THE NIGHTMARE

(This story contains issues of health, including HIV infection.)

There is a well-known aphorism warning people not to get sick just before or during the July 4th weekend. Why, you ask? Because July 1 is the day each year that a new crop of interns takes the reins of medical management in the hospital wards throughout the United States. Yes, they have completed medical school, and yes, they are bright, industrious young doctors. But they lack one indispensable quality: Experience. 

Of course, there is ample oversight. The prior year’s interns are now 2nd-year residents and can offer a guiding hand. There are more senior doctors as well, including the leader of each team, the attending physician, who is usually a well-seasoned practitioner with a solid career in medical teaching. The intern is never completely on his own when making life-and-death decisions. 

As the elevator doors parted, Dr. Kevin Palmer took a deep breath. Stepping from its cozy confines into the hubbub of the nursing station, Dr. Palmer was ready for action. He had been an exceptional medical student and felt quite capable of taking on this next challenging phase. He was still a bit uncomfortable introducing himself as Dr. Palmer. He preferred Kevin. But the nurses soon disabused him of that. Upon using his given name, the nurses would invariably correct him, saying, “Kevin? Oh, you mean Dr. Palmer!” 

In his younger years, Kevin Palmer was a very sensitive, squeamish boy. He came from a lovely family. His father was a clinical psychologist and his mother was an elementary school teacher. His parents were very supportive and nurturing. When he would cry reading a poignant short story by Hans Christian Anderson, his mother would hug him lovingly and reassuringly and find a way of softening the pain. If he came home terrified by a science fiction movie like The Fly, with Vincent Price, his father would comfort him and imbue him with confidence and steadfastness. A level of introspective delicacy followed Kevin into his teen years. But medical school’s practicality and assiduousness has a tendency to knock these types of quirks out of a student’s psyche rather quickly, as it did for Kevin.

Kevin also had a different type of emotional support. He was engaged to a charming young woman whom he had met the previous year. Cassandra was studying to be a pathology technician and worked in the electron microscopy laboratory. Kevin had been fortunate enough to meet her at the time he delivered a biopsy specimen. His first thought was that she was utterly and udderly amazing. 

He asked her, suggestively, “So, what’s the prognosis?” She answered, “The prognosis is looking good for dinner tonight.” 

Despite the pandemonium of his internship year, Kevin sincerely wanted to get married. He loved his sweet Cassandra and she seemed to love him. Her older sister was to be married later that month, and Kevin planned to propose during the reception. But, as Robert Burns opined, “the best laid plans of mice and men often go awry.” In this case, it wasn’t a plow causing the destruction, but a phone call. 

There was no discernible anxiety or tension in the voice on the phone. It was a simple request, stated perfunctorily. “Kevin, could you come down to the medical clinic for a moment? We have to discuss an abnormal lab value which just came back from your pre-employment testing.” 

Despite the indifferent timbre of the voice on the phone, Kevin’s heart skipped a beat. He asked a colleague to cover for him for a short time and hurried down to the clinic. He was met by a nurse counselor who ushered him into a quiet, private office, where an infectious disease specialist was also awaiting him. He kindly asked Kevin to sit down.

He began, “Kevin, we had an abnormal lab come back in your testing. You were found to be positive for HIV. As you know, that’s the virus that causes AIDS. Because of this, I need to ask you a few questions. Kevin, have you ever used intravenous drugs? You can just say yes or no to these questions. Have you ever had unprotected sex with a man, including anal sex? Have you utilized the services of a prostitute during the past five years?”

Dr. Palmer did not hear any of these questions. His mind swooned into a dark vortex of panic and nausea. “How could this be? It’s not possible!” he clamored almost incoherently. “I’ve done nothing wrong! Why would this happen? It’s probably a mistake! It’s impossible!”

The nurse counselor placed her hand on his shoulder as Kevin slumped into hysterical, gut-wrenching crying. She said to him, “Kevin, I saw in your profile that you had a needle-stick injury last year as you were placing a central line. That could be the source.”

Kevin cringed. “No, I don’t think so. We tested the blood in the syringe at the time. It was negative. They told me I was in the clear. This is probably a mistake. I’ve never done any risky behavior. I’ve never had sex with a man. I‘ve never used IV drugs. I’ve never done anything like that.”

