My patients get the final word on their HIV treatment. Once we’vediscussed the options, the plan they commit to is the one that willwork best. Rarely, I feel someone is making risky choices. Then officevisits can get heated.

 “Miriam,” 52 and positive sincethe ’80s, has a strength and serenity derived partly from her churchwork. For years she was undetectable. But then she had gynecologicsurgery with complications, then back surgery, liver disease—andfinally an infection, likely resulting from the hospital stays. Notsurprisingly, all this seemed to alter her feelings about workingwithin the medical system. She decided to try herbs and prayer insteadof 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.

Miriamalso had pains that were hard to treat, but she rejected 90% of mysuggestions. One day, my patience snapped. “Maybe we should find youanother doctor.”

“No, I really want you,” she said. “Let’s keep trying.”

Asher 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’swaiting again, not choosing another. But she agrees to keep an openmind, and so will I. At her last visit, I said, “All I can do is behere when you are ready.”