New

One of the patients I admitted last night had a new diagnosis of HIV. He came in with nonspecific symptoms and one of the routine labs sent by the emergency department included the rapid HIV test with over 99% sensitivity (that is, <1% results are false positives). He was shocked. At San Francisco General Hospital where the incidence and prevalence of HIV is relatively high, we have a lot of resources for newly diagnosed patients. I was not there when the emergency department delivered the news, but I saw the patient afterward.

How many ways one could react to such news! He went through all the Kubler-Ross stages that night. Early, he could not believe it happened, reciting to me his avoidance of high risk activity, struggling to come to terms with this shocking news. He never really became angry, but there were moments of impulse and outburst, punctuated by severe anxiety and panic. He bargained; if only the laboratory samples had been mislabeled, how he would take care of his health. Finally, he moved into depression, a time of introspection and grieving before showing signs of starting to accept.

It was good for me to be involved in this patient's care. Although we see many patients with HIV, I'd never seen someone with a new diagnosis and facing the psychosocial burden that comes with it. It reminds us why we went into medicine, to care for people, not simply for their diseases.