The infectious disease physician added, “Kevin, we verified the result with a more advanced test called a Western Blot assay. It confirmed the findings. I’d like you to start a cocktail of anti-viral medications that my nurse will give you. It comes as a starter pack. It involves taking eight capsules four times a day. And, of course, we will be available to you whenever you might want to discuss things.”

The remainder of the day was a sickening blur. Kevin steeled himself and finished his shift, constantly feeling the weight and ominous shadow of a massive sledge hammer hanging over his head. How could he explain this to his parents? They would be so heartsick. And how in the world could he tell Cassandra such terrible news? It would devastate her beyond comprehension. 

But Kevin realized that such an awful development must be shared. He bought flowers for Cassie in the impossible hope of assuaging her inevitable dread. As expected, the news fell like an anvil on a toe. Cassie was inconsolable. 

“Kevin, how could this be? Where did this come from? Oh my god! Am I infected, also? I have to get tested. Oh, no! I’m going to die! Kevin, how could you do something like this to me? What kind of creep would do this?”

Kevin, heartbroken at Cassie’s reaction, but at the same time taken aback by such cruel accusations, protested. “I didn’t do anything purposeful. I didn’t ask for this. This whole thing came out of the blue. I never engaged in risky behavior. How could you accuse me of purposely doing something to you? I know you’re upset, but that’s not fair. I wouldn’t hurt you for all the money in the world.”

Cassie said, angrily, “Listen, you just leave me alone. I’ll get tested, and you better hope I’m negative. I can’t believe this! What a creep you are! I never want to see you again! Stay away from me. Don’t ever call me or text me or try to get in touch with me. Get lost, you creep!”

Kevin cried himself to sleep that night, although waking every two hours in a fitful sweat. He had a thousand questions. In the morning, he called the nurse counselor to discuss his options. In addition to speaking with him and reassuring him of generally good outcomes with the proper medical treatment, she strongly recommended joining an HIV support group. There he would meet others with HIV, some of whom might have similar circumstances. He was also counseled that he would not necessarily need to give up a career in medicine, but would be better served by entering a field not involving direct patient contact, such as radiology or psychiatry. 

The following week, Kevin had his first group session with his new HIV positive compatriots. The meeting was quite nice. Many in the group knew how they had contracted HIV, but a few had no clue, just like him. One young woman became infected after she was involved in a motor vehicle accident. She was the passenger in a car in Mexico during a vacation when it was struck by a drunk driver. In the trauma unit, she needed a transfusion, likely the source of the bug. 

Kevin and this nice young woman, Elise, struck up a very warm friendship, and in time, they felt a romantic connection developing. Elise was a very sweet person and was an accomplished violinist, pursuing a doctorate in music at Juilliard. She and Kevin enjoyed cooking together and listening to music. They would take their medical treatments together, a team approach. Within three months of knowing each other, they had grown extremely close. 

Kevin continued his internship at New York Hospital, although changing his focus to radiology, while Elise prepared for her graduate violin recital. She had decided to take on some very challenging works by Bach, Beethoven, Cesar Franck and Wieniawski, and Kevin loved listening to her practice sessions. He found himself carried away in ecstasy as Elise performed a Bach Chaconne, and thoughts of marriage and perhaps even future children dared to conceptualize. While she was playing, Elise caught Kevin’s eye, and somehow she knew what he was thinking.

And then the phone rang.

“Uh, hello, Dr. Kevin Palmer? This is Dr. Farmischt, you know, the infectious disease specialist. Oh, good, you remember me. Um, listen, Dr. Palmer, would you be able to come down to the clinic tomorrow morning? I have to discuss something very important with you. This is very embarrassing, but there was apparently a slight mistake in our quality control. It seems that the blood sample from your pre-employment testing was somehow mixed up with one of our clinic patients. We reran your blood as soon as we identified it, and it looks like you’re not HIV positive. We would like to run another test tomorrow for confirmation, free of charge of course. But from what we see so far, it looks like you’re negative for HIV. Would you mind coming down?”

Kevin sat on the couch for more than an hour, the news swirling like a tornado within his skull. “It’s great news, for sure! No, not just great news. It’s the best news I’ve ever received. I’m going to live! I don’t need these hideous anti-viral capsules! Just think, 32 capsules a day now not needed.” 

But his happiness and relief suddenly turned dark and painful. “What about Elise? What should I do? She is HIV positive and now I know I’m not.”

And with that thought, Kevin Palmer fell asleep, and had the most horrible nightmare. What should he do?

What would you do?