One of the bane of practicing medicine are defaulters.
Defaulters are those who either neglect to come for follow up or those who turn up but soon decides not to take their medicine; or those who take their medicine at their own whims and fancies!
Last Friday, I had all three.
Every Friday, my nurse told me that some patients have not turned up. I usually get her to call them by phone and ask why they did not turn up. It’s not always fruitful. A lot of times we couldn’t reach them, either because they have changed their contact numbers, or moved elsewhere or passed away. We never know which it is.
Last Friday I waited for a particular man to turn up. He had advance AIDS and presented in such a wasted condition that I thought he would not survive. But he did and I started him on HAART. His recovery was slow and painful. He was supposed to come for follow up last week. He didn’t show. His phone went unanswered.
And then there was this 30+ year old Malay man whom I’ve been treating for the last 6 months. When he first presented to the hospital, he was severely ill with a CD4 count of only 2 cells/dL (normal > 500). He has AIDS, Hepatitis B and C. He pulled through and was started on HAART. Four months later his CD4 climbed to 74 cells/dL and he was gaining weight.
Last Friday, his CD4 had plunged back to 6 cells/dL! When probed, he confessed that he has stopped taking his medications for the last 2 months because “he lost his prescription slip” and didn’t think to come to the hospital to get a fresh one! His face was pockmarked with what I suspect to be cutaneous fungal infection. Now I had to restart him on his medications, fervently hoping and praying that he has not developed resistance to his medications. If he does, there would be big trouble ahead.
Just as he walked out of my room, the pharmacist counselor told me that there was another man who has not taken his medications for months!
And then there was this 40+ year old Malay lady. When I first saw her almost 2 years ago, she was wheeled into my room on a stretcher. At the time she was emaciated and suffering from PCP and pulmonary tuberculosis. Her CD4 was in single digit. Her weight was merely 25 kg! Over the last 1 and half years, she made good progress. With HAART, her CD4 climbed to beyond 250 cells/dL; she remarried, put on a decent amount of weight (she is now 54 kg!) and is happy.
Then, over the last few months, her CD4 count started dropping. She swore she was taking her medications regularly. Last Friday, her CD4 count stood at 76 cells/dL. When probed repeatedly, she finally said that she has been omitting one of her medication because “she did not like the new brand that they give now because it gives her pimples!”
It’s going to be tough going with her.
I’ve been reading this book for a couple of weeks now.
It was written by Randy Shilts who chronicled the early days of HIV and AIDS in an investigative journalism sort of way. To read a sypnosis of the book, click here.
In the early days of the HIV and AIDS, which struck most prominently in the gay population in the USA, people at large, politicians, doctors and even the gay people themselves paid scant heed to what would become world wide scourge. The people and politicians did not want to be associated with a ‘gay disease’; doctors were in denial and those who weren’t were ridiculed. Gay people did not want to acknowledge the disease as it would hurt their movement and the ‘freedom’ they had fought so hard for. As a result, they were slow to catch on to an epidemic spinning out of control.
Today, everyone knows what are HIV and AIDS. Everyone knows how it is transmitted. Everyone knows it can be treated if not cured.
But not everyone knows this…
I believe we are heading for another disaster. There will be an epidemic of defaulters and this would bring us back to the early days of HIV and AIDS.
The only difference is, this time, we will have a lot less options.
I made a remark to the pharmacist counselor when she informed me of the defaulter. I said: “Some times, I don’t know why we are trying so hard to treat them”.
It was not said out of malice. It was said out of frustration and despair. After 25 years or so, we are no nearer to a cure.
For who would want to spend a life time taking medications just to stay healthy?
Wed, 261108 @ 0700