yet had the opportunity to visit. That said, I must say that he actually works at said bar and hall---cleaning, organizing, washing dishes, and otherwise pitching in for a small wage. It keeps him busy, off the streets, and allows him to earn a little cash which Social Security (SSDI) doesn't need to know about.

X greeted me warmly and eagerly, almost like a sheepish dog. He actually looked relatively well, his psoriasis less angry, his eyes less jaundiced. X swore that he's drinking only non-alcoholic beer (a step in the right direction, at least), eating well (apparently a chef's salad the day before), and drinking plenty of water. A cursory physical exam did indeed bear out the fact that the swelling of his legs is decreased and his blood pressure improved. The most worrisome factor now is a growing paranoia and anxiety which, thankfully, he's able to reconize and verbalize, adding that he's now eager to re-enter psychotherapy. I recommended decreasing his coffee intake from 8 or 10 cups a day to a mere two or three in the morning, in an attempt to decrease his anxiety and improve the quality of his sleep. While actions speak louder than words and many an eager patient will "yes" the well-meaning clinician to death, perhaps a renewed therapeutic relationship might solidify his tenuous and newly-found recovery, and break the pattern of poor habits which only serve to exacerbate his poor health, both physically and mentally. I take these signs at face value, and remind myself that even seven days free of alcohol is a gift that X is giving to himself. Stay tuned.

Another patient of mine who we will call "Y" had been in complete recovery, with fully suppressed HIV disease, excellent adherence to his meds, and a graduation last summer from an 18-month residential stay in a facility for Latino men with substance abuse issues. Having failed Hepatitis C treatment due to falling blood counts, Y still had shown great promise and was a model patient, quitting smoking and really cleaning up his act. After living in a lovely sober house for HIV+ men in recovery, Y disappeared last fall, ostensibly returning to Puerto Rico to see his family. He resurfaced two weeks ago, calling me on our office's 888 number from Puerto Rico, alerting me that he'd be back in town within two days. During a brief visit in the office several days later, I ascertained that he had stopped all of his meds and didn't currently have a place to live. I actually drove him to the bus station after our visit (a general no-no in my office these days), and he was planning to catch the next bus to a town 40 minutes to the east to stay with a cousin. Promising to return in two days for a clinic visit with a doctor, we parted with a hearty handshake.

Several weeks passed after he missed that appointment, and just this past Friday I received a call from a residential substance abuse treatment center in a city two hours from here, informing me that he's now residing at their facility. I requested a signed consent be faxed to me so that our two agencies could openly discuss his case, and having received that paperwork, am expecting a return telephone call soon to advance the discussion and learn the details of Y's current state.

These bumps in the road are just that---bumps---with the added caveat that for a person living with untreated AIDS and chronic Hepatitis C, recidivism back to drug use and avoidance of medical care can be exponentially harmful and worrisome. Nonetheless, when and if Y returns to my care, I'll plan to meet him where he's at, begin afresh, and walk the road with him, if he's willing to do so. Meanwhile, dozens of other greasy wheels beg for attention, and there's no shortage of needy patients for this nurse. Monday will open that office door once again, and I will surely hit the ground running, my plate fuller than it should be even before I sit back down at that cluttered desk, already littered with the flotsam and jetsam of last week's unfinished tasks. Oh my.


kris10cat said...

"He who has a why to live for can bear almost any how."
-Friedrich Nietzsche

I can understand how you wouldn't get hopes up for X yet. As impressive as it is that he is trying, it is such a long journey ahead. Having you who genuinely cares...this is the difference. A sense of purpose is something he can only find for himself. How lucky he is to have the influence of someone who already possesses his own sense of purpose who cares for him as well.

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Thanks, Kris10! It's gratifying to have you following my journey as I follow yours.