11/24/06

It's dark...outside, in the Alabama Theatre, and in a little part of my soul.

It's dark on this World AIDS Day. Every day more people die of AIDS than I can count. Today I learned of one man who passed away with whom I only had 20 minutes or so of interaction. Mr. C was an HIV+ patient with pneumonia - a bad pneumonia.

Three classmates, Jennifer Ellzey, Jennifer Feucht, and Tyler Stracener, and I are part of an Introduction to Clinical Medicine group in the University of Alabama School of Medicine. Under the tutelage of Dr. de Andrade, we were introduced to Mr. C, a 41 year old African-American man who was in the ICU, sick with a bad pneumonia, but he was vastly improved from the time of his admission. We spoke, we examined Mr. C., and we learned from him, with his patience and permission.

I heard egophany for the first time, and demonstrated fremetis for the first time. Both of these, egophany and fremetis, are simple tests that demonstrate lung consolidation or infection. With egophany, the consolidation changes the sound of the utterance "eee" to "aay" when heard through a stethoscope placed over the affected area of the chest. Fremetis is sensed with the hands placed on the back, and with the patient vocalizing. The vocal vibrations may be felt in the hands, but in the case of consolidation, the vocal vibrations do not transmit.

I spoke with Mr. C.'s doctor after visiting with him. She talked about the plan for him. Mr. C. was diagnosed with HIV approximately 10 years ago. I silently hoped he might be a long term non-progressor. Mr. C. is currently unemployed and has alcoholic behaviors. He has been counseled for alcohol cessation and for HIV treatment, so the ball is in his court. For his pneumonia, he will be under the care of thoracic surgery, and he was scheduled for a thoracotomy, as opposed to a chest tube. The scarring and fibrosis is too great, and so a more open procedure will be required.

I was grateful to Mr. C. for his patience with us, and for speaking with me, and I've thought of him several times over the last couple of weeks. It turned out that Dr. King (his Infectious Diseases doc) is also my Microbiology Laboratory instructor, so I had a chance to catch up the next day. Mr. C's plan remained the same.

Today on World AIDS Day, I learned from Dr. King that Mr. C. passed away, rather unexpectedly. They say that pneumonia is dangerous, but I never really understood how dangerous it could be.

I feel bad that Mr. C. died. I shouldn't, I think; I didn't even know him. Maybe part of it is because it's World AIDS Day, and old wounds are brought a little closer to the surface. I'm sure part of it is that Mr. C. didn't have to die, but he did anyway. That frustrates me in ways I'm not quite able to articulate now in a satisfactory way.