December 1994 / January 1995
Checking In: Caro Diario
by Patti Wetzel, MD
Few people can remember exactly when they were exposed to HIV, but the moment is crystal clear for Dr. Patti Wetzel. "It was a crisp, sunny, September-in-Texas Saturday morning," she says. Soon after drawing blood from one of her AIDS patients at Jon Peter Smith Hospital in Fort Worth, Wetzel jammed her hand against the needle. Now, Dr. Wetzel travels across the country speaking about HIV. She fervently rejects the notion of "innocent victim." "I know what people's biases are," she says. "I know when a group asks me to speak because of how I got HIV. And I call people on that as soon as I get to the podium." Here, drawing from journal entries, she shares with us her unique perspective on treatment as both a physician and as a person living with HIV.
September 14, 1991
I was jabbed with a needle today after drawing blood from one of my patients with AIDS. I never wanted to believe that this could happen to me -- that I could be vulnerable. I feel so anxious, frightened and angry. In my desperation I've decided to take AZT -- actually, in those first few moments after the needlestick, I felt that I couldn't get to the AZT fast enough! Funny -- I'd always thought that I wouldn't take AZT if I ever found myself in this situation. But today I felt that I couldn't turn my back on the slim chance that these little blue and white capsules might protect me.
September 24, 1991
It has been 10 days since my needle-stick and I've lost as many pounds. I feel sick all of the time -- I cannot sleep, I cannot eat and I can barely swallow the AZT capsules. I want to blame all of my symptoms on the AZT but it's impossible to separate possible side effects of the drug from my baseline anxiety related to the exposure. Nonetheless, my 10 days of treatment are up and I don't have to take another AZT capsule -- hopefully forever! It should have had an opportunity to work its magic, if it is going to work at all.
December 17, 1991
My worst nightmare has come true. I am HIV positive. I feel so numb -- how do I even begin to process this information?. This disease is what I do, not who I am.
In the past year, my CD4 count has made a steady decline from more than 700 to around 500. Dan [my physician] and I finally discussed my beginning AZT. Both of us feel uncomfortable with the downward CD4 trend and he recommended that I try AZT. I agree. God, I had hoped to never take those little capsules again. I'm not certain that I have the best attitude about the AZT -- I already feel that it failed me once -- yet once again I feel the desperation to do something targeted toward the virus! For me, for now, that's AZT.
I don't think that it is my imagination -- I'm certain that these headaches are worse than before getting infected. I even had to cancel two speaking engagements last week because I felt so rotten. It must be the AZT. A part of me wants to discontinue the drug and then I hear myself telling my patients to "give it a chance -- it may take some time to get used to the medication." How easy to give advice and how difficult to listen to it myself.
My CD4 count has fallen 100 points while taking the AZT! I just knew; I had bad vibes about the whole thing. I must admit that I've been very sporadic about my whole meds regimen this past month but now I can find no reason to continue the AZT. In addition, I'm much more neutropenic now, so it looks like my bone marrow doesn't much like this stuff either. Should I just flush the remaining pills down the toilet or push them to the back of the medicine cabinet?
I may smell like a vitamin, my urine may literally glow in the dark and I may be downing 48 pills (vitamins/minerals/herbs/antioxidants) each day, but I feel great! No more headaches! My acupuncturist says that I have rid myself of the excess heat in my body (this is good, yes?) and my therapist also notices a happier me. The HIV roller coaster seems to be smoothing out. Nearly two years into this, I'm finally feeling more -- what shall I say -- accustomed... adjusted... at peace...
The last few weeks have been pure hell -- headaches so severe I wanted to decapitate myself, a claustrophobic MRI scan whose jack-hammer-like noise was the first real competition for the pounding inside my head -- and still no real diagnosis. Is it HIV-related or not? Should I be worried? I feel like my doctor is as frustrated as I am, and I think he is hoping to silence me with Demerol and Seconal. I think I need a second opinion.
A new year, a new doctor and an old recommendation -- AZT again! Actually, I like my new physician so much that I would probably do anything he suggested (oh, to finally get how important that "fit" between physician and patient really is). Keith (my physician) felt that I should give AZT a second try at a lower dose -- 100mg a day -- to see if we can mitigate some of the side effects while still, hopefully, retaining some benefit. I do believe in the effectiveness of antiretrovirals... I do. I do. I do... yet, I'm not sure I believe in AZT for me. I always told my patients that it is so important to believe in whatever you are doing for your disease. My own dreaded advice again. Well, now with my CD4 count back in the 400s, I will give AZT one more try.
360! my CD4 count has fallen again despite (or is it because of?) the AZT. I deemed myself a complete AZT failure but Keith, always the voice of reason, suggested we try to ascertain whether I'm truly resistant to AZT -- a real possibility since the patient to whom I had been exposed had been on AZT for a while at the time of my needlestick. We have also decided to add Zovirax [acyclovir] 400mg twice a day to keep bothersome herpetic outbreaks at bay. And, finally, I will continue both the AZT and my alternative regime with the hope that it's all beneficial.
The genetic sequencing results are in, and they have proven once and for all that I am not AZT resistant! Although there has always been a part of my psyche that has been somewhere resistant to AZT, I am very pleased with the news... full steam ahead with the current regimen!
The HIV roller coaster is climbing uphill for a change! My CD4 count is now 565! I felt terrific before this but now I feel even better -- yeah, yeah, yeah, as I told my patients, it's just a number, but now it's my number! Could it be a result of adding the Zovirax or is the AZT finally doing its stuff? "What's working" is most likely a combination of everything I'm pursuing to battle my disease -- not the least of which is a remarkably supportive husband, wonderful friends, work that I love and that essential "optimistic realism" as I call it. For right now, for me, this "combination therapy" is working, and I'm not going to change a thing.
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