My patients get the final word on their HIV treatment. Once we’ve
discussed the options, the plan they commit to is the one that will
work best. Rarely, I feel someone is making risky choices. Then office
visits can get heated.
“Miriam,” 52 and positive since
the ’80s, has a strength and serenity derived partly from her church
work. For years she was undetectable. But then she had gynecologic
surgery with complications, then back surgery, liver disease—and
finally an infection, likely resulting from the hospital stays. Not
surprisingly, all this seemed to alter her feelings about working
within the medical system. She decided to try herbs and prayer instead
of HAART. I fretted and argued as her T cells dropped—300, 200, 100.
“It will all be OK,” she would say, “I put my faith in God.”
“Don’t you think God put doctors here for something?” I would plead.
also had pains that were hard to treat, but she rejected 90% of my
suggestions. One day, my patience snapped. “Maybe we should find you
“No, I really want you,” she said. “Let’s keep trying.”
her T cells hit 49, she agreed to try a new regimen. Wouldn’t you know?
She got a rash and had to stop. The combo raised her T cells, and she’s
waiting again, not choosing another. But she agrees to keep an open
mind, and so will I. At her last visit, I said, “All I can do is be
here when you are ready.”