The Reality of AIDS

When patients come into the clinic for testing, I like to ask them what they know about HIV. If they realize HIV and AIDS are not the same thing (for those interested, HIV is the virus, which can stay in your system quietly for a long time, and AIDS is, last I looked, defined as a syndrome occurring after you have two or more opportunistic infections). I tell them that at least 75% of the patients in the clinic have HIV, but do not have AIDS. Sure, a few of them present with thrush, or pneumonia, or candidia, or something like it. I am sure a few would qualify as having AIDS, but not so that you'd notice. AIDS the way I had read about it, from doctors working at the beginning of the epidemic, was never real to me. At least not until this week.

The first patient is one whose story I had been a part of since probably early December. I knew his wife first, because I had been there when she was admitted to the ward and visited her and fought for her while she was there. When they came in together after both were discharged, she was fighting for breath and stressed, and he had to be carried in. All he said to me was "I remember your voice." They came in three weeks ago too, and that was when I nearly burst into tears to see her smiling and he walking nearly on his own. And then last week, his wife came back, with symptoms mirroring a heart attack (if I didn't know her better...but I know that she manifests intense stress that way), half sobbing, a wild look in her eyes. Her husband was back in the ward, a lot worse off than she thought. After working for an hour to calm her down and convince her to take her tablets and try to eat something, I promised to visit him. Monday, he looked terrible. My unpracticed medical mind thought it could be a coma. He was completely unresponsive. I took his hand and got nothing. His eyes were closed. Nothing seemed to know I was there, and yet...it may have just been a twitch, but I feel like he knew my hand was missing when I took it away. Still, I was shaken--enough that I came back on my way in Tuesday, just to be sure he was still alive (I was encouraged--his eyes were open, though his cheeks still twitched and his jaw gyrated). The doctor thought toxoplasmosis, but I felt he had a stroke--even now he still cannot move half his body. Both are common in AIDS. By the end of the week, his eyes were open, his mouth had closed (though still revealing a few decaying teeth). He was trying to form words, but couldn't quite. When I took his hand though, he would hold it tight, reluctant to let it go. Like I and his family were his only lifelines into hope and the world.

The other patient came into clinic just after the blood rush ended on Wednesday. I was the first to see him and greet him, asking him in my usual cheerful way, "How are you?" His reply was "sick," and when I asked why, the first reason he gave was the virus, and then he described his chest pain and general malaise. He sat to wait for the doctor. He complained of his temples being sunk in. When I asked him when he last ate, he said three days ago, and when I rubbed his back later, I could feel every vertebral protrusion and every rib. Brenda in the clinic helped me find some food to give him, and we also gave him some juice, which he promptly and loudly threw up (making me fight my fear, which I did reasonably successfully). While he waited, he moaned loudly and wondered why he was being ignored (I wondered the same thing). Ultimately, he was admitted and his admission sheet read like a classic AIDS symptom list: night sweats, fever, thrush, etc. I worried about him, but when I saw him the next day, his spirits were good. He was eating, hopeful, making plans for the future and seemed determined to live. I think he was simply starved for human kindness as well as food, and being around people who cared made all the difference. He was discharged, and I have not seen him since. I hope and pray he makes good on his word.

These two men were the first two cases of full-blown AIDS that really jumped out at me. I was re-reading a memoir of an AIDS doctor, and seeing cases he described in patients at the clinic. I knew it was coming, and am grateful for the opportunity to see AIDS and to learn how to deal with it. I am still working on the dealing with it part, but I am praying a lot and so blessed to have some very good friends here.

I wish you blessings, and challenges, and beauty in the midst of it all. Thanks for listening :)