Thursday, February 17, 2011

Is 'honor' more important than your wife's health?

Few days ago a doctor who is well known to me called to ask the diagnosis of one of his distant relative who is under my treatment.
 I hesitated.
 I asked him why you were asking that question.
He said that the guy was admitted in a critical condition in another hospital.I asked further details and realised that the patient is in deep coma and not in a position to give consent  to reveal his diagnosis.
Then I told the doctor that his relative was under my treatment for last 5 years for HIV related illnesses. He was very surprised.Nobody in the family it seems know about it. But I was not surprised.

Let us call this guy Mr K.
He was referred to me 5 years ago by another doctor after he was found to be HIV positive while he was being investigated for recurrent fever. He came alone to me and was mentally a wreck. I could make out that he was thinking about taking his life.
It was very difficult for me to convince him that there is treatment for this and everything is not lost. I told him you can live as near normal life as others if you take proper care and regular medicines. Then I told him that his wife has to be tested.
 He said he cannot tell this to his wife as she will be shattered and the family life will be doomed.
" It is better for me to take my life than to tell this to my wife".
"OK you should tell this after some time.But meanwhile do not have any sexual contact,I warned".
He agreed.
Every time he come to me I used to ask him about informing his wife and he was adamant that he cannot.
I continued to prescribe medicines and monitor him. He was doing fairly well continuing his job and doing everything he need to do as the head of the family.
He did not attend my OPD for last few months and I was wondering what happened to him. I was afraid he was not taking medicines properly and his illness must have exacerbated.
What I was afraid of happened.
Just now I received a more dreaded news. His wife was also tested positive for HIV, though she appears relatively healthy at present.
Was she positive at the time of her husband's diagnosis? Or did Mr K broke the promise he gave to me and had sexual contact with her even after knowing he is positive.I hope it was the former.
 If she was already positive and I knew it I would have been able to manage her health better.Should I have insisted on bringing the wife and telling the truth before prescribing medicines for Mr K?
Why Mr K refused to tell the truth and test his wife?

Is 'honor' more important than your wife's health? 


Indian Home Maker said...

This was extremely irresponsible of this man. If he has told his wife in time, you would have been able to either prevent or atleast start her treatment in time.

We have weird notions of honor, and fear of public opinion,that become more important than one's family.

dr.antony said...

There is still the taboo related to sexually transmitted diseases.But it is not so in other countries.We had a visiting consultant from the UK,and he told me,there is nothing unusual about someone found with the diagnosis of HIV.They lead normal lives.
This is a difficult situation.
We need the consent of the patient to reveal any information related to his illness.I would leave the choice to him.By all probabilities,the lady would have been infected earlier.The only hurdle is not following up her and denying her of treatment.I would have found some way to discuss the matter with his wife,after properly priming her up. But you have the right to do it now.
Sometimes,these are matters of serious consequences.The whole family get involved.It is still a bad reputation.He probably did it for the sake of his children.

kochuthresiamma p .j said...

it's not easy to be a doc. isnt it? you have to take decisions which in hindsight appears wrong. you should not blame yourself. a doc deals with human beings, the most complex of all creation. you can do only what you think is right.

Charakan said...

The man died and her wife seems to be in good health now though she is positive.She needs close follow up.
It is our feudal and patriarchial mind set that needs to change.

Charakan said...

Dr Antony,
Yes as society gets used to it stigma should wane.Compared to say 10 yrs ago even in our place the stigma has considerably reduced. She might have been already infected. Still I wish I hnadled it differently.In future I will learn from this and try not to repeat it.

Charakan said...

KPJ, Thank you for the encouraging and comforting words. Yes better not to look back too much but at the same time learn from mistakes.

Sarina said...

kudos to you for sharing this with us - but for this kind of mindboggling situations you cannot take blame on yourself - continue your good efforts to make life good to others.