Coughing Up Clots

I had a routine visit with my infectious disease doctor in May. Blood was drawn as usual…oh, five or six vials, to check my blood chemistries, my HIV viral load (number of particles of virus per milliliter of blood), my CD4 count (how many infection fighting cells I have per milliliter of blood) and anything else that might be helpful in fighting my illness. I have become a bit blasé about these visits after twenty years of checkups, but if there is any significant change in my results from one visit to the next, then the latest visit takes on a whole new, obsessive-compulsive meaning for me.

My doctor has been in Africa working to fight the pandemic there, so I had put off calling to get my results…partly because I knew he hadn’t been in the office, and partly out of the denial and fear of finding out that there could be an issue brewing with my health. Yesterday, I finally picked up the phone and called. I found out that for the first time in my history with HIV, my creatinine levels were "ever so slightly elevated".

This indicates a number of potential issues. The best choice is that the lab screwed something up and I just need to have the test redone. The second stop on this train of thought is that one of my medications is causing a problem with my kidneys and that if it is a non-essential (HIV) medication, then we can resolve the problem by changing the prescription. The third potentiality is that something is askew with the functioning of my kidneys, my adrenal glands, my thyroid or some other organ system. After about fifteen years of exposure to HIV medications whose effects are still being studied, cancers and organ failure are definite possibilities.

Today, I went in to have a new blood sample drawn in hopes of finding out that nothing is truly wrong. The phlebotomist pulled out four vials and talked to me about the need for compassion between health care workers and patients. She shared with me how she had watched nurses care for her father when he was in the hospital a few years ago and that they taught her about the need for a smile, a kind word and love for her patients. I shared with her how the nurses cried when we all stood around my dad’s deathbed in the minutes after his death. When she finished her work, she reached out and hugged me. She called me "Baby", a kind name for a forty-six year old man.

Despite the phlebotomist’s display of love, I saw the list of tests that were ordered today and realized that we were not simply repeating a single creatinine test. I began to think of all the horrible possibilities that could be lurking out there in the realm of medical possibility for a man who is twenty years into HIV infection. I used to share my obsessive fears with people who are not infected with HIV, but I soon grew really tired of their lectures on how I shouldn’t imagine the worst, or how we can all get hit by a bus tomorrow and that I would be fine. I quit talking to them about my potential problems. It seemed that they didn’t want to be bothered with my concerns.

Instead, I developed a special relationship with my friend Donald in Washington who also had been infected with HIV. If either of us received bad news, we would call the other one up and start the conversation with "Well, I am dying!" and then the other would ask "What is it this time?" or "Are you coughing up clots, yet?" or something equally as smart-assed in order to knock the other one of us off his pot of self-pity. By the end of the conversation, we would have exhausted a list of horrible things that might happen to us in the most humiliating of circumstances and we would have laughed together until we literally lost our breath and had tears streaming down our faces. At the end of these conversations, it would have just been one more damn blood test and not the end of our world.

I found myself wanting to pick up the phone today to tell Donald that I am "about to start pissing blood", but I just couldn’t make myself do it. You see, Donald died last August. It is days like today that make me really miss him.

Categories: HIV/AIDS medication side+effects humor black_humor favorites News and Observer Blog Watch kidney+disease