Saturday, August 4, 2018

Breaking Bad News

When I called out for the next patient, a dad got up carrying his son, his wife trailing behind him. When they got into my room dad sat down, still holding his son, and his wife kneeled beside them.  When I asked what was wrong, they said they had recently gotten medicine for their son’s diarrhea, which is now improved, but now he has some sores in his mouth.  As I asked more questions, everything seemed to be okay, and just looking at the kid he looked okay. 

As I started to get closer to examine him, dad mentioned that his hair wasn’t really growing too well.  He still had quite a bit, but it was an unusual thing to say.  The kid easily opened his mouth and I found his mouth was coated by a white film.  While it can be usual for kids to get thrush (a yeast infection of the mouth), especially after taking antibiotics – it usually happens in younger kids and it doesn’t usually coat the mouth this bad.  I was worried about HIV, but the kid looked pretty well and the parents didn’t look sick.  I asked mom and dad if they had any illnesses and they said no, and when I asked about HIV they said they hadn’t been tested, but not that they were aware of. Since they looked healthy, I started to think of what else could cause this extensive film of his mouth. 
Not John, but a patient doing well and happy to be better

I asked the parents if it was okay to do an HIV test, just to make sure and they said sure.  About an hour passed, and they were outside my door again with the result.  Dad still holding his son, mom handing me the result and his clinic book.  While I was certainly hoping the result would be different, I wasn’t exactly shocked when it came back positive.

Like I have done many times, I now had to break the news to this patient and his family that he had HIV.  You never know what the reaction is going to be when you break bad news, but I wasn’t expecting this.  Mom just put her head down and started sobbing.  Dad squeezed his son even harder, saying words I can’t repeat.  They were obviously devastated. 

There have been times when I have had to explain what HIV is, this family obviously knew, and their reaction seemed to be more than just the news, but grieving over everything they all were potentially losing.  Initially, I didn’t know how to respond.  What could I say to a family who seemed to think their life was over?  I told them I was sorry.  I wasn’t sure that telling them about the medicine that we have to treat HIV would be helpful at this time, so I didn’t say anything.  I gave them time, explained how we would be with them through their process, and then I asked if we could pray. 

I struggled to compose myself, mom still sobbing, dad still holding his son tightly, but I prayed for them and their son and the journey ahead of them.  While the encounter was probably less than 10 minutes, it was still very moving to me.  To see the love, the grief, and the loss of planned tomorrows isn’t something that PNGians usually share.  Pray for John and his parents in the days, weeks and years ahead.  Pray that they can continue to find strength and hope in the middle of the valley they are facing, pray for a comfort that only the Lord can give to be upon them in this battle.