In the last month and a half I have met and treated two women, both newly
diagnosed with HIV and previously unaware and unsuspecting of their
corresponding diagnoses. In both cases the women contracted it from their
former husbands. I say former because one of the men died approximately one
month before his wife, patient #1, learned of her diagnosis. My other patient,
patient #2, was divorced and remarried; her current husband is HIV negative. At
the time of diagnosis, each patient had a CD4 count of less than 20 copies/mL,
and each presented with an AIDS related illness.
Despite their similar diagnostic presentations, their responses were
diametrically opposed. Although patient #1 was overflowing with anger towards
her newly deceased husband, she embraced, as best one could in such a
situation, this new reality and was eager to begin treatment and therapy.
Patient #2 left the hospital AMA only to return about 24 hours later due to
compounding complications associated with her AIDS related illness. Due to the
precarious state of her health, avoiding treatment was no longer an option.
Nonetheless patient #2's husband had to convince and coax his wife to return to
the hospital for treatment.
Over the next two weeks, while patient #2 remained in the hospital, I had to
routinely remind her that maintaining her appointment with her ID specialist
upon discharge from the hospital was paramount. At one level I understand that
returning to the routine exercises of her life outside of the hospital shielded
her from the ambiguities and uncertainties of her new diagnosis. However, as a
clinical optimist, I found her lack of engagement frustrating because an HIV
diagnosis is not a death sentence, unless a patient fails to comply with their
Now I know tomes have been written analyzing the psychology of diagnosis and
disease. I don't claim to contribute any pithy additions. I recognize that some
patients need time to process the totality of their diagnosis, however in the
case of patient #2, time was not on her side. I have found, in no uncertain
terms, that candor and consistency, rather than dogmatism and sternness, are
assistive approaches to acknowledging and treating disease.