Friday, December 08, 2006


interstice \in-TUR-stuhs\, noun;
plural interstices \in-TUR-stuh-seez; -suhz\:
1. A space between things or parts, especially a space between things closely set; a narrow chink; a crack; a crevice; an interval.
2. An interval of time.

Today is a Friday at home. While the ostensible reason for not working is my dog's recovery from knee surgery yesterday, this is also a chance for me to take yet another breath amidst the maelstrom that can be the workweek.

Earlier this week, I described a patient with AIDS who has dementia of unknown origin. Luckily, he came to his appointment at the clinic with our Infectious Disease specialist after leaving the hospital "AMA" (against medical advice) twice in one day. Aided and abetted by his family, this demented man in need of an extensive workup was back in the community where he should not have been until we had made some treatment decisions. With great skill, the whole team managed to convince him to be readmitted to the hospital---where he is safely ensconced as I write. A collective sigh of relief can be heard, despite the fact that we still have no known cause for his symptoms.

Another patient has spun out of control again. I have taken her off of her AIDS medications since she just can't manage to take them correctly, if at all. She's living on a knife's edge and she knows it. Will her school-age children live through their teen years with or without their mother? What hope is there for them?

Still another patient will simply not even talk to me about why he isn't taking his meds. He knows that his options for HIV treatment are dwindling, yet he continues to throw it all out the window, even as his wife is a model patient and takes her meds like clockwork.

Yet another person has taken his recent hospitalization and illness as a sign from God that he now has a second chance. He has rededicated himself to his medications, his health, and his survival, especially in light of his granddaughter with whom he is totally enamoured.

It's hard to care so much. Some patients engender such concern, while others engender quiet indifference, or at least a feeling like indifference. I guess we all have patients whom we would rather avoid, those who drain our energy and come across like psychic vampires, bottomless pits of unmet need. This may seem harsh, but down in the trenches it's a fact of life. There are some patients for whom we will move Heaven and Earth, and some for whom we are simply not disposed to go above and beyond. Motivation and the assuming of responsibility on their part has an enormous impact on how we finesse that dance.

Anyway, it's time for some cuddle time with my little Tina, who moans in distress beneath the table. She's not the easiest of patients, but she makes up for it in so many ways. Her wish is my command.......

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