Saturday, September 19, 2009

The Many Faces of AIDS, part 1

Notice: this series of posts will highlight the personal side of one of our country's major health problems. Please note that these are in NO way portraying real people, but are a combination of my experiences. If you think you recognize someone, you are wrong, these are not real stories.

She was wasted, emaciated, almost nothing on the stretcher. Friends, family members all piled at the bedside, all concerned about her. They had pictures from a month, a year, several years ago. All these portrayed quite a different picture: laughing, dancing, normal weight, friends and family all around.
Today, she was crying, covered in sores, odd lumps present here and there. She said that her family had brought her in "because they are all worried about me". History was hard, if not impossible to obtain with all of them around. The family painted a picture of declining appetite, declining weight, declining energy, "she just seems sick all the time".
I asked for a little privacy so I could get a urine sample. The family willingly filed out to the waiting room while making it clear that they would be back, they weren't abandoning her. Once gone, she dissolved into tears.
In bits and pieces the story came out, she was born in poverty in the inner city. While attempting to earn a college education she had run out of money. Her minimum wage job wasn't paying enough to allow her to finish school. There just weren't enough hours in the day for her to work enough to pay for school. So, she turned to what she knew would make her a little more money. She stated it started out slowly, but quickly it trapped her. Selling her body became more and more easy, and made more money. She finally made enough money to finish those last 2 years of school. She graduated top of her class, with a degree that ensured she would never have to stoop that low again.
She left that city, went to another one, got a good, well-paying job. She never turned to the streets again, thought she was done with that shameful period in her life. But, the deed had been done, and there was no avoiding the consequences. After a time, she moved back to her hometown and continued to work at her new profession. She had money, friends, influence, and even a new boyfriend.
But then, the weight loss started, the frequent infections. She knew that her old life was coming back to bite her, but didn't know how to tell her family and friends. She was scared of what they would think of her stooping so low for those 2 years. So, she avoided the issue. She told them she was getting back into shape, that the cross-country move was to blame for her frequently being sick, anything to get the attention off of her increasing sickness.
Now, she was lying on our gurney, sick, scared, and broken hearted. She told me she knew it was AIDS, she said "I just know I caught it in those 2 years, but I don't know how to tell them". I stayed with her until the sobs quieted, and tried to offer reassurance. But deep down, there wasn't much reassurance to offer. The signs were all too obvious, and the stigma all too deep.
We ran a few blood tests to confirm what was already obvious. We arranged for her to be admitted to the hospital for the first round of medications. We helped her break the news to her family, who solemnly shook their heads and filed out of her room. We answered questions, and tried to reconcile them. Hoping, hoping that she would have someone left to support her through the ugly days ahead.
I sent her upstairs, and sent her family after her. I sent the chaplain up after them, hoping to break the cycle of social stigma. I didn't see her again for awhile.
4 weeks later, a familiar name flashes across my screen. I quickly ask to have her again, to follow up on what I had started. This time, the scene was so different. She was even sicker, but alone in the room. A small heap under the bedclothes was all that was left. She sobbed again as she told the story. The tests were indeed positive, and confirmed her worst fears. Her family and all her friends had immediately abandoned her, even her roommate had moved out while she was at work one day. She had lost her job due to being unable to work from the illness. Her boyfriend had left town and wouldn't return her calls. She was facing the horrible truth, all alone.
We saw her fairly frequently for the next few months as we tried to curb the spread of her illness, stop the insidious slide toward the grave. She was always alone, scared, trying to find her footing alone in the world.
About 8 months after that first day, we got an EMS call. "Unknown female, unresponsive, initially pulseless, revived after one round of CPR and a defibrillation. Now unresponsive, pulse of 100, BP 60/40, ET tube in place, 2 min ETA, blood glucose 200". For some reason, my mind flashed to her as soon as I read the report. As I readied the room and summoned the other personnel needed, I mentally reviewed her case. Sure enough, when the Paramedics rolled in, it was her. She was down to less than 70 lbs, and had obviously not been able to care for herself in sometime. EMS reported a very dirty house, and indications she had not moved from bed for some days. Nobody knew who called 911, but she was alone when EMS arrived.
We tried our best, but her fate was sealed long before she arrived. She died soon after arriving despite our best attempts. She didn't die alone, but she died without any family or friends by her bedside. The horrible grip of the viscous disease finally won.
We attempted to contact family and friends, but no one would come, no one was willing to be associated with her. We finally sent her body to the morgue, alone. The disease had won again, and social stigma had taken another victim.

1 comment:

Anonymous said...

Man, oh man...hard to believe this story was written so recently. Thank you for writing this.