Just one day after I wrote my last post about people still dying from AIDS, I had a surprise visit from one of my erstwhile patients. She’s a HIV-positive woman who has struggled with substance abuse for most of her life. The last time I saw her in clinic was a year ago. Her last appointment with the infectious disease specialist was 18 months ago. From what she tells me, she stopped taking her HIV meds 6 months ago–although I suspect she might have stopped a while before that. She came in because the pain in her throat had become too much to bear. When she opened her mouth for the exam, I wanted to weep. Her throat was covered with thrush, and the pain in her throat and chest indicated that she had developed esophageal candidiasis. She lost 40lbs in the past year. I drew some labs, and today I got the results. Her CD4 count is less than 10. Mine is probably 800. It’s like she’s a walking illustration to my point that HIV meds only work when you can actually stick to the regimen. Somehow it doesn’t feel good to be vindicated.
One of the things that keeps me going at work is a sort of cynical optimism. I don’t think she’s going to survive much longer. But that didn’t stop me from thanking her for coming in, starting her on anti-fungals and antibiotics and making plans for follow up. As long as she’s alive, I can keep trying…as long as she does.