I was on duty that day when a young man, surnamed Zhao, walked into the clinic. After carefully inquiring about Zhao’s medical history, I learned that Zhao had a black-brown lesion on his forehead the size of a pea since he was a child, and had been ignoring it. But recently this black bumps began to have itching and other uncomfortable feeling, sometimes wash face also easy to rub broken, appear bleeding, etc., because of the fear of “to the bad direction”, today he specially took time off work to come to the dermatology clinic.
He was given a simple examination: a dark brown papule of 0.8cm in diameter on his left forehead, protruding from the skin, smooth surface, no hair, clear border, no similar lesions around. After a brief record, a dermatologic surgery date was scheduled. During the process of asking medical history, Xiao Zhao volunteered to me that he was an HIV-infected patient and his current CD4+ T lymphocytes were still not below 350/ul and he had not started HAART treatment yet. I informed him that it was okay, it was not a contraindication to the procedure, but that he was immunocompromised and should pay attention to incision care to prevent infection. He nodded his head with confidence.
AIDS, short for acquired immunodeficiency syndrome (AIDS), is caused by infection with the human immunodeficiency virus (HIV). As we know, HIV mainly invades the helper T lymphocytes (i.e. CD4+ T lymphocytes), causing partial or total loss of immune function. Therefore, after HIV infection, if the patient’s CD4+ T lymphocyte count is less than 200/ul, he or she is at increased risk of developing a conditional pathogenic infection, etc. If there is no emergency need, surgery is generally not recommended. It is possible to do the corresponding surgical treatment after elective antiviral therapy when the CD4+ T lymphocyte count recovers to a certain level. However, the above patient, Xiao Zhao, with CD4+ T lymphocytes greater than 350/ul, was able to undergo skin surgery even without HAART treatment and before his body HIV viral load turned negative.
On the day of surgery, when I came to the operating room, I instinctively extended my right hand to Xiao Zhao before surgery, and he held my hand tightly, and I believe all the concerns and anxieties in his heart at that moment were dissipated with a simple handshake. After that, I talked to Zhao about his work as I did on my daily surgery day, while packing, putting on sterile gloves, sterilizing, spreading sheets and anesthesia to distract him and reduce his nervousness. Everything was ready and about to make the surgical incision when Xiao Zhao reminded me once again, “Dr. Zhang, I am an AIDS patient, I have not yet taken oral medication, the viral load must be very high, you must be careful not to stab yourself.”
A short sentence made me feel extremely warm. Yes, the doctor and the patient this family, each other’s starting point is to cure the disease, if we can step back for each other to think a little bit more, where to so many medical disputes and medical regicide incidents. A little more understanding, a little closer.