My Patient Joe

I have a patient, I’ll call him Joe.  Joe loves to drink beer. He loves beer more than anything, it seems.  He doesn’t think of beer as alcohol.  When we ask him, “Joe, are you drinking lately?” He says no. Then there’s sometimes a pause.  “I drink beer,” he says. “That’s all.” But the problem for Joe is that he drinks beer and he doesn’t take his medication to treat his HIV. I’ve known Joe for about six years now and every so often, for a few months, he takes his medication beautifully. When he does, his HIV viral load goes down and his T cells rise. Not long ago he even had an undetectable viral load. It didn’t last. When I saw him the other day he said he’d been off his medication for over two months.  He said it was because he’d moved and that had knocked him off his schedule. But he told me he moved two weeks ago, not two months ago. He wanted me to give him new prescriptions.  He claimed he was going to go that same day to the pharmacy in his new neighborhood and he was going to fill the prescriptions and start taking his medication again.

Joe used to come into the office smiling and he kept up a banter of talk of how great a doctor I am and what a great clinic we have and how I might not be happy with him but he’s going to do better because he wants me to be happy and I take the best care of him and it’s because of me that he’s still alive.  He was always very pleasant and mild and while he sometimes blatantly lied about taking his meds (we could see very well from the labs that he wasn’t) he would usually fess up about his drinking.  He’d always say that he was thinking about quitting but maybe would do it next year or for Christmas or for his birthday. The one time his viral load was undetectable he was ecstatic and told me he felt great and all his labs would be just as good going forward.

The other day, though, Joe seemed more sad. His excuses were flimsy and his overall appearance was ragged. He had a rash on his face that comes out when his viral load is high.  He said he hadn’t been drinking.  Just beer.  He came to his appointment with a woman who is a case manager for a community-based organization that reaches out to patients and helps them get to their appointments and reminds them to take their medication.  Joe has come with different case managers over the years.  This woman, like the others before her, seemed to know Joe fairly well, and to like him.  She told him she’d call him the next day to remind him to take his pills.  “I know you will,” he said, looking at her.  Our nurses will call Joe next week to check on him.  The case manager will call him every few days.  Sometimes Joe doesn’t answer the phone.  It’s been a hot summer.  The beer is cold.