Setting: Pitie-Salpetriere Hospital in Paris, France
Position: Specialist in tropical diseases
I am a consultant in tropical diseases at the Pitie-Salpetriere Hospital in Paris in professor Marc Gentilini’s department, which has been receiving HIV/AIDS patients from all parts of the world since the onset of the pandemic. Indeed, in the early days most patients came from Haiti and Africa and were seen primarily in tropical disease departments because of their geographical origin. Now famous international stars, such as Rock Hudson and Rudolph Nureyev, seek treatment on our premises and at the Pasteur Institute, which works closely with the hospital. In 1982, one of the patients of Dr. Willy Rozenbaum had a lymph node biopsied and sent to the Pasteur Institute where professor Luc Montagnier and his team identified the virus causing AIDS, which ultimately came to be known as the human immunodeficiency virus. In 2008, he and Francoise Barre-Sinoussi were awarded the Nobel Prize in Medicine for this breakthrough achievement.
One of my patients is a bisexual fashion designer in his mid-30s. He tells me about his past pleasures, attending colorful and extravagant parties on yachts belonging to billionaires in the Greek islands. He is happy to share the best moments of his life with me, and enjoys reminiscing. As he recounts with great details these experiences, I sometimes contrast the excitement in his voice with the poorness of his diagnosis, and I face my own conflicting feelings of joy and sadness on his behalf. Nevertheless, I try to live in the moment with him and I pay close attention to the descriptions that he provides. His current girlfriend sometimes comes with him and also tells me how she is doing. Over time, we witness the progressive physical and psychological downward spiral that leads her boyfriend to his death.
In the aftermath of the burial, she is despondent and keeps in touch with me at the hospital. One day she asks for my personal phone number, which I give to her. In the ensuing weeks her morale goes further down and she frequently calls me at night because she cannot sleep. This taxing relationship continues until she finally heeds my advice and begins seeing a psychiatrist when she starts to have suicidal thoughts. He treats her successfully. Though I am pleased with her outcome, I wonder whether I should have given her my home phone number in the first place.
Lesson for the doctor: Maintaining a private space can be difficult when patients share trying times with you. Hard choices must be made, but the patient’s best interests should always prevail.
Yann Meunier, MD, is the health promotion manager for the Stanford Prevention Research Center. He formerly practiced medicine in developed and developing countries throughout Europe, Africa and Asia. Each week, he will share some of his experiences with patients in remote corners of the world.