the kid next door

Yesterday, we had to tell a patient 6 months older than me that s/he (trying to keep really confidential here) had HIV.

Two days previously, I had asked this patient whether s/he used condoms during sex, and the answer was - as it almost always is - "Usually."

So there we were, the next morning, staring at the test result on the computer screen -

"Shit," I said to my resident, "I really didn't expect that."
"Me neither."

We broke the news in the afternoon, after waiting for the HIV specialist to join us. It made for odd morning prerounds for me, as I've never before kept anything that big from my patient and I'm not very good at it.

This morning, the day after the diagnosis, the patient's CD4 count came back. It was less than 200, which means that s/he actually has AIDS.

This afternoon, the syphilis and hepatitis B tests came back positive, though only for latent infection.

Our team was starting to get frustrated with delivering the bad news. The patient was obviously not doing any better. At some point, while discussing the patient's worsening prognosis (and mood) on rounds, someone on our team finally burst out, "You know, it's not our fault. This patient is the one who took the risks."

It was, of course, true. It wasn't our fault and there was nothing we could do about it, except what we were doing already.

It was also not our body or our life. We didn't have to worry about the people we may have infected, the future that suddenly became less certain, the friends and family we would have to tell.

We felt so bad for our patient -- for being young and taking risks that many people take - that we were actually angry for being left in a position where all we could do was monitor the lab results and deliver the bad news.