Seven Patients

by Atul Kumar

  Obviously the nice guy routine wasn’t going to work with Jacob, so I decided to give him a dose of reality. “Your clothes have been incinerated and your wallet confiscated. But after all the blood and puke you got on them no dry cleaner would’ve touched them. You had a seizure in the emergency room and bit off a piece of your tongue.”

  “Shit, really?” He stuck out his tongue; he had two small sutures on it. Apparently a very small cut on the tongue could cause a lot of bleeding. I’d have sworn he bit half of his tongue off down in the ER given the profuse amount of blood that was gushing from his mouth. “No wonder my tongue itches.”

  “You really don’t remember pulling out your breathing tube last night?”

  “What you talking about?” Confusion began to take over, and with it curiosity. Jacob began to calm down. I think he was starting to realize the gravity of his situation and that he wasn’t going anywhere anytime soon. “Ok, ok, back up. I’ve been here two fucking days?”

  “Well, closer to 50 some hours. I’m not exactly sure when the ambulance brought you into the ER, but close enough.”

  “Ambulance?”

  “Yeah, you were found down in some alley in Hollywood. Lucky for you a kind passerby called it in and you were brought here. Once in the ER you had a nasty seizure. That’s when we discovered you have an infection in your brain caused by a fungus. Hence the yellow IV solution you’re getting.”

  “Oh snap. Yeah, it’s coming back to me. I was partying at that new club, Drai’s or something, up in Hollywood … and … oh man, I was getting close to scoring with that blonde hottie. Damn, I forgot her name. Hopefully I got her number. She was so fucking hot and bothered, I wasn’t sure if we were going to make it to my car. Actually, we weren’t, that’s why we went to the alley, figured nobody would mind if we had a quickie there. Know what I mean? That way I wouldn’t have to deal with her the next morning either. The girlfriend can smell when another woman’s been in my bed.” And he winked at me as if we were in some sort of fraternity together sharing our exploits of the previous evening.

  “You must have been partying pretty hard if you passed out.”

  “Nothing out of the norm.” He was starting to become much more coherent and interested in the discussion. Jacob clearly thought a lot of himself and clearly had some narcissistic tendencies. I decided to run with it and see what I could learn.

  “What does that mean?” I inquired.

  “You know, same ol’, same ol’. Had some drinks and did a line or two of coke so I could party longer. Then my buddy and I met a couple of chicks who were definitely down to have a good time. They were even more interested when they found out we had some coke. Both helped themselves to a healthy dose and then were all over us on the dance floor. When I mentioned I had some E, their eyes lit up. After we all dropped a pill they were as good as ours. I mean these girls were horny even before the ecstasy.” He paused, and then completed his thought, “Damn! I wish I was around to see what she was like after the E.”

  “Your urine also tested positive for narcotics.”

  “You checked my piss?!” He calmed down almost immediately realizing I wasn’t trying to be confrontational. “Guess it makes sense to check it out when I can’t tell you anything, huh? I pop some pills here and there. Nothing too crazy, usually just Percs. Oxy if I can score it, but it’s tough to come by these days and costs a mother.”

  “That’s Percocet and Oxycontin, I presume? What about heroin?”

  “Nah, never tried that shit, I don’t like needles. I just stick to the pills. My buddies smoke heroin, but the vapors don’t agree with me. Besides the black tar just ruins anything it comes into contact with. Destroys furniture, which is bad for both business and pleasure.”

  “What do you mean?”

  “I help run a very successful interior design company, so looks mean everything. Can’t win over a client if you have tar under your fingernails or heroin streaks on your walls. I’m the best designer they’ve got. I would have been partner in the corporation last year, but my irregular hours don’t sit well with everyone on the board. But they all know they need me. I bring in the big Hollywood contracts.”

  I had no reason to think Jacob was lying to me; he was pretty forthcoming with his drug use and it was all consistent with his toxicology results. He really loved talking about himself. As interesting as his drug and employment history were, I was ready to take it one step further and delve into his sexual history and HIV status.

