Mysterious Ways

“ God will save me. ” Sharon said. Her longtime doctor, who was helping her fight a severe autoimmune condition, respected her faith but wanted desperately to help her with modern medicine. 

“ He saved my sister, because she kept her faith, stayed on the path. I will stay on the path and He will save me too. I will have many, many long years. I am not throwing in the towel now. Besides, you guys can’t even really cure me,  you said so yourself. With your care I will be bedridden in just a few months. Besides, I have things to do. I have to get to Costco or there will be no sandwiches for my kids in the morning and no cookies for the church meeting this evening! ” she explained as she stood up, clearly ready to leave. 

Her doctor looked at her with sympathy and confusion. 

“ Look…Sharon, you have been my patient for a long time and I need for you to trust me. You need to take this seriously. And getting care is the opposite of throwing in the towel. You’ve always been a good patient and done the right thing, I haven’t steered you wrong, so why wouldn't you listen to me now? You need to get checked into the hospital, you need real help with your lab work looking like this. I don’t know how you’re even standing in my office. But sometime in the next few days this is going to catch up with you, and without the proper medical care, or even with medical care, this autoimmune disease is going to take you down. And the less care you get the faster it’s going to do it. Your body is attacking itself. Let's work together and maximize your time. There's no cure but we can buy ourselves some time with what we've got, maybe try to get you into a clinical trial. They have new treatments that they’re testing everyday, you’d have to drive into the city but I can make arrangements for you. This disease is attacking almost every organ you have, there is no way you feel as good as you say you do.” He looked at her, eyes pleading for her to reason with him, he looked back softly at him for a moment, then rolled her eyes and sighed. 

“I feel great, because The Lord will save me. And while you may think that He has no hands but ours, I believe in my faith. I am not going to that hospital, at least not now. He cured my sister of this awful disease, just when things seemed the most dim for her. He will save me too, my faith is even stronger than hers! My miracle is just around the corner.Besides, if I go to the hospital now, what does that show for my test of faith?”

“It’ll show that you are trying to do the best thing for yourself.  I agree your sister's case was a miracle but we can’t count on miracles! My father used to always say ‘God helps those who help themselves’ and I believe that.” he told her somberly, his eyes begging for her to give in. He could tell he wasn't going to get what he wanted. She was headed for the door.

“ Well my sister aside, my grandma used to tell me that miracles don’t bring hope and faith, you gotta have that already. But faith and hope can bring miracles,” she said firmly as she walked away. 

“We need to have some faith in the miracle of modern medicine and current recommendations. And the current recommendations say you need an infusion at the hospital…like…yesterday! You need help. You’ll see that soon. Maybe God wants me to help you, by putting you in the hospital where we can help you!’ Dr. Anderson yelled, defeated, as she left to the parking lot through the back door. 

She always used the back door and the back lot for her appointments. She was a private and strong woman, well known from her active role in the local church, and she did not need everyone in this small town talking about why she was at the doctor again. She already had gotten comments about being pale and winded easily and she hated them. Years ago, her sister, who shared her diagnosis, was given only a year or two to live. She clung to her faith and a miracle came to her. She wasn't in the grave, and these doctors weren’t God. Sharon would take the medication and eat her vegetables and give up her wine, but she could not accept the fate they had spelled out for her. Her fate was in the hands of a much higher power than Dr. Anderson. She sped off. 

Back at the office, Dr. Anderson shook his head,  stunned at the interaction he just had. He had become a Dr to help people, but the fact was that nothing made him feel more helpless. Part of the job was the doing, and no matter how hard the doing was, the doing was what he was trained for, what he knew he could do, what he loved. Being the only doctor in a rural town was tough, he had to do almost everything– deliver babies, perform surgery, treat injury, diagnose infection, screen for scoliosis. The “doing” was exhausting, but it was ok. It was all the things that he couldn’t do that really got to him. When medicine stopped working, when his research didn’t yield any answers, when there were no other treatments left to try, when they couldn’t bring a patient back with CPR and epinephrine…he was left to simply bear witness to the pain and grief of his patients, to feel it with them. To sit with them as they faced some of the worst moments that life would give them. To simply be a fellow human was the hardest part of his job. 

But only human he was. He couldn't force Sharon to go to the hospital. He couldn’t explain how her sister was magically cured.He knew that he couldn't ever be God, but he wished that Sharon would at least let him DO what he COULD DO as a lowly human doctor in a little town that wished he was able to do more. 

