My patient ran away from the hospital.

This ordinarily is almost common place for a hospital bordering the south side of Chicago. In the last two years at the hospital, I had first grown surprised, and then helpless and finally weary to such mysterious absconding. This time however, it struck a chord.

Long before Mr B ran away, I had an inkling the new diagnosis of HIV would be difficult for him to accept. I had thus decided to recruit the help of counselors to join me discuss the diagnosis with him. If that was a thoughtful decision, it wasn’t any useful nonetheless. My patient showed little emotion during the discussion of his new diagnosis; however a little while later he was nowhere to be found.

Patients usually bolt out of the hospital because the pull of the street is too strong for them to resist. They come to the hospital when their bodies can’t take it anymore, but as soon as their as they gain any bit of composure, they are out of  the door. I have however, thus far, not had a patient who had bolted out because he was apparently traumatized by his new diagnosis.

A few years ago when I was a doctor halfway across the world, patients met a similar diagnosis with uncharacteristic resignation. Young housewives, growing up in grinding poverty, social oppression and lack of education had never really had any say whatsoever about how their lives had shaped up thus far. So if their husbands came home one day and then gave them the virus, that was just another of the upteen unfair hands life had dealt at them; there wasn’t anything for them to say or react about that. While their predicament was  profoundly unfortunate, their reaction was absolutely muted.

To these women HIV meant perennial ill-health, and burdensome stigma and discrimination in what was already a much marginalised existence. Here in America such barriers were not easily visible: treatment options were available and stigma if any was banished to the underground. Examples abound of people who had been able to overcome the crippling effects of the infection and lead a healthy and productive life. Rights groups and patient advocates were available. More importantly, my patient here had made informed choices about his own life; he had the chance to be the master of his own destiny. So while I had expected him to be shaken by the diagnosis, his running out of the hospital took me by a little surprise.

A few hours later, we traced our patient, and he returned to the hospital. He was visibly sorry for having run out, but it was not hard to gauge that he had been overwrought. By his own description, he blanked out and did not know what to do, so he ran away in a nervous frenzy.

I could not help rationalise how upsetting this new found diagnosis must have been for Mr B, but then my mind did a throwback to those housewives half way across the world; for them even an upset emotion was a luxury they could not afford; the grind of an overly unfair life had blunted their emotional responses to such an extent, their bodies did not even know how to react to a horribly unpleasant event. These women had been robbed of their ability to emote.

Such reminder brought me peace of mind- Mr B might as well have tripped into a hole right now, but is was no where the bottomless hole life could summarily consign you to. So what if he ran away from the hospital, that still is much comforting than an unaffected silence and an emotional void for a response.

Kiran Raj Pandey is an internal medicine resident who blogs at page59.

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