Cover Image

Not for Sale



View/Hide Left Panel

Régis

DAN AND I ALTERNATED MONTHS as attending physicians on the inpatient service. I was about to take over responsibility for the service and Dan was briefing me on the patients. We had been working together for three years and frequently commiserated about the plight of our patients.

“The sickest is definitely this fellow Régis. Have you heard of him? He was admitted with Pneumocystis carinii pneumonia. His blood count started to fall on Bactrim. We stopped it, and we’re waiting for Pentamidine to arrive from the CDC (Centers for Disease Control and Prevention). He’s dying fast. You may be forced to restart the Bactrim. It’s remarkable. He was a dentist in Haiti.”

When I met Régis on rounds the following day he was near death. He had pneumonia throughout his lungs. He was breathing heavily at three times the normal rate and was too weak to talk. His mouth was dry, despite the oxygen mist streaming from a mask over his face, and his eyes were rolled back in his head. When he was admitted his temperature was 105°F. It decreased to 102°F while on Bactrim but climbed again when his antibiotic was changed. Because of the glut of terribly sick patients the syndrome was already causing, there were no beds available in the intensive care unit. My



The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement



Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter. Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.

Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.

OCR for page 18
The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Régis DAN AND I ALTERNATED MONTHS as attending physicians on the inpatient service. I was about to take over responsibility for the service and Dan was briefing me on the patients. We had been working together for three years and frequently commiserated about the plight of our patients. “The sickest is definitely this fellow Régis. Have you heard of him? He was admitted with Pneumocystis carinii pneumonia. His blood count started to fall on Bactrim. We stopped it, and we’re waiting for Pentamidine to arrive from the CDC (Centers for Disease Control and Prevention). He’s dying fast. You may be forced to restart the Bactrim. It’s remarkable. He was a dentist in Haiti.” When I met Régis on rounds the following day he was near death. He had pneumonia throughout his lungs. He was breathing heavily at three times the normal rate and was too weak to talk. His mouth was dry, despite the oxygen mist streaming from a mask over his face, and his eyes were rolled back in his head. When he was admitted his temperature was 105°F. It decreased to 102°F while on Bactrim but climbed again when his antibiotic was changed. Because of the glut of terribly sick patients the syndrome was already causing, there were no beds available in the intensive care unit. My

OCR for page 18
The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti resident and I decided we would give the pentamidine one day to work, watch Régis closely, and then intubate and artificially ventilate him if necessary. We would not let the absence of an intensive care bed keep us from doing everything we could. After questioning the medical students and answering their questions, my team moved on to the next patient. As sick as he was, Régis was only one of about 25 patients under my care. The next morning Régis was even worse. The intern on call had been up all night with him, restarting intravenous lines, drawing cultures, and frequently checking his arterial blood gases. His chest x-ray showed more consolidation of the pneumonia, and his blood gases were deteriorating. We decided to give up on the pentamidine and restart the drug he had been on three days before. Bactrim could kill the organism causing Régis’s pneumonia more effectively, but it had stopped his bone marrow from making red cells. Now this seemed the lesser of two evils. We could always transfuse him, and we hoped a special vitamin-folinic acid would reverse the drug’s effect on his bone marrow. The intern on call was again up all night ministering to Régis. By the following morning he showed signs of improvement. He was breathing more easily and his chest sounded clearer. His temperature had dropped to 101. He had the strength to talk again. “Who are you?” he asked me as I leaned over to listen to his chest. “I’m Doctor Fournier. I’m in charge of the team you were admitted to.” “Oh, the name on the bracelet?” he smiled as he pointed to the identification band on his wrist that contained his name, his hospital number, and my name. In a teaching hospital hardly anyone notices the name of the attending physician on the I.D. bracelet. Even after having so recently climbed out of the grave, he was handsome and noble looking. His skin was truly black, unblemished, and shining with the moisture of perspiration and the oxygen mist. His eyes were animated and accentuated by angular cheeks and