“Dr. Anderson, the next patient is here, I roomed her in room 2, she should be ready. Her chief complaint is vaginal burning and discharge but says that she’s also got an infected cut on her left ankle that she wants you to take a look at.” His assistant pulled him out of the mental rabbit hole that his first appointment of the day had put him in. He took a deep breath, looking forward to the relief of a little distraction from the last case and some problems he could actually solve.

“ Ok, thanks Rhonda” he replied. 

He knocked on the door without even looking at the chart, still thinking about his last patient. Before he looked up, he heard a cheerful voice begin to rattle off.He recognized it immediately and rolled his eyes at what a small town this was. 

“ Hey Doc! How you doing? I shouldn't take too much of your time, just a yeast infection again and a little infected cut on my ankle. I guess that's what I get for trying yoga pants in a heat wave and shaving my legs with those cheap daisy razors. I’ll just take a scrip for Diflucan and some antibiotic ointment and then I’ll be on my way” she said hurriedly.

“ You know… having this many infections implies that your immune system is somehow run down. I haven’t seen you have this many infections like this since you came off of your immunosuppressant drugs that you used to take for the autoimmune disease. Any chance you went to the city and got prescribed something by another doctor? Taking something that I don’t know about? You know I need to know what you’re taking, for a lot of reasons…”

“Nope, I haven't needed anything since my miracle. I don't know what cured the autoimmune disease, I have to just chalk it up to the Lord. He saved me, Linda Baker, a sinner, just like the Bible said. Besides you know I wouldn't trust any other doctor but you Doctor Anderson! Did my sister tell you about it? I’ve been telling her that she needs to listen to you, she keeps telling me that she’s fine and that her miracle will kick in any day. That her faith will bring it to her. And I…I just don’t know. I mean I do have faith but…I mean I– nevermind.  I want her to have the best chance at surviving this, that’s all. It took our father and it's caused us both so much pain.”

“ Well I appreciate your confidence in me and you encouraging your family to take care of themselves, but I can’t discuss her case with you. You know that. But I can discuss your case, which is why you’re here.”

“ I just need that prescription and I will be fine, this is nothing!”

“ Frequent infections are not nothing. I need to make sure something more isn't going on here. I’m sending you to the lab for some bloodwork, we need to rule a few things out. Now you go across town and let them take your blood and then go to the pharmacy to pick up your prescriptions. And  I am going to have Rhonda call the lab this afternoon to make sure that you did it, and if you didn’t you're going to hear from me, directly. I know you think I'm a little annoying but this is for your own good.”

“ Yes, sir” she said with a bit of an eyeroll. 

“ See you later, I hope you’re doing better soon!”

After stitching up a hand that belonged to a farmer who insisted it didn’t need stitching, breaking the news to a teenager that you can indeed get chlamydia in your throat, performing three well-baby exams, explaining why eating a diet without fruits or vegetables will cause constipation to two different patients and seeing a countless number of people for a sore throat that was going around, he finally got to go to Carson's for a drink and end his day. 

It was Friday morning, but the days really didn't matter. There weren't really any days off when the next doctor was 287 miles away. 

“ Doctor Anderson! I’m so glad you're here, Robert from the big lab in the city is on line one, says he really needs to talk to you” his assistant shouted at him as he walked into the clinic.

“ Ok thanks Rhonda!” He picked up the phone.

“ Hello, this is Dr. Anderson” he answered.

“ Hi, Dr Anderson, this is Dr. Robert Duvall from Questcorp Science Laboratories and I have some news I need to discuss with you”

“ Which Patient is this regarding?” Dr Anderson asked curiously.

“ Linda Baker, date of birth 06/17/1972”

“Okay, got it. Diabetes, right? She’s been showing signs of immunocompromise and she’s always got a piece of hard candy in her mouth,” he sighed with frustration in his voice. 

“ Actually, no. Before I explain the results I just first need to explain that there was a bit of a mistake. I can see on your original order sheet that you only checked off about 12 boxes for the tests you wanted ran, but our intern had his first day on data entry and thought that the entire list needed to be ran, not just the checked boxes. So he typed up the order for essentially every possible test and we drew 7 vials of blood from the patient and ran all those tests. I didn’t want the blood to go to waste so i just decided to test it, and I personally oversaw the testing and retesting after seeing the results”

“ Well you had better talk to Rhonda about working out billing for that, neither my patient nor my office will be paying the bill for these extra tests!” he stated firmly. 

