30 year old patient with HIV admitted for altered mental status, tremors found to be febrile. I ask him how he is doing, he is like fine how are you. LP was done and it is positive for cryptococcal meningitis. I have started him on amphotericin B the induction phase which is for 7 days on top of high dose fluconazole. Every day, however I am amazed at how positive this person is. I ask him each and and every morning "how are you". His eyes deflected upwards with a persisted upward gaze, his neck stiff, occasinoally making jerking hand and leg movement he responds, I am fine how are you. That being said, he is febrile every morning despite being on paracetamol (similar to tylenol) at 39 degrees celsius, not to mention I poke him in his back to do daily LPs to decrease his intracranial pressure using a 16 gauge IV catheter (no Lumbar puncture kits here) but still each and and every morning he responds and says I am fine how are you. Fine? with meningeal signs. In the US this patient certain would be already in the hospital with a million pain medications, oxycontin, oxycodone, ativan and still would not be fine-- maybe patients back home are a littler needier? i begin to feel that each and every day. maybe it comes from wealth. who knows.

Today i learnt that trying your best sometimes isn't good enough. You have to keep trying and don't stop when you think it's the best you can do. Especially when it comes to life and death decisions. I'm talking about an HIV positive patient severely anemic coming in with fevers, general body pains, dyspnea, weakness. pallor of the skin and looking at her eyes i could estimate a hgb in the 3 range. very dehydrated. tried many times to get a peripheral IV in- no success. i tried, the nurses tried, the other interns tried. the veins just collapsing. Thsi girl was cold as ice and barely palpable pulses. I knew she needed an IV ASAP and fluids if blood could not be found. I finally made the decision to place a central line. a femoral line which i now am an expert at. The canulation was a success however not suprising very poor blood flow. the problem came with threading the wire. i guess the vein just collapsed each time i tried to thread the wire. who knows. minutes began to an hour, then 2. sweating profusely- until everyone around me told me that i tried my best and we would have to try again in the AM. I kept trying and finally after the third hour I felt that I had to throw in the towel. She was mentating somewhat... but would she be alive in the morning if I left and came back. It was now getting dark outside--- and maybe it was a little peer pressure- i left the poor girl saying we would try again in the morning. I thought of her all the way home. She'll surely die. she's dehydrated. she just has to survive till the Am. then i can try again.
Today I return to find her bed occupied by someone else. I desperately went searching for her among the crowds of ppl lined up in beds. room by room until ultimately i checked with nurses and after a perusal their big book she died at 2:00 am.
so maybe I tried hard, and my best but sometimes when it comes to someone's life you have to keep trying till you are successful. That's what i learned today.