  “Do you have any other medical conditions I should know about?”

  “Apparently I’ve got a fungus in my brain. Strange since I’ve never even done ‘shrooms. Is that how somebody gets a brain fungus? From eating those magic mushrooms? I always knew it fucked with your mind.”

  I wasn’t sure if he was serious or just messing around, so I decided to keep it professional. “Certain mushrooms are certainly hallucinogenic, but a Cryptococcal brain infection isn’t from eating mushrooms. Most people get it by inhaling aerosolized spores from bird droppings.”

  “So you’re saying I inhaled bird shit?”

  “Well, we all do it simply by breathing. It’s just that people don’t get infections unless their immune systems are severely compromised.”

  “What are you trying to say?”

  “I know you have some other medical problems.”

  “Look at me, would you?” Jacob flexed his arms showing off his well formed biceps. “Do I look sick to you? I work out and exercise, even do a little modeling on the side. I’m healthy. I ain’t got no medical problems. NOW, when can I get the hell out of here?”

  “Why are you suddenly getting defensive? Our goal here is to help you get better, and to do that we need to know your whole medical history.”

  “Well, I’m telling you I ain’t got no other medical history than what I just told you. Now can you tell me when I can get the hell out of here?” He was starting to get confrontational. I could see it in his demeanor. He was tense with his jaw clenched and his hands balled up as though he was ready to rough me up. Though I had little to fear, if he got himself worked up to the point of getting out of bed he’d likely suffer a severe headache and send himself into a fit of seizures.

  Instead of patronizing him with the typical line of ‘calm down’ that so many doctors use, which only serves to further rile up patients, instead I decided to buddy up with him to see if I could get any more information. I’d just feed into his narcissism.

  “Jacob, I know you don’t want to be here; hell, I wouldn’t either. You’ve been through a lot in the past couple days and come out of it like a champion. Most people in your situation wouldn’t have even made it to the ICU, if you know what I mean. And the strength it takes to pull out a breathing tube is just incredible.”

  “Damn straight, I didn’t even feel it come out.” His jaw slackened and his fists uncoiled. My plan seemed to be working, so I continued to feed his ego; after all, medicine is about building rapport, not friends.

  “Incredible. You must have a pretty high pain threshold. I’m assuming it comes from the hours that you obviously spend in the gym?”

  “Interesting, I never thought about it that way. I guess as I build muscle I’m probably also building up a higher pain tolerance. Makes sense, more muscle means more tolerance for pain. I bet that’s how I can do lots of things that my other friends think are too painful, like eating hot sauces and lifting heavy stuff.”

  “You might be onto something.” God this guy was so full of himself; it was amusing. At least he was starting to warm up to me. Now I could get to the heart of the matter. “Do you remember anything else about the night when you were found passed out in the alley?”

  “I told you all I remembered.”

  “Is it common for you to party like that and hook up with random people?”

  “Hey hey, I don’t hook up with random people, only chicks of the most attractive variety.”

  “Must be pretty easy for you to get girls, h
uh? They love bad boys who workout.”

  He was getting into the conversation. He clearly enjoyed speaking of his exploits. I, on the other hand, was starting to get sick. He was committing manslaughter if he knowingly had unprotected sex with others while being aware of his HIV status.

  “Single chicks are no problem. But I like to go for the ones who are with other guys. There’s a challenge to stealing another man’s old lady for a night.”

  “That’s a dangerous game. If one of the girls was to get pregnant, they could trace the child’s DNA back to you and nail you for child support or even go after your corporation. You must use some sort of protection, no?”

  “Used to, but stopped last year. Figured I’ll only be young once and it feels so much better without a cover on Jacob Jr.”

  “Aren’t you worried about getting HIV or Hepatitis C or some other STD?”

  “Not really. Why are you asking all these questions? If you want to hook up, I know some pretty ladies who’d love to have a doctor. But those dates aren’t cheap, if you know what I mean?”

