Wednesday, April 25, 2007

The Never-Ending Story

"What usually keeps you from taking your HIV meds?" the doctor asks. We sit looking at her.

"When I start using drugs again," she says, unblinking, holding my gaze.

"And how can we figure out when it's time to try again? Do you feel like you might be getting ready to give it another chance?" The doctor and I exchange glances.

"Oh yes, I'm ready. If you want to try, I want to do it. I know it's important."

I know she's sincere, but we've been here so many times. Once, she almost died from liver failure from her meds, a negative side effect of adherence. Another time she had toxoplasmosis (a brain infection) so bad she had a seizure, and that was because she wasn't taking her meds. Talk about a double-edged sword.

The doctor gives her the rest of the spiel. "You understand that without the prophylactic meds, you could get very sick or die from an opportunistic infection. If we can get you back on HIV medication, those infections are no longer a worry. But you have to stay clean and on the meds."

She's a very sweet person, and we've worked together for six years. I think we really admire one another. I've brought her kids Christmas presents. I bought her an alarm clock so that she would wake up in time to get her kids up for school since they were truant more than 100 days last year. I think she sold the alarm clock. She also sold her grown daughter's TV and DVD collection.

The doctor asks some more questions.

"Do you have a partner, spouse, or husband?"

"Yes, my husband."

"Does he know your diagnosis of HIV?"

"Of course, yes."

"Do you use condoms when you have sex?"

"No, never. He doesn't like them." She looks gravely at the doctor.

I chime in. "So, even though he knows he's at great risk of infection with HIV, he won't protect himself?"

"We've been together so long---more than twenty years. That's the way he is."

"Has he been tested?" the doctor asks.

"He won't," she says. "He doesn't even go to the doctor."

We end the interview and send her to the lab for the bloodwork. Sitting down with the doctor who is a second-year resident doing his Infectious Disease rotation, we begin discussing the case with his preceptor, an Infectious Disease Fellow at the hospital.

The preceptor says, "Haven't I heard this story a thousand times before? Cocaine, unprotected sex, avoidable opportunistic infections, virus out of control?"

"Probably ten thousand times," I say. "It's the never-ending story."

And so it goes.
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