By far, one of my favorite aspects of medicine is its progression towards speed and accuracy. A full genome can be sequenced for the cost of a Step exam, with results having a similar turnaround of only a few weeks. We emphasize efficiency in tests out of necessity; illnesses often do not proceed at a leisurely pace, and their interventions are time sensitive.
When the patient needs the truth, this becomes deeply relevant, and sitting in the proverbial waiting room does nothing good for the nerves. Historically, and very much still the case today, there are few results that come to mind with the weight and permanence of a HIV diagnosis.
But, we also live in a time with prophylaxis, and pharmaceutical management that can titrate the viral load down to undetectable levels. The progress made in treatments is hope made manifest, and it starts with a test. It is very different to suggest testing a hypothetical patient for HIV in an active learning lesson than it is to actually administer it.
I was in the middle of eating a fig bar outside a community room when he stepped up to our mobile health unit. Before I could choose between scarfing down my snack or communicating with gestures, I heard a bright laugh and he advised me to chew, “careful, accidents happen, accidents happen.”
There’s the business of silent killers and common prevalence, the implications of hypertension and diabetes necessitated this screening effort. I explained what we screen for as I prepare the intake form: blood pressure, blood glucose, cholesterol, among a few others upon occasion. A small set up of equipment and papers organized on the tables provided, the large leather arm chairs gave the encounter a leisurely feel. Behind me a Harry Houdini documentary plays mutely on the television, a compelling distraction to everyone in the room—patients and public health coordinators alike. I gave it a glance, I recalled the team’s earlier discussion on how Houdini’s fatal ruptured appendix and peritonitis would not be treated with antibiotics in 1926—another modern thing to be grateful for.
Moving through the questions, I paused at the bottom section. I whispered to the event coordinator, as one would off stage, if I should ask the HIV questions. I was unrehearsed and I felt the pang of uncertainty. The coordinator looked over my shoulder and asked if he’d like an HIV test, he agreed easily, shrugging his shoulders. I timed it for last.
Blood pressure was high, it was attributable to medication, and blood sugar was fine—jokes followed one after another. Being able to laugh, the unspoken vital sign.
With blood glucose testing comes an opportunity to collect blood. I kindly had the test tray set up for me, and as I’m tapping the sample into capillary tubes, I think of what I am doing.
One thing I have heard several times while studying, from professors and step review, “what is the purpose of a test? What will you do with the results?”
I was guided by the coordinator, thankfully. The patient tilted his head to watch. Curious, not willing to look away, rather there to bear witness …
I moved my arm, trying not to obstruct.
I squeezed out the blood sample, then two drops of the solution…
Now to wait, ten to fifteen minutes; I offered to answer questions. We retook the blood pressure, and I meticulously recorded lab values. The easy laughter now comes scarce, we talked of general health, the day to day.
I think, amidst small talk and busying gestures.
What do I say if it is positive?
What do I do? How do I speak, and what is the best way to offer reassurances?
I’ve heard of denial. I thought of algorithms and turns of phrase. I’ve heard of anger. I asked again, how long it should take. Sometimes the results come sooner than 10-15 minutes, reassured that I was working with someone who had experience.
It was enough time, the results came earlier.
I looked at the results, the coordinator read it before I could, distinguishing the control marker, and the absence of any antibodies.
“It’s negative.” He said.
I echoed it, and then again, this time to the patient.
Silence, then a nod, another nod. He leaned back in his chair ever so slightly.
What response did I anticipate? To place myself in their position, to imagine their thought process behind a controlled expression. The heavy weight of that test on anyone’s shoulders, anticipating what it could mean. Modern medicine still has no true cure.
I offered to answer any questions again, there were none, he had done this before, he confided. A silent moment dragged along and then there was a certain calmness in the air, with him sitting casually again, back to talking again. I filled out his copy of the data form and provided summaries and closing statements, swapping thank you’s and there was the upbeat smile again, I could finally relinquish the stress in my jaw. He took some free multi-vitamins and we wished each other well, waving goodbye.
Not every test goes this way. This served as a reminder to anticipate how any test result may go, and I hope to be more prepared for it. Is it needed? Is it specific? What do I do with the results? There are multifaceted implications when it comes to choosing the right tests, and most importantly, the matter of being able to best support the patient with what you find.
Fatemah Alzuhairi
Fatemah Alzuhairi is a UACOMP med student from the class of 2028. She graduated from ASU in 2022 with a degree in biomedical sciences and a minor in history. In her spare time, she enjoys planning creative projects, reading, and drinking copious amounts of Earl Grey tea.