  “Thanks, but I’ll pass. I have somebody I’m interested in already.” Guess Jacob supplemented his modeling and interior designing income with some pimping on the side. I was about to start probing him about his HIV status when Cindy entered the room.

  “Hellllllloooooo, nurse! Here to give me my sponge bath?” Jacob was clearly interested in Cindy. And who could blame him? She looked good, especially since she wasn’t wearing a gown or mask. Like many docs, she ignored the personal protective equipment requirements. She’d also had a lot more experience with AIDS than I did, so she likely knew what was and wasn’t really needed.

  “No. It’s Dr. Lee. I’m Raj’s boss on the team managing your care,” she said with authority as she showed Jacob her ID badge.

  “Well, if you’re free for dinner later, you know where to find me.”

  “I’m busy.” Redirecting her attention to me, “Dr. Raj, did you confirm with him about any illnesses he has, or might have contracted, that can account for his weakened immune system?”

  “Uhh, umm, I was …”

  “WAIT … are you saying I’m sick with something else? Is that how I got this fungus infection?” Jacob cut me off and was angrily staring at Cindy.

  “Well, I was speaking to Dr. Raj, but yes, that’s what I’m saying. There were some lab tests we got back that indicate your immune system is not as healthy as your appearance would belie.”

  “What are you trying to say, Cindy?”

  “It’s Dr. Lee. What I’m saying is the infection you have in your brain typically occurs in people who are significantly immune-compromised, meaning in those with weakened immune systems. It can be due to many things such as genetic immunoglobulin abnormalities, cancer, previous organ transplantation, or AIDS.”

  He again started to get agitated. Sitting up and leaning slightly forward, the muscles in his jaw clenched and his eyes squinted ever so slightly. He did not like where this conversation was going. “Well, I’m the exception to the rule, none of those in this body,” he said as he gave himself a very approving once over. “Does it look to you like I have a genetic problem?”

  “Well on examination you don’t have any of the scars that recipients of organ transplants usually have. However, that doesn’t preclude any cancer for which you may be under treatment or infection with HIV.”

  “I don’t take any meds. You already checked my piss, so you know what all I’ve used recently! I’ve been honest with Raj here, ask him. What exactly are you getting at, Missy?”

  “I’d like to test you for HIV.” I cringed as she said it. I’m sure Jacob wouldn’t take nicely to being confronted so bluntly by a female. I was definitely starting to get male chauvinistic vibes from him.

  “I don’t have no HIV!” The too quick and overly emphatic reply implied that he had something to hide. Though technically he was right, given his low CD4 count and an opportunistic infection with Crypto, he had AIDS, not HIV, but I’m fairly sure that’s not how he was thinking.

  “Then you won’t mind us testing you? With modern technology we can just take a small droplet of blood from your finger and have the results within 20 minutes. If we can exclude that condition, we can focus on other causes of why you have a fungus infecting your central nervous system and get you better that much faster.”

  Jacob was not taking kindly to Cindy’s in your face style of doctoring. He was turning red with rage and repeatedly opening and closing his fists. He was used to being in the position of power and I don’t think he liked the role reversal and feeling of impotence he was experiencing. His only options were to lash out or admit defeat.

  “This is bullshit! I’m outta here, you can’t keep me here against my will, and I know you cannot test me for HIV without my consent. Give me the AMA forms. I want to sign out of your nuthouse.”

  “Jacob, you seem to know a lot about hospital protocols for somebody who’s supposedly so healthy with no medical problems. Care to tell me how you know that we can’t test you for HIV or that you have to sign special forms if you wish to leave a hospital against a doctor’s advice?”

  “I know my rights. Besides it’s all over the news about how health protection and anti-discrimination laws prevent testing for HIV and other genetic conditions without explicit written patient consent.” Jacob said this smugly, clearly thinking the verbal jousting was now in his favor.

  “I suspect that you already know what the results of your HIV test will show.”

  “Yeah, they’ll be negative, Miss Lee.”

