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October 27, 2004 Internship Journal

Earlier this month, an HIV patient was admitted with masses around his spinal cord that left him as a paraplegic. My attending asked me to come speak to him because he was very down about this. I came and told him that he would be able to live independently after going to rehab. I told him that they would teach him to dress himself, transfer himself, etc. I also told him that there are government programs that would pay for hand controls in his car. I went by later that week to say goodbye to him before I left for vacation. I figured I would go see him in rehab when I returned from vacation.

When I returned from vacation, I saw Dr. Millan (the spinal cord attending) and asked him about the patient. He said the name sounded familiar, so I figured he was in rehab. I had a busy first week back, so I actually forgot about him. Then the following Monday, we received a consult from psychiatry on him. I went to psychiatry to try and figure out what happened. Well, he obviously did not go to rehab. He was diagnosed with lymphoma (very common in HIV patients with low CD4 counts, like him) and he was discharged home on the 20th with this diagnosis and as a new paraplegic. He came back on the 21st saying that "he would rather be dead, then to live like this." Well who wouldn't? He had a Foley catheter (an indwelling catheter) and he didn't know how to do a single thing for himself. Unfortunately for him, his doctor had done him a huge disservice getting him to rehab. Since he was in psychiatry, we added a recommendation to our infectious disease recommendations and recommended physical and occupational therapy.

The following day, I learned that the patient had been transferred to the oncology service. I went to speak to him again. I learned from his occupational therapist that he wanted to go home. I went to speak to him again regarding rehab. I once again explained that if he goes home from the hospital, he will rely on someone else to take care of him for the rest of his life. After about 20 minutes, I thought that we had come to an understanding that rehab would be the best thing for him. I was wrong. I went to see him today and asked him if he had been working with the therapists. He screamed at me "What's the point, I can't do anything. I'm paralyzed!" I took a deep breath, and tried to calm him down. He started talking about all the people that have lied to him, and how bad medicine is today. After a few minutes, he finally calmed down, and I left him by saying that I wanted the best for him, and the best thing for him was to go to rehab. We will just have to see where he ends up.

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