World AIDS Day

At the clinic today, a slide show depicting dozens of people who have died in the last twenty years of battling AIDS in our neighborhood was the close of the day's work. Patients and staff gathered together over snacks, pizza, and soda, acknowledging the day, what it represents, how far we've come, and how far we still have to go. The fact that someone is infected every eight seconds is no comfort.

Just this afternoon, one of my itinerant patients surfaced. I have been trying to keep her on antiretrovirals for several years. I took over her case from a nurse practitioner who left our practice for a new life in the Southwest. When we discussed this woman, my colleague said, "She's a lost cause." Perhaps she was, but I took her at face value and invested in the relationship.

Several years earlier, my former colleague and the patient's primary doctor had visited this woman at home and said goodbye, the patient's liver finally giving out from the effects of AIDS meds, a common occurence for meds that can burn up the liver. For some reason, that ravaged organ decided to have another go at life, and she bounced back from the brink of death.

So here I was today, faced with this woman who has been on and off of crack and heroin, her school-age kids in and out of protective service, and her young adult daughter trying to hold it together for the family even as she struggles with mental illness and drug-addicted parents.

The focus of the brief visit was explaining that we would stop the antiretrovirals. "Why?" she asked. "I need those meds more than anything else!" I have explained to her countless times that it's better to stop the meds altogether than to take them poorly. She looked at me and nodded, but I registered her discontent. I handed her a seven-day medication box prefilled with everything but her antiretrovirals, and sent her and her daughter on their way, admonishing them that I expect a phone call in six days to schedule the next med prefill. "Gracias, Keith!" they yell on the way out the door.

As I watched the slide show, I imagined that I saw this particular woman's face flash across the screen as the background music swelled, Sarah McLachlan crooning "I will remember you." She may not be up on that screen this year, but eventually she'll be added to that lengthening roster of losses. Tears will be shed, and her children will be alone without her.

How many more lives are also on the brink in a similar manner? We'll save quite a few, but there are always those who we just can't keep afloat. That said, our lifeboat has plenty of room, and I'll keep pulling on those oars until I no longer can sustain the effort.

I will remember you.