When newFNP last wrote, she noted that she had disclosed to a patient that she was HIV-positive. NewFNP was wrong.
She has AIDS.
When newFNP told her patient that she was HIV-positive, her patient asked, "Does that mean I have AIDS?" When she asked, newFNP knew that AIDS was a possibility. NewFNP replied that she would know more when she got the rest of the blood-work back.
Her CD4 count came back today at 166 - an AIDS defining number according to the 1993 AIDS Surveillance Case Definition of the CDC. NewFNP had a shit fit when she learned from the lab that the viral load was submitted incorrectly and could not be determined. It matters and it doesn't. The CD4 count is in the toilet, the patient is smoking crack and drinking on a daily basis and newFNP can't reach her. She can't start on anti-retrovirals anyway - you don't want to have a patient fail her first, and best, option and - frankly - active debilitating addiction is not an ideal starting place for HAART if one is looking to prevent resistance.
The situation is, pardon newFNP's French, fucked.
NewFNP wrote the prescription for Bactrim for PCP prophylaxis and attempted to reach her patient in order to get it started. Of course, being precariously housed and without a phone, newFNP could only leave a non-specific message on her patient's friend's cell phone.
NewFNP's patient did not show up in clinic today to pick up the prescription.
NewFNP's passport is out and her dollars are exchanged as she is heading out for a longer long weekend in a far-away land. But newFNP's patient will weigh heavily on her heart while she is away.
So, so sad.
3 comments:
wow...I don't know what else to comment regarding the situation...Do enjoy your well deserved vacation and post all about it when you get back. Bon Voyage!
ttt
I remember in NP school being told not to run an HIV test unless you were prepared to deliver the result. What prepares us for this? It is so incredibly sad for this woman. And some think handing out condoms is a bad thing.
This is a difficult situation no matter how you slice it. AIDS is a chronic disease now, but that does not decrease the devastating and life-changing effect of the diagnosis being delivered. Keep the faith!
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