Wednesday, August 10, 2005

Mixed Bag

As always, work is certainly a mixed bag these days. On the one hand, I had the wonderful experience the other day of reminding a patient that he has now achieved five years of having his HIV fully suppressed with no detectable virus in his blood (based on the most up-to-date assay that we have, anyway). His determination and desire to be healthy have kept him on the right road and now he is reaping the benefits. I explained to him how we can now view his HIV like his diabetes---a chronic illness controlled with medications and a positive lifestyle, with the goal of avoiding as many long-term complications as we can. As more and more people with HIV age, we will begin to see the data regarding how they fare as their bodies begin to go through the ageing process. We still don't know for certain how infected people of very advanced age will do in the long term, but it looks like we may have a chance to find out over the next few decades.

On the other hand, there are patients who never quite "get on the bus" and we track the slow and inexorable progress towards their eventual demise. There's not much to do in many of these cases except to be there when they crash. Then there are others who simply have lives too dysfunctional to fix, patterns of behavior and learned helplessness just too entreched. It is some of these individuals who can make a workday miserable.

Aside from the patients themselves, paperwork, organizational issues, the healthcare system itself, and other factors all combine to make the providing of quality care a challenge. Not everyone has the same work ethic, not everyone cares as much. And when money is the bottom line, everyone suffers.

Yesterday, we heard that an amazing doctor specializing in HIV in our community died of a heart attack while swimming from one island in Maine to another to raise money for an AIDS-related organization. Her loss is a shock to the community, especially since we lost another local HIV expert to suicide two years ago. When the healers die, those who rely upon them are stopped in their tracks. How many people see their doctors as something other than mortal and fallible?

Next week I have the entire week off to celebrate my birthday (41!) and soak in some of the final days of the summer before Labor Day heralds the beginning of school and that September feeling of renewal and change. In many ways I look forward to the autumn: the crisp air, wearing a jacket on the cool mornings, getting back to teaching on Thursday nights as the summer wanes and the leaves begin their transition. The end of August also heralds the beginning of the big harvest time when the abundance of autumn graces the land. As always, there is much to look forward to and cherish, and the mixed bag is just a fact of life on this awkward and lovely physical plane.
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