Did she know? I sat there having just learned that doctors can at times test for HIV without the consent of a patient. You just write R.C.T. on the paper (Routine Counseling and Testing) if you suspect HIV and then bam, you know before a patient even suspects what’s going on that they are positive. I sat there knowing the news before this woman and as I studied her face and the way she was still able to laugh at the jokes of the doctor I felt sure she didn’t know. I drifted to a different place remembering my tasks and things to do, pulling out my phone I began to text Sarah to remind her to get pictures from Jean. When I looked up again the woman was tearing up. She hadn’t known. It felt so insensitive, so rude that I was texting while she found out news of a disease that will dramatically alter the rest of her life. Then I really began to observe how the doctor handled this. Routine would be the best description. At that moment she was just another patient with another problem to be dealt with. Sure, he spent more time with her explaining things to her than usual, but as usual there was no compassion.
Does treating it as another routine diagnosis make the blow any softer for the patient? Is it merely self preserving? As I tried to put myself in this woman’s place I felt like screaming. I would feel like saying doesn’t anyone understand, my whole life has changed in this moment and you’re texting on your damn phone. Won’t someone scream with me? Does anyone else feel this pain, this regret, this overwhelming suffocating fear? Instead I sat there following the routine. Doctor asked me to take her blood pressure and I was surprised as I wrapped the cuff around her arm, the cuff was much too big for her small arm. I always wonder how this affects the reading. I am happy to touch her, I am happy to be the first one to touch her after finding this out. I only wish I had control of the situation and I could be the one delivering the news, or do I? The BP was not routine though I thought I must be doing something wrong, I heard nothing up to 100, then suddenly there it was coming fast as if breaking through a dam. 95/55, why is it so low? The bad news has sent her into hypotension the doctor explains, a result of the bad news. Everything has an explanation. As I observe her more closely with the clinical eye I have begun to develop I notice the tassles on her scarf shaking ever so slightly. The scarf reminds me of Courtney, what would I do if this were Courtney? This poor woman, she has a child I gather, was it 3 or 5 years I can’t read the doctor’s handwriting. Does the child also have HIV. I think of the infant we saw just on Monday, scrawny with lots of skin lesions. Will the child live to 25? This woman will be lucky if she lives past 60, but she lives in Kosovo so probably even less time as diseases thrive in the flood waters that so often wreak havoc on that village. She is so small. Which partner gave her HIV. Was it her husband or someone else? Was it of her own will or forced upon her? Which faces flashed in her head as she found out she was positive? Did she ever imagine that her diarrhea was the result of HIV as she walked down that familiar road from Kosovo? And then it is over as soon as it began, she walks past the curtains, a face I will never see again and another patient walks in. Routine, is there ever a place for compassion in the routine?
