False Test and True Love

They had both weathered ugly divorces in their thirties.  

The kind of divorce that becomes the fault line between the tectonic plates of young naive adulthood and a sobering middle age. If there had been social media at that time she would post pictures of her stunning success with her new exercise program and clever memes subtly, if not outright, suggesting her ex-husband is an idiot.  

He would, of course, post pictures of his new girlfriend for his ex-wife to see how happy she makes him and how wonderfully fit and endowed she is.   

But, it was the 1990’s and social media was the old slow word of mouth thing of such and such seen having dinner together.  Nevertheless, they had found true love and contentment in the first few months together and were both quietly excited about the relationship moving forward.  

She wanted to be sure there was nothing from the old him that might be possibly transferred to the new him when the new him became her him.  She came to me for the testing.  

I was working for a large medical organization in Georgia at the time as a family physician.  Her request was completely reasonable and we did the testing.  Results in a week.  

She felt fine and had no symptoms.  I expected the tests to be all negative (no infections).  

Her HIV, the virus that causes AIDS, came back positive.  

The default test, automatically run on the same sample, was also positive.  

She was called to come in earlier and brought her mother with her.  There is no easy way to inform an unsuspecting patient of this devastating result.  Compassion, courtesy, common sense and training teach us to sit down, make eye contact, express the true compassion that should accompany such news, and tell it as it is.  

“I am truly, sorry, but your test result says you have HIV.” 

Her meltdown was immediate and enormous.  She buried her face into her mother’s shoulder weeping and wailing the same phrase - “He’s going to leave me! He’s going to leave me! I know he’s going to leave me!” 

She, who clearly hated her ex-husband with a passion known only to a woman who gave her youth to a betraying spouse, didn’t even think about the man who had infected her.  She only thought about the man whose love she was now going to lose.  

She called her boyfriend and he came to the office.  He walked in with a strong focussed look, stood next to her in the exam room, and asked why he was there.  I told him and the color drained from his face.  

Then it came back.  

He embraced her and she began sobbing again.  He told her he loved her and would never leave her, no matter what.  They would face this together.  I had never heard sobbing change from despair to joy, but there it was.  

He turned to me - still with a focussed look - and said, “Is there anyway this could be wrong?”

“It is double checked and routinely verified by a second test, but any test can be wrong,” I replied.  “That’s why I am  going to order another one.”

The sample was drawn, we discussed the next steps and referral, and they left holding each other closely.  

She, emboldened by his love and support, told her family.  She told her co-workers.  She even went forward in her church the next Sunday, shared the story of her love and her diagnosis, and the entire congregation came to the altar to pray for her and her family.  

She, who had feared isolation and loneliness, was embraced by the heartfelt compassion and genuine outpouring of support and love - with one exception - one brother cursed  and yelled at her with accusations and condemnation before storming out of the house. He was friends with her ex. 

Then the second test came back. Negative - no infection.  None.  Not a trace. 

I believe in miracles, but I also like to know the facts.  A quick phone call launched a rapid inquiry with the lab company we were using.  The next day I learned the truth. 

Her name label for one tube of her blood had accidentally been placed on the vial for a patient who already was known to have AIDS and was undergoing treatment.  The label error in the lab down the hall made his blood look like hers. 

She had lived a week thinking she had HIV.  

She and her boyfriend were immediately called and came to the office.  The risk manager for the corporation was there, too.  The results, the reason, and the responsibility were laid out in plain language.  She deserved to know the truth and why it had happened.  

The risk manager, the lab company’s administrator and several other people with suits met with the couple again a few weeks later in the boardroom.  The lab company was deeply sorry for the “mix up.” An agreement was reached.  A large check was written.  It had a lot of zeros.   

The check was a very nice beginning for their marriage.  She knew, even at the risk of his own health and well being, he would stay with her.  That had been proven. 

The lesson?  Any test can be wrong.  Nevertheless, her false test produced the truest love she had ever known.  And still knows. 

Eric J. Littleton, M.D. (@DrEricLittleton) is a musician and Family Physician in Sevierville, TN.  Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com

Code Blues

“ATTENTION!”

Every muscle in my body tensed and my brain immediately awoke from a light sleep. 

“ATTENTION, PLEASE - CODE BLUE ROOM 315. CODE BLUE ROOM 315.”

My mind began a sequence of thoughts but then remembered and important fact: I’m a visitor.  