  “Interesting, given you have an extremely low CD4 count and a very elevated HIV viral load.” I shuddered as she said it, fearing he might physically lash out at her. The New York style of patient care was much more confrontational than the laid back buddy-buddy California style.

  “WHAT … THE … FUCK? You can’t know that, I never said you could test me.”

  “We didn’t test you for HIV. We simply counted specific blood cell types in your body and checked for replicating viral particles. Nowhere does it state that consent is needed for those tests. Especially from somebody who is found unconscious and almost dead upon arrival to the ER. We ordered those tests so we could save your life, which we did, might I add. You should be grateful we checked. Otherwise your diagnosis might have been delayed and you’d be in the morgue instead of talking to us.”

  Jacob was livid. Standing ramrod straight right next to his IV poles which were infusing into him the very chemicals that were keeping him alive, he looked from the hanging IV bags to Cindy and then to me. I can only imagine what was going through his head. He had just been called out and proven to be a liar. Worse yet, Cindy wasn’t done.

  “Jacob, I know what you’re thinking. You want to lash out against me because I spoke the truth. I’d strongly advise against that, not only because it will get you thrown in jail, which it will, faster than you can imagine, but also because we are here to help you. In order to help you we need honesty and cooperation. You seem like a bright guy, and with the right care you can live a long healthy life.”

  “I don’t need your help; I was doing just fine on my own. Just treat this fucking infection and let me out of here. I have shit to take care of. You’re just a doctor, you can’t tell me what to do. Just do your job and quit preaching to me, you little bitch.”

  Wow, I’d never seen such insolence on the part of a patient before! But Cindy was nonplussed and took it in stride; she’d seemingly been down this road before.

  “Listen Jacob, I’ve only treated you with respect and been forthright with you. I expect you to show me the respect that I deserve. However, it doesn’t seem like that’s going to happen, so let me lay it out for you. I believe you know about your HIV status, and if it turns out that is true, and you’ve been having unprotected sex with other individuals, male or female, without informing them of your infection, you are guilty of manslaughter and a slew of other charges that only a lawyer can tell yo
u. I already know about the numbers on your cell phone. It won’t be hard to get a court order to contact said individuals and ask them about their sexual relations with you and their knowledge, or lack thereof, about your condition.”

  That was my cue to grab Cindy and run out of Jacob’s room. As the door was closing behind us I heard a loud crash. It was one his IV poles smashing into the door followed by a solid kick that must have dented the inner door of his room. As we ran out of the second door I intentionally kept it open. Doing so ensured the inner door leading into his room was locked. Because he was in an isolation room, both doors could never be open at the same time. One had to enter into the anteroom allowing the door through which he entered completely close before the other door unlocked and could be opened. Had I let the outer door close behind us, he’d have been able to exit and follow us in his rage.

  The charge nurse saw what transpired and immediately called security. Two officers and Jack materialized within seconds and we explained to them what had just transpired. The security officers called for backup and conferred with Jack about what to do.

  “Yeah, we’ll need to let the attending know, but I think we should make sure the patient is calmed down before trying anything. Raj, good thinking on locking him in there. There’s no knowing what he’d have done if he escaped. If he doesn’t calm down I think we’ll have to put him on a psych hold as a danger to others. Let’s give him some sublingual Xanax and see if he relaxes a bit so that we can reason with him.”

  Security nodded their approval with Jack’s plan. Jack turned to Cindy, “What the hell did you do to get him so agitated suddenly?”

  Cindy, having composed herself stood her ground. “Well, I confronted him about his HIV status. He was clearly lying about his knowledge of his disease and wasting everyone’s time. Worse, he knew he was infected and he’s sleeping with unsuspecting people on a regular basis after giving them drugs to get them aroused.” Turning to me, “Yeah, Raj, I heard a large part of your interview from the anteroom. You did a good job, but I couldn’t stand to hear any more of that jerk talk about his ‘Jacob Jr.’”