The High Stakes How-To of HIV Diagnoses & Other Bombs

morse-code

 

Have heard the story of the S-4 submarine? Pretend you’re–not a medical student this time–but a diver. The year is 1927. One frosty December day, your Massachusetts Coast Guard crashes and sinks the USS S-4. Heroically, you rescue many survivors yet six remain. Any attempt to open the hull simply allows more water stealing away precious oxygen. During their final hours, you place your ear to the hull and pick up faint Morse code–is there any hope?

This question adds a layer of complexity to the already daunting task of delivering difficult diagnoses. The white coat isn’t all glitter and glitz. Us medical students feel uneasy about expectations of becoming an ingenious healer mixed with a compassionate stoic tied up in a bow of professionalism. During fake interviews, awkward feelings of inadequacy already surface– Do you mind if I… umm, touch? I mean feel… I mean examine?!? Examine… You? Nevermind, you have… Herpes. 

If destiny dictates that doctors feel funny saying what needs said, patients probably sit precariously within their own bubbles of self-inconfidence. Not everyone has a stethoscope or piece of land or a happy family for shelter. Imagine entering the chop-chop shop of an OB/GYN painted glaring white and accented with shiny metal objects. All alone. Compassionate Doc tells this story of how a pediatric patient felt:

Estranged from her grandma and father, wandering from foster home to foster home, Sarah decided to go to the clinic. An HIV test was performed. When she returned alone, the doctor simply said her results then scheduled a follow-up. It was her sixteenth birthday. He just sent her on her way. On her sixteenth birthday! For many months, months! she was scared to death and didn’t tell anyone. 

Doctors suffer from a completely opposite condition, diarrhea of the mouth. But spouting diagnoses without providing support is like pushing a non-swimmer off a ship into swirling, stormy waves without a life jacket, refusing to toss a flotation ring, then expecting spontaneous, adaptive butterfly strokes. Humans don’t evolve at that pace. We look for quality not quantity of words no matter the storm, shake up–or diagnosis.

HIV.

Hepatitis C.

Hep G, Hep B, Hep D.

CMV. HPV. Karposi. Herpes.

Depression.

Schizophrenia. Anorexia. Bulimia.

Psoriasis. Lung cancer. Obesity. Leprosy.

When the diagnosed ask is there any hope? Modern medicine should let down all its life boats. Infectious diseases are intimidating, especially if you haven’t studied them ad nauseam. But the world and web spill over with medical communities. Physicians have access random facts in their brains, hopeful resources and, 90% of the time, supportive staff.  No one has an excuse to drop a bombshell on a patient then walk away.

If bombs and storms shall break, to help shoulder the fallout becomes a distinct privilege. Compassionate Doc gave some tips for managing high stress and high water. She thinks there’s something beautiful about the physician-patient relationship, unlike any other with a husband or wife, child, neighbor, friend. Her how-to’s?

Put your personal prejudices aside.

HIV transmission rates are less than 1% and don’t have to effect spouses. No tricks to that. The government says we won’t let people die of two things: kidney failure and HIV/AIDS. Treatment is available. If you think people don’t look like they should be tested then voice that, or if you judge them based on their results–you can ruin people’s lives pulling stunts like that. 

I often place my arm around patients’ shoulders or touch one elbow or shoulder. HIV is often analogous to leprousy–people feel cut off from the world. You feel like you’re going to die alone. It’s a horrible feeling. Now if you’re in psychiatry, physical contact is a no-no. But peds? internal medicine? That’s why they call it the doctor’s touch.

Make sure you have a something in place. Even if you give patients your phone number. I have; they can call me if they need it. And they never abuse it.

Hopefully, we’ll survive medical school long enough to turn out like Compassionate Doc. When given HIV results, patients want to hear there’s always hope. A plus sign could send them huffing and puffing or sobbing and sitting or running and hiding. Of greater importance than the diagnosis, the delivery helps them take a deep breath, come to terms, and think positive.

They’re HIV/HPV/CMV/HBV/etc. positive.

 

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A Hopeful note:

Compassionate Doc does exist, did say and experience those things, and works at our medical campus dispelling the myths of HIV/AIDS.

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