18 May 2010

It's NOT 2 Late 4 U

Hi Brian.

I just wish to inform you that a patient of mine expired yesterday due to pneumonia that doesn't respond to antibiotics. He never sought consultation with any doctor despite bouts of easy fatigability for more than a year and on & off low grade fever for almost 6 months. He got admitted 5 days ago due to 2 weeks of persistent high grade fever and progressive cough and difficulty of breathing.

On his 2nd hospital day, symptoms got worse despite the potent antibiotics given. As I was having a doubt with persistent fever and cough, progressive labored breathing and the unusual heart size on his X-ray, I referred him to a cardiologist, whom, the same as I, thought of similar differential diagnosis pertaining to the heart and possibly, a hidden 'infection' which would worsen the present pulmonary infection, which would aggravate the already worse heart condition. We talked to the patient privately, and he admitted to having unprotected sex with multiple partners. He immediately consented to an HIV screening procedure.

On his 4th day, he worsened progressively, and fast! The screening result then came in. Two different test methods were used for more validity. Both gave the same results... POSITIVE. His blood sample is to be sent to San Lazaro Hospital for the confirmatory test the day after. However, few hours after the screening result came in, his heart suddenly stopped in a blink of an eye. He did not make it despite aggressive CPR.

Before his death, with the results still unknown to him, he told his best friend that in case the result is positive, not to tell his family, in fear of the social stigma his family would be facing. Maybe, he knows he's not gonna make it through the day. His friend also had this inclination that the patient wouldn't make it. He went home, not wanting to see his friend suffering more. He was later informed by the relatives that the patient expired 4 hours after he left.

I talked to the family and I had to tell them everything, since the patient's friend failed to inform me of his last wish, until he arrived after my lengthy talk with the family. Nevertheless, it is my professional and social responsibility to inform the immediate family members present in the hospital, to remove doubts as to the patient's demise. I told them that a confirmatory test are still to be done, although 2 different screening procedures that showed positive results almost always would show positive in a confirmatory test. The family members requested me not to tell anyone, moreso, identify the patient to others, especially about his HIV status, but even if they didn't ask it, they need not fear about it.

Since they plan to do the regular Filipino funeral service, with the embalming and everything, and their wish not to inform anyone, I advised them that it would be best to have an immediate cremation, to protect everyone who will work on the person's body. It is also to protect others by not having the body fluids go down the drainage and probably affect street Filipino children who plays in sewers and canals. You know how 'effective' the sewerage system and flood control is in Manila, right?

I really don't know why I had to write you a letter about this. Maybe because I know you understand how an potentially infected person feels, or how the family would handle the situation. Or maybe because I just want you to continue with your information campaign about the disease, and how important it is for people to have tests done, especially if they know they are at high risk. Maybe this story would help you more in making everyone aware of the hazards of the disease if left undiagnosed, and the unpreparedness of an unknowingly infected person to face the eventual outcome.

By the way, just a month ago, another young man died in the same hospital, admitted to tuberculosis, with very progressive symptoms, he was under another doctor's care. HIV screening tests were positive... as well as, the confirmatory one. He succumbed also after 4 days despite aggressive measures. I was just made aware about it a few hours after I got my patient's results. If only these young people had their tests done, they might still be living a happy and healthy life now.

Many thanks Brian.
Keep up the good work.
And please stay healthy.
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