poured out before bed
“With the controlling medications we have today, the life expectancy for someone with HIV is actually longer than for most people with diabetes… And the infectious disease people here are really very wonderful. I think you would like Dr. Jones.” I look at the three “No Show for Appointment” notes in the EMR, all three designating Mr. Smith’s refusal to attend the HIV clinic, to see if any reason had been given, if Mr. Smith had ever called with an explanation.
“Can you tell me why you’ve not been able to make it to your appointments with Dr. Jones?”
Mr. Smith looks me straight in the eye, his face painfully pleasant.
“That doesn’t really apply to me.”
“What do you mean, Mr. Smith?”
Still he looks at me, in a sort of blank, comfortable defiance.
“I read on the internet that there are a lot of false positive tests for HIV. That kind of stuff always happens to me. I’m pretty sure I don’t have it.”
“You’re correct that there are sometimes false positives on the screening test for HIV. But after we get a positive on the screening test – we call it a screening ELISA – we run a confirmatory test, a test that is much more specific for HIV. That confirmatory test – we call it a western blot – was run on your blood sample as well. And it was positive. Also, we have measured the actual virus in your blood. I wish I could tell you that there was some doubt about your diagnosis, but I’m afraid you do have the HIV virus.”
Mr. Smith shakes his head.
“I’ve thought about it a lot, and I know better. It can’t be true. I’ve made up my mind. And I don’t want to talk about it.”
I look at this calm 20-something before me, feel the denial packed in about him like a shielding bubble, consider his quickly rising viral load, and mark in myself a slowly rising panic about his future.
“Mr. Smith, thank you for being honest with me about your feelings. But I need to be honest with you about – “
“I SAID I didn’t want to talk about it.”
His hands are drawn into hard fists, his face is alive for the first time in our interaction. But in an instant he relaxes, his countenance again complacent.
“I’d like to talk about my shoulder. It’s been sore the last few months. I think I did something to it during our last softball game.”