OCR for page 18
The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti a broad, sharply crested nose. His teeth were impossibly white and perfectly shaped and spaced. His English was perfect, without a hint of an accent. There was no doubt he had AIDS. In addition to pneumonia, he had patches of fungus inside his cheeks and on his palate. The number of lymphocytes in his blood counts was depressed, a sure sign, and his “helper” to “suppressor” T cell ratio was inverted. T cells are the part of the immune system that fights off unusual infections. We now know that the AIDS virus specifically attacks the “helper” or “T4” lymphocytes slowly, over time depleting their numbers. When they reach critically low levels, patients become sick with unusual infections. But Régis had no signs of tuberculosis and a test for syphilis was negative. The residents were justifiably proud of pulling him through, especially since they had done it without the benefit of an intensive care bed. Paul, his intern, couldn’t wait for my arrival at rounds the next day. “Boy, you’re not going to believe how much better Régis is today. The man’s incredibly smart. He was asking all about his illness, and I told him about the pneumonia, and the Bactrim and the pentamidine and how his immune system is all screwed up. He understands it all. His blood gas is almost normal, and his chest x-ray’s even starting to look better.” When I arrived in Régis’s room, I was greeted with, “Good morning, Dr. Fournier. How are my T cells doing this morning?” He was up in a chair, had washed, and was able to breathe comfortably without oxygen. I paused for a moment to let the residents bask in their accomplishment. “Well enough. You have improved greatly.” “Then you think I will recover?” “You’re recovering already.” “But will my T cells recover?” I would have taken this last question as a joke except that he asked it with complete sincerity. I had never been asked a question of such immunological detail by one of my patients. Clearly, he was

OCR for page 18
The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti seeking reassurance for questions deeper than T cell function. I felt constrained by the format of attending rounds and answered with a trite, “Only time will tell.” I shared the resident’s exhilaration in pulling Régis through. He had been all but dead three days before. Had he presented as little as six months earlier he surely would have died despite our efforts, as we wouldn’t have had a clue as to the true cause of his pneumonia or the best treatment. His strength increased daily. Soon we incorporated Régis into our rounds, asking him to translate for all our Creole-speaking patients, rather than waiting for an interpreter. He was excellent at this, reporting not only what the patient said but also an assessment of the patient’s level of understanding and unspoken concerns. He added a touch of drama and eloquence as he told each patient’s story. The patients were puzzled at first as he emerged from the group of physicians and students wearing a hospital gown and pajamas and still attached to an IV pole. But he stated plainly what he was doing and then put them at ease with a smile and a handshake. We all remarked what a luxury it was to have our own interpreter and one of such quality. Régis seemed different from many of the other Haitian patients. For one thing, no family members ever visited him. He was always reading or writing. His bedside table had only a King James Version of the Bible to adorn it, rather than the usual pictures of saints that graced the tables and walls of other Haitian patients. “Mysterious,” I thought. One day toward the end of his hospital stay I was making rounds alone, dictating my daily notes into a handheld recorder. When I got to Régis’s room I decided to stop in, since I had missed the opportunity to see him during particularly hectic morning rounds with the team. I knocked and entered. He was reading his Bible. “Hello, Régis. I didn’t get to see you during rounds this morning. Continuing to make progress?” “Yes, doctor. I think my lymphocytes are holding their own now. Thank you. Won’t you visit for a while?” He closed his Bible and

OCR for page 18
The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti placed it on a photo album on top of his bed stand. I accepted his invitation and asked how he had come to this country. He told me he had grown up in the Haitian countryside but had always been a good student at the Protestant missionary school in his village. After high school he took a correspondence course in dentistry, there being no dental school in his part of Haiti, and the mission sponsored him in setting up and running a dental clinic. He did this for five years and even wrote a book for the public on dental hygiene. As he told me this, he pulled the book from his drawer and displayed it with a smile. Now he had come to this country to formalize his education. He both studied and taught English as a second language at a local college. He was 33 years old. The book was in English and was obviously written at a time when Régis’s English had not reached its present state of perfection, for it was grammatically but not idiomatically correct. His picture was on the frontispiece, handsome in a three-piece suit. The content concerned fundamentals of caring for teeth—the importance of brushing and cleaning and what happens during a visit to the dentist. It had been published by the mission. He was quite proud of it. The photo album, however, was of greater interest to me. There were many pictures of Régis surrounded by white people somewhere in the United States. These were his visits to the mission’s stateside base. Interspersed with these were photos of him in an obviously tropical setting, usually surrounded by groups of children or adults. But one picture arrested me—Régis in a small, bare room with one chair and an older woman seated in a handmade chair. Régis had one bare hand in her mouth and with the other was extracting a tooth with a pair of pliers. The woman’s face was contorted, and her legs were crossed in pain. Remembering cases of dentists with hepatitis, I could not escape the revelation: “This was how he had contracted the disease!” I told him how fascinated I was by the pictures of his life in Haiti. He seemed pleased and told me I should visit Haiti someday. He asked me what would become of him. It was clear that the knowl-

OCR for page 18
The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti edge he had absorbed from Paul’s lessons in immunology was more than superficial. But he was calm and not frightened. He said he had to get better so he could finish his education and return to his work in Haiti. I told him that his problem was serious but not hopeless. Several patients had died, but more and more were surviving, and this illness was still too new to predict the future. I offered to follow him in my office and promised that, if the situation did become hopeless, I would tell him.