The Patient (June 26, 2001)

I knew as soon as I saw her sitting weakly on the bench, awaiting her appointment, that she was going to be a complex patient.

 

As she was carried into the exam room by her mother, grandmother and friend, it was evident that she couldn’t sit any longer, and that she needed an IV.  She was pale (hematocrit of 16), with yellow sunken eyes, breathing rapidly.  Her mother told me that her daughter, only 28 years old, had been sick for 4 months, and had been in private hospitals twice, but no one could help her get better.  They thought she had hepatitis, and showed me her lab results.  They only showed that she had hepatitis A in the past, but did not have an active infection currently.

 

She looked like an end stage cancer patient, dehydrated, not long for this world.  I could not see an obvious cause for the problem on physical exam.  I looked for a vein to start an IV, but had doubts.  I prayed for God’s help, found a small vein, and was able to cannulate it and begin the rehydration fluid.  

 

As I looked over our list of lab tests, checking almost everything.  I hoped this might only be an advanced untreated case of malaria, but I also checked the “HIV” line, the test for the AIDS virus.  I called the visiting medical technologist, who drew blood with skill, and hurried off to the lab to begin work.  I called two of our nurse aids in training, and instructed them on how to obtain a urine specimen, advising them to wear gloves, since the patient might have a contagious disease.

 

Many other patients were waiting, so I continued on with clinic while awaiting the results.  A while later, the lab tech knocked on the door.  His face showed some urgency.  Almost every test ordered was markedly abnormal. The HIV line was marked “Positive”.  My heart sank.  I would have rather seen her with an incurable cancer than this.  The ramifications were so far more reaching.

 

I sat down, collected my thoughts, and prayed for wisdom.

 

As I entered the room, the mother and grandmother stood up to hear what I had to say.  The patient looked up weakly, hoping for an answer.  As I spoke the word “SIDA”, the Spanish acronym for “AIDS”, her eyes turned away and filled with tears.  Her mother was emotionless, as if she already suspected so.  Her grandmother quickly sat down in shock.

 

I placed my hand on her emaciated shoulder and waited.  Finally her eyes turned back to mine, to see what else I had to say, asking the question silently “What next?”  I asked about her husband.  “Gone!”  Nothing more to say about him!  She had a daughter, one year old.  I inwardly feared for her health.  I asked if she was well.  “Yes,” she responded.  I encouraged the family to bring her to be tested.  More tears!

 

I left her alone with her family with the promise to return in a few minutes, when I had the rest of the lab results.  I gathered our clinic staff for a quick, unscheduled meeting.  I told them about the patient and the diagnosis.  I reminded them of the need for confidentiality, and of the need for infection precautions, not just with this patient, but also with every patient, since we never know who may have the disease.  We prayed together for her and her family, and for wisdom for our staff pastor who would give her spiritual counseling.

 

More lab results indicated an infection that we could treat.  Maybe we could help her improve a bit, for a while.  We started the antibiotics, and continued the rehydration fluid as the pastor talked with her.  She claimed to be a Christian, and claimed to be spiritually ready to die.  The pastor encouraged her as best he could, and prayed with her and the family.

 

After three liters of fluid, her veins were fuller, she seemed to be breathing easier, but was feverish.  We don’t have in-patient facilities yet, so we gave her some medications to take home, and helped her to the waiting pick up truck.  

 

I don’t know if I will see her alive again.  If the statistics and predictions for Latin America are correct, we will see many more like her.  We will certainly need to be involved in end of life “hospice” care.  Sick people will come to us “North Americans”, with some hope that we may be able to help them.  We can’t begin to afford the medications available easily in The States to treat AIDS.  But we can offer comfort care, possibly making the exit from this world a bit easier, and the love of Christ, hopefully pointing the way to a better eternity!

 

Dave Drozek with

 

Thoughts from Honduras