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ramblings of an unknown psychiatrist

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” I could not tell him that he is HIV positive for two weeks ! “

Posted by Dheeraj Kattula on May 3, 2009

He was young and suave.  Like many educated metro-Indians, he spoke English more fluently than his mother tongue. I could see bandages around his wrists, which he tried to cover with a full sleeves shirt. His grandpa arranged his appointment a day before. He wanted to share things regarding the grandson in private. He did not want to reveal ‘personal’ things in front of the grandson to avoid embarrassment for everyone.redribbon

Basically his grandson had become a ‘drug addict’ and was using intravenous drugs. He was not seen in his college or the neighbourhood for a couple of days, when someone intimated the grandpa. His grandpa rushed to his college immediately on a taxi. The patient was found lying unconscious in his room. He was ALIVE! He was taken to a nearby hospital and was treated for sepsis with intravenous antibiotics. He had developed a major infection. All the points from which he had shot drugs were swollen and were oozing pus.

The patient’s only concern was to find out if he had to continue antibiotics or not. We could connect well. He was young , English speaking gentleman, who felt no one is interested in him and I was a person interested in all aspects of his life if not personally at least professionally :-).  I asked him to do a couple of blood tests. He readily agreed. I asked the lab technician to also do the HIV test. I had reasons to suspect a immuno-compromised state in him and also had the responsibility to protect our staff involved in his care.

I did not do the pre-test counseling or tell him about which tests were done. Reason- I did not want to rake up a emotionally disturbing issue in the beginning of a therapeutic relationship. I thought once I develop rapport and stabilized him, I would bring the topic, re-do the test and then declare the result to him.

Following this, I had a couple of sessions with him. His childhood experiences, his brought up under his mother after a painful divorce from the father, his troubled school life, his grief when his mother was diagnosed of cancer, bereavement  when she died, his lost love during college years, his one night stands and his encounters with the ‘drugs’. He was a talented man. He had a scrap-book full of songs he had written during intoxicated states. They resembled the songs written by rock stars. They lyrics were full of emotion, even if devoid of rhyme and reason 🙂

I had few sessions with his grand father too. He was an old man of about 75 years. His wife had died when he was relatively young. He brought up three children. The eldest was a nurse, mother of the patient. She had a troubled marriage with an alcoholic man. She found peace in divorce. She brought up her son all alone and sent him to a metro city for his graduate level education. She was diagnosed of cancer and subsequently died.  The old man had a paraplegic son who was dependent on him. The third child was a responsible one, who was single and worked in another part of the country. Grandpa had a comfortable pension, which was in addition to the pension the patient received. Their family income exceeded the salary of a consultant doctor of the hospital!

He came on a regular basis for two weeks. In the third week, I mustered courage to tell what had to be inevitably told.

I asked him,” What do you know about HIV?”

‘A bad disease.’

“How do you think it spreads?”

‘When a person is not careful during…’

“Ok” ,I added “also a child can get it from a HIV +ve mother during birth and people who share needles when they take drugs”. I could see anxiety in his eyes.

“Is there a possibility that you could get HIV?”

‘No, I cant get it.’

“I am saying if there is a slight possibility, as you have said already that…”

‘Yes, possible.’

“Would you like us to test you for it? The result would be between you and us. That is all”

‘Ok. Where can I do it?’

” Here itself. You can give a blood sample  now. We will tell you the result tomorrow. That should be Ok. Can you tell me what would you do, if you were positive?”

with a smile,  he said”Just live till I die.”

“I have some good news for you. Nowadays with newer medicines life expectancy in nearly equal to not having the disease if the person who is HIV +ve takes regular medicines. If you are +ve would you take these medicines?”

‘Sure, sir. Where will I get them?’

“Let us first do the test.Ok?”

Test was done. I already knew the report.

“What do you think is the result?”

long pause.

I nodded my head slowly. He understood. He did not mind me sharing this with grandpa.

” What should we do now?” they asked.

I told them all the details I had gathered from CMC, Vellore’s Department of Medicine ( and Infectious Disease ). They planned to go to the nearest centre for T4 cell counts within a week. I never saw them since then. Our staff told me that they had come, when I was on vacation. It seems he was looking much better nourished. Thank God, he is still alive…

I still wonder, why is it that I did not ‘break bad news’ for two weeks!!! It looks so simple now 🙂 Was it my own anxiety that he being unstable, might do something drastic like commit suicide or less lethal step of relapsing into drug use? Was it my psychological voyeurism to understand a ‘case’ with multiple problems from many dimensions?  Was it my fear to loose a psychotherapy client due to distress caused by a medical diagnosis? Was it me buying time to get the best information possible for his further management?

I do not know and might never know my own fears and motivations… I went by ‘gut’ and probably, was right. I feel timing was right in breaking bad news in this case. The reason is that the manner in which it happened and it’s outcome was smooth, predictable and under control.

Why did they then stop following up??? !!! I do not know, and I have no guesses. I hope that he is following up in the center which gives them Anti- Retro-viral Drugs and that they a managing his psychological and substance abuse related problems.

What do you think?


2 Responses to “” I could not tell him that he is HIV positive for two weeks ! “”

  1. 7L 7L said

    that was wonderfully handled. very sensitively done. 🙂

    this post was done a year ago. but a year ago i wouldn’t have understood the full context of it.

    • Dheeraj Kattula said

      Thanks 7L. The last I heard of this gentleman, he was off all illicit drugs and was on regular treatment from a higher center.

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