When I began work on this month’s project, I contacted a clinician, a case manager, and a scientist to get their perspectives on how we’re making progress fighting HIV and AIDS. I’ve introduced you to the clinician and the case manager, but not the scientist.
Dave Wessner doesn’t actually study AIDS, but he’s written a textbook supplement on HIV and AIDS and teaches a course at Davidson College on the subject. His students have even set up a blog discussing the history and science of HIV and AIDS. He also regularly lectures on the topic. I’ll be attending one of his talks tonight. Read more »
Last November, the National Football League devoted the entire month to breast cancer awareness. Players like Reggie Bush wore pink gloves, armbands, even shoes, to promote efforts to fight the disease.
There were some heartwarming moments. Players brought their mothers, grandmothers, and other women who’d battled breast cancer to the games, all of them wearing attractive pink game-day jerseys. Announcers told their own stories of “courageous” battles against the disease waged by friends and family members.
It’s powerful and inspiring, these overpaid hulks of manhood showing they’re secure enough in their masculinity to don feminine-ish garb to support their sisters and mothers.
But try to imagine the NFL — or any sports league — launching a similar campaign to fight HIV and AIDS. Which player would trot out a brother, sister, or father who’s HIV positive? Which television announcer would proudly point to the afflicted and speak of their “inspirational” battle with HIV?
In an NPR interview last week, Theresa Skipper talked about why she concealed her HIV diagnosis for 19 years: Read more »
I first heard about the female condom in 2006. I was in Seattle to see what was happening at the Bill and Melinda Gates Foundation. One of the many impressive projects it was supporting was at PATH, a non-profit organization that was developing and promoting a new female condom. The sad, age-old reason: the health of millions of women around the world is threatened by irresponsible men. Read more »
Yesterday I introduced my friend Charles Roth. Charles was diagnosed with HIV/AIDS in 2003 and was already in bad shape. He had been tested as healthy the previous year, but the disease struck quickly, hospitalizing him for a week and keeping him out of work for a month and a half. He returned to work but repeated illnesses due to AIDS meant that by 2006, he was unable to work full-time. A bank executive, Charles still tries to find occasional contract work or odd jobs like résumé writing and tax preparation, but with the recession, these jobs are low-paying and hard to come by. For the most part he makes do with a tiny state disability check and food stamps.
So how typical is Charles’s case? We’ve all heard of success stories like Magic Johnson, who was diagnosed with HIV in 1991 and still has not developed AIDS. But clearly neither case tells the whole story. Read more »
M and M was never fun. Sometimes I would walk out feeling I’d just escaped by the skin of my teeth. Sometimes I would feel like my teeth had had too close a shave. But once…just once, it could have been worse.
It was a pretty standard call. It was very busy. In the early evening I was called to casualties for a patient with severe abdominal pain. When I examined him it was clear there was something seriously wrong inside. He had a classical acute abdomen with board like rigidity. He clearly had a perforated peptic ulcer and needed surgery. I set my house doctor to work to get him admitted and on the list. Meanwhile I went back to theater to work through the number of equally critical patients already on the list.
Things then settled down into a rhythm. I was in theater with a student operating the cases one after the other while the house doctor separated the corn from the chaff in casualties. Finally it was time to do the laparotomy for the guy with the acute abdomen. I needed to shoot through casualties before we started so I decided to swing past the ward and make sure the guy was still ok.
The ward was dark. Pretty much everyone was asleep. Without wanting to wake the other patients I turned on the small bedside light of my patient. Even in that dim light I could see a bit of oral thrush. I was surprised. I was thinking to myself how the hell did I miss that in casualties. I felt his abdomen. It was no longer quite so tender. I turned to the student.
“See why it is important to make your decision before giving opioids?” I said with an air of authority. “Now he is actually not so tender but he definitely had an acute abdomen. We must go ahead with the operation.”
I quickly felt for lymph nodes. He had them everywhere. Once again I was quietly thinking that my clinical skills must be slipping because that I also didn’t pick up in casualties. I kept this new information to myself. Imagine the shock to the student if he realised I was not all knowing. i just didn’t want to be responsible for that level of devastation in his life. But I started considering other causes for his condition. It was clear he had AIDS and TB abdomen started looking like a possibility.
While we were still with the patient, the theater personnel arrived to take him to theater. I told them to get things going so long while I quickly shot down to casualties to evaluate a patient the house doctor was unsure about. And off I went at a brisk walk.
I walked into casualties. The house doctor led me to the patient in question, but as we approached his bed my blood went cold. In the exact bed where my acute abdomen had been lying about four hours previously was my acute abdomen still lying there!! I turned and ran back to theater. Fortunately I was in time.
Later I found out what had happened. Once we had admitted the acute abdomen, the porter had come in to take him to the ward. One of the patients lying in casualties was a guy that had just come in. His HIV had wreaked havoc in his life causing a number of unpleasant things, including AIDS dementia syndrome. The exchange went something like this;
“Timothy Mokoena? Is there a Timothy Mokoena here?” the porter called out.
“Here I am, but it’s not Mokoena. It’s Magagula.”
“Ok, Timothy Magagula, I’m going to take you to the ward.”
“Ok, but it’s not Timothy. It’s Michael.”
“Ok, MichaelMagagula. Let’s go.”
And thus MichaelMagagula, the AIDS dementia patient (not to be confused with Timothy Mokoena, the acute abdomen patient), thinking he had just jumped the queue to see a doctor was carted off to the ward and prepared for theater. He even signed for a laparotomy without even having seen a doctor.
In the end it all turned out well. Timothy got his operation and the hole in his stomach was patched. Michael was referred appropriately to the physicians. But I couldn’t help wondering how this could have looked in the next M and M meeting.
“Well, prof, the patient died on the table basically because I operated him unnecessarily.”
“And how is the other patient? The one you should have operated?”
“Well, he died too because I didn’t operate him.”
200% mortality for one operation. Not easy to achieve.
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