26 June 2008

wait... WHAT?!

So, how is this voluntary, if it is mandatory?  Am I missing something here?  

Apparently, in the next three years, every adult in the Bronx, will be required to take an HIV test... voluntarily.  

Let me tell you a couple of things.  More than fifty (yes, 50) per cent of the Bronx is Hispanic (with the largest Dominican and Puerto Rican population in the United States).  In fact, there are many areas in the Bronx where not a lick of English is spoken.  People are not going to be interested in getting HIV tests.  They wait too long to get treatment for HIV for the same reason that they wait too long to get treatment for breast cancer, or any other such disease.  Trust me, I did my fellowship in the Bronx.  These people are not stupid, nor illiterate; they are simply IN DENIAL.  

These are the kind of people where instant gratification is in its exact meaning.  Mobile phones, bling, labels on clothes are much more valuable than the spots on their skin or their rotting teeth or that lump on the breast that now is eroding through their skin.  They do NOTHING until it hurts.  And, well, let's face it--HIV does not hurt, not until it is too late, same with breast carcinoma, or any other carcinoma.  

Now, let me tell you a more personal story:  When I was in my fourth year of surgical residency, there was a certain (ehem) gentleman in our SICU s/p trauma.  The trauma consisted of a 3 AM "But I was just on my way to church, and was jumped by some dudes" sort.  Now you are getting the picture.  So, now, this dude is vented in my SICU and I need to place a line and, sure enough... I stick myself.  We know NOTHING about his HIV status.  

I call my attending.  "No big deal (!), just talk to the wife (he had one), draw the test, and we'll get a result by the morning."  "Got it."  The wife was overly willing to help--very sweet.  I go to the bedside to draw blood, and my right arm is seized by a nurse.  "What are you doing?"  She growled at me.  I explained the situation to her.  I had a great rapport with all of the nurses, so I couldn't figure out what the problem was.  

Well, apparently, the New York City laws are such that ONLY the patient can say OK to an HIV test.  And this kind RN is just trying to protect the patient.  It doesn't matter that he is on a vent and on a drip--SEDATED--so that he doesn't rip all of his lines, etc out.  She is "just looking out for the patient's rights" she says to me with a sweet smile on her face.  

This actually went to the hospital's ethics committee, and they could do nothing.  The only consolation that I had was that we could draw a hep B titer, which came back fine.  And, in theory, if that is negative, well then, he shouldn't have HIV.  But, can you really deal with shouldn't when you have your WHOLE LIFE to live, your entire career ahead of you--in SURGERY, of all things?!  I ended up taking a full course of HIV meds, and being sick for 3 months.  When the "dude" finally came to, he took the test and (thank God, but also, of course) tested negative.  


DrB said...

wonder of all wonders... It's National HIV Testing Day today (the 27th). Just a point of interest.

Chrysalis Angel said...

I know our state is very strict about the patient's rights, but I do feel the caregivers have a right to know what they are dealing with, especially in a situation such as yours was.

DrB said...

Yes, and still-this went to the hospital ethics committee and could not be touched. NY laws are very strict when it comes to patient rights. Once set, that's it--especially dealing with the "sensitive" issue of HIV. Shoot me, but I think of this as a disease like any other! Unfortunately, it has become such a social issue, that it is not *just* a disease.

Chrysalis Angel said...

You are so right.

It makes me think of the differences in the way the different cancers are responded to by medical personnel as well. Sad, but true...People with lung cancer are asked right off if they smoked - like well, there you go...but breast cancer, where we still really don't have a clear indication of what contributes to it, you are treated differently to some degree. You are "innocent" of what has befallen you, seems to come across. I can remember thinking how awful it must feel for those that did smoke, and were diagnosed with lung cancer. There is already enough self recrimination. We all (cancer pts.) think back and wonder - what is it I could have done?

It is bad enough to have something so horrible, but to attach a judgment to it, compounds those issues for the patients involved. HIV unfortunately is one that has a potential to kill the caregiver as well. I really think NY needs to revise their stance and protect both patient and caregiver.

I really like your blog. I'm glad to have come across you. I would like to put you on my blog roll if you don't mind. If you do, please contact me and I'll remove it.

Jeffrey said...

glad you're alright now. needle stick injuries are pretty common and my coursemate just got one this semester.

i'm enjoying your blog. Dr Ramona from Suture for a Living just submitted one of your posts for SurgeXperiences which will be hosted at my blog this Sunday.

SurgeXperiences (http://surgexperiences.wordpress.com) is a biweekly surgical blog carnival that collects the best surgical-related posts around. Pay us a visit and submit a post or 2 some time. :)

Bongi said...

recently i stuck myself with a needle in closing a known hiv positive patient. i took my antiretrovirals and then needed to be tested post treatment. i live in a small town and if i got tested there, if it turned out positive, before long the whole hospital would know my status. this would be a serious professional problem. who wants to go to a positive surgeon. luckily when i had it done incognito, it was negative, so i'm still ok.

the point is, i agree with anyone who refuses to be forced to be tested. i'm all for testing, but i'm not for someone telling people to be tested.

by the way, ramona allerted me to this blog. welcome to the medical blogosphere.

DrB said...

I assume that you are referring to the first part of this post. And I agree. It is ridiculous to make something "mandatory, but voluntary," especially something with as much social stigma attached to it as HIV testing. Trust me, I know exactly what you mean. Regardless of the size of your town (mine being NYC), the HOSPITAL in which you work suddenly becomes even smaller if you decide to get (or must be, in my case ) tested there.

make mine trauma said...

Welcome to the blogosphere. Found you from a comment you left for Bongi. There can never be too many surgery blogs.

Dragonfly said...

That is interesting.....I thought being a medical proxy applied to everything. Clearly not...
At least you didn't get it.....I have heard the meds are awful (though of course preferable to AIDS).