Heartbreaking...

I just cannot focus on the enormous amount of studying I have to do because I can't stop thinking about the patient I had last night. I was a assigned a 17 y.o. HIV positive male who was admitted for cryptococcal meningitis. He was no longer under contact precautions so I was able to go in his room without a mask, etc. (hallelujah for that one--I always have a pt with contact precautions of some sort). He's been in the hospital for about 2 weeks now and is expected to go home sometime next week.

When I first introduced myself he ignored me and the other nurses; he just played videogames until I needed to put a BP cuff and a pulse oximeter on him. He has a history of refusing his medication. Today it was one of the antibiotics he needs to take by mouth--2 of the 4 doses he needs to take in a day. He's depressed (and taking bupropion), stuck in the hospital and bored. And both of his parents are HIV positive as well.

I spent almost and hour and a half with him while he ate some of his dinner and took his meds. He was scheduled to take 9 pills at dinner and an IV injection of an anti-nausea medication. He says that the pills make him nauseous and he doesn't like to take them. He takes a lot of pills. A lot. He's on about 5 anti-retroviral drugs plus the other meds he takes. He said his mom takes her pills 4 at a time. He takes his one at a time over a long period of time. I got him to take 6 of them over the course of an hour and was waiting for the nausea to pass to give him the last 3.

We hung out and watched Mythbusters and the stupid show with the guy who shouts about laundry detergent. You know who I'm talking about. Anyway, we talked about school and videogames and tv shows and why he doesn't like vegetables. He's a nice kid, a good kid, and sometimes he acts like a pissy teenager because...he's a teenager. And maybe, if I were him, I might refuse my meds, too. He tells me just looking at them sometimes makes him gag. But he also knows what happens if he doesn't take all of his ART meds. We talked about the importance of that. And the nurses on the ward have 4 other patients to take care of and can't spend 1.5 hours hanging out trying to cajole him into taking his meds the way a student nurse can.

I got him to take 2 more ARTs before I left last night. I tried to get him to take the last one, the biggest one, the one that can't be cut in half or crushed and put into applesauce, but he was sleepy and didn't want it. But he took the antibiotcs and most of his ARTs so I'm pleased with that. It's hard to do this job sometimes. You want your patients to get better and often times that means just taking all of their medications. And a lot of them take a lot of meds. They're like walking pharmacies, these patients. But they have every right to refuse even if they're minors. But if they don't take their meds, you can't keep the disease in check and/or cure them. In this case, as we know, there is no cure. And he's walking a very fine line between HIV and progression to AIDS by not following the prescribed regimen. He's only 17.