“ Yes of course…well you see the extra tests did actually yield something relevant” he stated as if it was a question.

“ I tested for everything that was relevant for a suspected immunocompromise for her demographic!” Dr. Anderson was getting defensive. 

“ Well I don't know  this woman or her exact social history, but I did find the reason for the remission of her autoimmune disease” he remarked smugly.

“Her HIV test came back positive. Her CD4 counts are ever so slightly low, but they are pretty close to normal. Probably just enough to account for a few opportunistic infections if she isn’t taking proper precautions, but not enough to give her any major issues. The thing is, according to her chart, she has recently experienced an idiopathic remission of her autoimmune condition, a complete reversal from where she was several months ago. I think this is the reason.” He sounded stunned by his own words. 

“ So you’re saying… that this woman was cured…by catching HIV?” Dr. Anderson pushed the words out in disbelief.

“ Ok so think about it. Her immune cells are attacking her body. Then a virus comes in and greatly decreases the immune cells. There is going to be less of an attack on her body, because her attacker is going to be attacked,” he explained. 

“ Oh I get it, I just can’t wrap my head around all this. How do I treat her now? I can’t really replicate this ethically I don’t think…”Dr. Anderson could feel his head spinning. 

“I think we can be on to something. I theorized on this during my postdoctoral study but I had never seen a case, let alone a whole study. I mean it’s going to take research and funding and a lot of political and ethical hoops to jump through, but I think using this as treatment is a real possibility. I know the disease is extremely rare, and the success will depend on the genomes involved with the autoimmune condition, the strain of the HIV but I think that this is a real discovery. Clinically she has been stable for years, if we could titrate the HIV treatment in a way that keeps her immune system relatively balanced, we can probably buy her quite a few years, and she’s already gotten more years than she would have without it” he explained. 

“ Listen Rob, let me get back to you.” He hung up and asked Rhonda to get Linda Baker in that day. 

She came in, assuming that he wanted to see her ankle again. When he told her that she had HIV and explained that the HIV had essentially treated her autoimmune disease she was confused. He explained that the virus was likely attacking the cells that were attacking her body, and thus had weakened her enemy enough for her to get healthy again. She understood eventually. She wasn’t sure how to feel and her face was just blank. She put her head in her hands. 

“ I don’t know how to feel. What about my sister? She’s going to be crushed. She thinks I got a miracle and that a miracle is coming to her too. I should have known that it wasn't a miracle. I sinned. I didn’t have any faith in a miracle. I knew I was going to die! That’s  how I got HIV, I’m sure of it! I went to the city and tried heroin. I had sex with a man I met at a bar that night. I just wanted to go a little crazy and do all the things I had been too good or too scared to do. I thought I was dying! I mean, I WAS dying. But now I’m not..because I thought I was dying so I lived it up! I mean this whole thing is just INSANITY!” She broke into tears. She was hysterical. 

Rhonda walked in and rubbed her shoulder. 

“ Do you want me to call someone for you? Maybe you shouldn’t drive home just yet.” she asked.

“ Call my sister. Tell her that there’s no miracle. That I had no faith and I did heroin and slept with a stranger and now I have HIV and that's the only reason that I’m not dead! Why don’t you do that? Why don’t you break her heart and her faith that has carried her for her entire life?” She sobbed. 

“Well I can call her and have Dr. Anderson explain the recent results, if that’s ok with you.” Rhonda said. Linda handed her phone to Rhonda. She dialed her sister, who answered right away. 

“ Hey, I have…news. Here’s Dr. Anderson, he can explain it all.” She handed the phone to Dr. Anderson. He explained everything to her. At the end of his long explanation, she asked him to put her on speakerphone.

“ I just wanted you ALL to hear me say…I told you so! I told you my miracle was coming! I kept the faith and He came through!”

They all looked confused. 

“ Why are you all so quiet? Did you think I would be mad? What, do y’all think this isn’t a miracle just because there’s an explanation? She was dragged off of death's doorstep for goodness sakes, what do you people want for a miracle?! The Lord works in mysterious ways! He has no hands to do his work but our own! And you think that lab error wasn't divine intervention? That lab error that led to this explanation was my miracle! This is my chance at life! If it worked for me it can work for her! Linda! Steal a needle from the clinic and meet me at my house!” She hung up.