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Concerned and overwhelmed
Jul 26, 2005

Dear Dr.Frascino: I received a call last Friday afternoon concerning my brother. He was placed on the ventilator due to severe SOB. The next morning suffered a massive MI with Troponin level starting at 200 peaking at 274 and on Sunday began to decline to 174. Kidney function became poor - started on CRRT to flush the toxins and help with fluid overload. A brief history: diagnosed with HIV 15+ years ago - recently taken off his medications that had stopped helping and tried on several other regimens as well with no results, CD4 <200 for at least l year that I know of- has been having fever,fatigue,sob for several weeks prior but would not go to his specialist. My question is that the physicians are atating he's critical and that his condition can go either way, but they are waiting on a lab result (PCP) before they can do anything further or inform us of his prognosis. Why do they need this the outcome from my point of view is the end of life discussion needs to begin am I wrong to think this way or is there HOPE in his case? A loving sister.

Response from Dr. Frascino

Hello Loving Sister,

I'm sorry to hear your brother is having such a difficult time. There is no doubt that he is critically ill. However, there is always hope. If your brother has as treatable opportunistic infection that responds quickly to appropriate therapy and if his other complications can be stabilized, it is possible his condition could indeed improve, despite the dire circumstances he is currently facing.

I am concerned that, despite fevers, fatigue and SOB for several weeks, he "would not go to his specialist." It may be that your brother has decided enough is enough, and that he is ready to transition on to whatever happens when we leave our mortal bodies. As a loving sister, I suggest you communicate with your brother. Find out what he wants. If he wants to fight, fight with him. If he's afraid, help calm his fears. If he is nearing the end of his life's journey, help make his passing dignified and peaceful. As a "loving sister", the best and most crucial thing you can do is to be a sister and love him.

Please give your brother a hug from me.

Dr. Bob

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