A visit to an HIV clinic: Part 1

Posted by Dave on February 15, 2010 | 7 Comments

Wednesday, February 10. I arrive at the Carolinas Medical Center Myers Park office at 7:55 a.m. A security guard informs me that the clinic doesn’t open until 8 a.m. and tells me to wait in the pharmacy. There are dozens of others in the room with me, and initially I wonder why so many folks needed their prescriptions so early in the morning. At 8:00, I have my answer: we’re all waiting to get into the clinic. When the doors open, there is a rush to the elevator. I head upstairs to J. Wesley Thompson’s office in the Infectious Disease Clinic.

“It’s like this every morning,” Wes told me. It’s a busy, urban facility with a number of different clinics housed in a compact, three-story building. Wave after wave of patients rush in throughout the day, hoping to get their care and return to work as soon as possible. Many patients are treated through the clinic’s sliding-scale program, paying what they can afford based on their income. There are more patients than appointment slots, so the schedule is always packed.

Wes is a physican assistant with extensive training in HIV and AIDs treatment. His official title has a dozen letters behind it, and I can’t tell you what they all mean. HIV and AIDS consume nearly his entire life; when he’s not in the clinic, he’s sitting on the board of regional HIV/AIDS charities or speaking to school groups, doctors, or community members about the disease. Next week he’ll be attending an international conference on HIV and AIDS in San Francisco.

I sit and chat with Wes for about 35 minutes before his day’s round of appointments begins. He has about 14 patients on the docket today. He explains to me that for every 15 minutes he spends with patients, there’s an additional 45 minutes of work he needs to do, filling out online forms, requesting lab work, and dictating his notes.

He sits at his computer and reviews the day’s cases before seeing anyone.

Some of the patients are doing just fine, with normal viral loads and t-cell counts in a reasonable range.

But some patients have unusual results. He reviews the lab results of one patient showing a higher viral load, and in this case, he sees that the patient now has a mutated form of the virus which is resistant to his current treatment regimen.

Fortunately other drugs are available that are known to be effective on this strain, so Wes will be changing this patient’s regimen to counter the new threat.

He also has a recent college graduate interested in medical school following him as he begins his work. Nurses periodically enter his office asking questions about his patients. No names are mentioned during any of this so as to protect the patients’ privacy.

Wes’s officemate arrives at around 8:30 and soon I’m escorted out of the office. Government regulations require that I not listen in on any private medical conversations, and there’s no way to ensure that I won’t accidentally be in violation with all the work going on in the room.

I volunteer to sit in the waiting room with the patients. A TV blares the latest CNN headlines: Mostly it’s breathy journalists talking about how much darned snow they’re getting in Washington DC. Patients (or perhaps their friends and family members) shuffle in and out, getting called one by one for their appointments. Understandably, everyone seems anxious to get through their appointments and leave. Who wants to hang out at a doctor’s office?

Wes asks each of his patients if they’re willing to talk with me; just one of them agrees: LaShana Walker, who has been HIV positive for more than 10 years. Three years ago, she progressed to full-blown AIDS. She’s been having trouble taking her medications, and she recently found out that she was pregnant. While most women with HIV are able to deliver healthy babies as long as they stay on their medications, she has a different concern: “I just found out that if you’re not taking your medicines well, then DSS will take your newborn child.”

“It’s hard for me to keep my drugs down, so today I was going to change medications, but [Wes] told me that wasn’t a good idea.” Apparently the new medication Walker wants to try hasn’t yet been tested on pregnant women, so there might be a possibility of endangering the baby. She tells me that the side effects of the medications she’s on now are so bad that sometimes she just throws them away, despite the risks. But now, with a baby on the way, she seems resolved to change. “I’m going to try to stay on them, but it’s hard…. To think of someone taking away your newborn away, that’s neglect and I cannot do that, so I’m really concentrating on taking my medications. I’m going to take them, seriously.” She pauses. “Not throw them away. I’m not going to do that any more.”

Despite these concerns, Walker seems optimistic. She’s in community college, finishing up a G.E.D. She wants to be a stylist. Her HIV and AIDS hasn’t kept her from working; she’s been out of work the past year, but due to a back problem, not the disease.

After I finish talking with Walker, I head back to the waiting room, gathering my thoughts.

I’ll share more of my visit to the HIV clinic later this week.

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