It was just after one in the morning at a hospital in Knoxville last Friday.  My mother was asleep in the bed struggling with the first night of discomfort from a scheduled surgery.  I was asleep, no, dozing, in the recliner next to the bed taking the seat my dad would always be in when she was in the hospital.  

First recollection:  There is no rest for anyone in a hospital.  It’s a simple fact.  Too many vital signs, medication schedules, loud rolling equipment in the hallway, and blood collection interruptions which make a night in the hospital anything but restful. I knew that, but got to learn it again. 

Yet the called code early in the morning brought back a wave of memories from residency over twenty years ago.  There were usually one or two interns and a second year resident on duty.  We were the only physicians in the hospital overnight and responsible for running all codes on all patients.  

A “Code Blue” is called when a patient is unresponsive or in severe distress.  A team of nurses, respiratory techs, phlebotomists and physicians are assigned to drop everything and respond.  The protocols have been refined over the years and everyone knows their duty.  

Airway.  Breathing.  Circulation.  Someone adjusts bed.  EKG leads placed.  Oxygen is confirmed flowing.  The crash cart is wheeled in from its standard location loaded with drugs and equipment for the code.  

It was routine in residency.  A resident, in that day, may have been up since six AM the day prior but the adrenaline would jump from the first word.  I was taught the first rule of a code was to check your own pulse.  Recognize you need to be awake, alert, calm and thinking clearly.  

And we saw a lot of them.  It became an expected occurrence on the medical, surgical and oncology floors.  It was an outright terror to be called to labor and delivery or the pediatrics floor.  

As I awoke from my sleep last Friday morning many of the codes I was a part of in that phase of my training came to mind.  Once, I was casually asked to see a patient a new intern was seeing as I was simply passing in the hallway.  It was a patient I had known from an earlier rotation.  She had a look of terrified fear on her face and in her eyes. 

It’s a look I’ve never forgotten.  She was having mild shortness of breath but had smoked for over fifty years.  But it was the look.  She truly looked like a woman staring straight into hell.  

I called her name and she turned her head to me.  Stared at me for a moment then grabbed the collar of my white coat with both hands and pulled me into her bed as she fell back in cardiac arrest.  She literally had a death grip on my coat.  I wedged her fingers loose, told the nurse to call the code, and cracked her chest with a blow to the chest that is suggested if there is no other equipment yet available.  Chest compressions, bagged respirations, until the team arrived.  She didn’t make it.  I have never forgotten that look.  

I remembered the sweet older couple at the Memphis VA hospital in 1993.  He had been in reasonably good health, but had some blood in his cough for a day or two.  Chest x-ray showed something in the upper right lung.  Full work-up with the team would be done in the morning. She could not stay.  I remembered how tender they were to each other as she said goodbye.  

His bleeding into his lung became dramatically worse at 3 AM.  We battled suctioning blood out of his lungs while trying to put oxygen in.  It was a very ugly code.  That sweet couple who had shared years together had said goodbye to each other as if they knew.  Their tenderness in how they parted has stayed with me to this day.  

I stopped shopping at KMart while I lived in Rome.  The last time I was there an announcement came across:  “ATTENTION! Blue Light Special is now going on in jewelry…..” I nearly jumped out of my skin after the word “blue.”  I literally started to sprint to the jewelry section before I came to my senses.  No more. 

After airway, breathing, circulation, comes a host of questions.  What is the history? Who has the chart?  (Confirm it is the correct chart - learned that the hard way).  What meds were recently given?  What is the cardiac rhythm? What is the blood glucose?  Check the airway again.  Most code teams are so well trained that the questions are answered routinely as everyone is doing their job.  

“CANCEL Code Blue room 315.  CANCEL Code Blue room 315.”  

It had been about a minute.  Probably some poor soul was finally sleeping well, didn’t have his hearing aids in, and was tough to wake up for vital signs check.  The code was called and the patient woke up to a crowd of people about to unleash a lot of activity on him.  Good for him.  

But I was awake.  My long journey down a memory lane of a lot of codes had taken a minute or so sitting in the reasonably comfortable naugahyde recliner.  Mom was sound asleep.  Closed my eyes and drifted off for another hour or so of stolen slumber in the hospital.  

I am thankful for those who run the Code Blues at night in the hospital with great skill.  May God bless them for their dedication and training. Nevertheless, I don’t miss it. 

Eric J. Littleton, M.D. (@DrEricLittleton) is a musician and Family Physician in Sevierville, TN. Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com

Medical Care in Your Easy Chair

Edwards was the place to buy shoes.  For decades the store in downtown Harriman was the place to find men’s clothing and shoes for the entire family.

The staff seemingly never changed.  Bob was the salesman we always used, but there were the women who catered to the lady’s shoe sales and two other men who assisted with the sale of suits and fine hats, usually Stetson.  

They knew their clients when they walked in the door.  What they liked, what they had purchased, who their family was and any other gossip that small towns know but don’t put in the paper (with the exception of Rachel Goldston’s column in the Harriman Record which routinely listed birthdays, anniversaries, and who attended funerals and if “a good time was had by all.”)

It was personalized service.  

When the first Pic ‘N Pay store opened in the Big K shopping center, it was a puzzle to me when mom took us in.  Rows of shoes displayed with sizes listed.  No funny device to put your foot in to see what size I had grown to.  No help at all, really, until we wanted to pay.  

No one told us anything about the shoes, the manufacturer, and we certainly didn’t have to wait.  It was cold and impersonal, and either real or imagined, the shoes didn’t fit as well.  But it was cheaper.

Banking was the same.  We routinely had the same teller and used the same branch.  Then the Bank of Roane County opened an Automatic Teller Machine.  It was so unwelcome that it had to be put in a separate building in the parking lot.  

Grocery stores, too, went through this change.  The standard for the industry was a clerk who would reach for all the items behind the counter, total the purchase and collect the money.  Then Clarence Saunders’ Piggly Wiggly Stores in Memphis began a trend in 1916 that allowed customers to use self service.  

Then Sam Walton, Krogers, Food City, A&P, White Stores, and IGA all followed.  

Now we can order anything from toothpaste to televisions with our phones from anywhere.  

Yet medicine, the old fashioned fill out a blue million forms sit and wait in the lobby to enter an exam room medical care, really hasn’t changed that much.  

Medicine is basically simple.  A person has a problem, symptom or worry, wants to know if it is serious or minor, and needs to know how to remedy it either on their own, with a medicine that has risks but may be beneficial, or if a specialist’s care will be needed.

It is the figuring out of what the problem is, how to test for it, how to interpret it, and what to do with that information and where to go next that is the complex task requiring years of training.  

Or, maybe not.  

A new device from the Imperial College of Medicine and DNA electronics has been developed that plugs into the USB port on a computer and will test one drop of blood for the presence of the HIV virus. The small device creates an electronic signal which is interpreted by the computer with a greater than 90% accuracy.  

This is momentous.  We are accustomed to following blood glucose levels and home and this has enabled many individuals to have a very active role in controlling their diabetes, but to actually test for the presence of a virus at home?  

This is similar to walking into that first Piggly Wiggly in Memphis.  

Imagine being able to check to see if symptoms are the flu, common cold, or strep at home.  Or to check cholesterol levels at home along with red and white blood cells.  Or maybe thyroid levels.  Or liver and renal function.  That, along with Dr. Google, has an exciting potential that will inevitably occur.  

All this information would be transmitted to either the local medical office, or to the Big Health Care Insurance Company (Big HIC).  Need a personal interaction with “health care provider”? The real time video consult for the test results can occur with “Nurse Sally” or “Doctor Ed” can be accessed from the “trusted professional group” of Big HIC’s Health Care Team.  

Digital doctoring is already occurring as many have learned through their employers for sore throats, cough and sinus issues. That form of blind doctoring across state lines has a lot of risks, yet the convenience and price is appealing.  Some is good and some is bad.  The question is, how do you know who you are trusting?

The ability to actually obtain blood tests at home is a completely new threshold.  This, along with collected weight, blood pressure, sleep patterns, memory testing, gait analysis and oxygen levels can all be gathered and transmitted to either the local physician who has adapted and can manage the care over the computer or to the Big HIC who will assign a health care provider (of some level of training) to the patient randomly.  

Whether or not the local physicians adapt to the new digital age is the question.  Big HIC will, and will quickly.  Otherwise the local physician’s office will be the dark shell of a building like Edwards was when I drove past it last month.  Full of memories, but empty of any current relevance.  

Eric J. Littleton, M.D. (@DrEricLittleton) is a musician and Family Physician in Sevierville, TN.  Topics covered are general in nature and should not be used to change medical treatments and/or plans without first discussing with your physician. Send questions to askdrlittleton@gmail.com