Case
# 2: Mr. NN
Personal Data
Mr. NN was a 46-year-old joiner, married,
and had one son. The couple split up in 1996. Until the end of 1999 he
had regular contact to his son. From 1970 until 1983 NN had been ad-dicted
to drugs, and from 1975 until 1983 he was injecting Heroin. Since 1984
he was HIV-positive, with a HCV-cooinfection. I have known him for ten
years. He liked to discuss, was well informed about up-to-date events,
such as his son´s first day at school or anything that had to do
with his job, and restored old furniture. It was never easy for him to
make a deci-sion, as he always carefully considered all aspects involved.
He regularly came to my office to talk to me, quite often for no specific
reason, just to get some relief or to explain another aspect of a problem
to me.
Mr. NN was infected by needle-sharing
and in the stadium C 3, AIDS, CDC-classification. For a long time he did
not take any antiretroviral therapy.
His social situation was relatively
stable. He lived in a rented apartment by himself, financed his living
by working regularly in a joinery and received additional social welfare
benefits.
For about 5 years he used to participate
in a self-help-group for people with HIV and AIDS. Since Juli 1996 there
had been various attempts to motivate him to start with an antiretroviral
therapy. He talked about his doubts, anxieties and fears in the self-help-group.
Further Development
In 1997 his immune status was poor,
he had only about 50 CD4-cells. NN was almost “clean” and hardly ever used
any drugs. But from 1998 on the situation deteriorated. He had some relapses
and started using morphine and tabletts (barbiturates and benzodiazepine).
He still hadn´t begun with any
antiretroviral therapy although he had been treated in hospital for an
HIV-related skin disease. He had an open, inflamed wound at his chin which
attracted a lot of attention. A beard grew out of that wound, too.
The lack of continuity of the patient
was met by a comparable discontinuity on the side of the medical staff
treating him. From 1986 – 1999 he was treated by 8 different physicians
at the outpatient clinic alone. Eight different ways to approach the patient.
Furthermore he was treated by various other physicians specialised in other
medical fields.
In the middle of 1999 the patient underwent
detoxification therapy at a hospital in the surrounding area in Offenbach/Main.
Until September 1999 Mr. NN still refused
to take any antiretroviral treatment or to take any prophylactic treatment
against PCP.
His physical condition was very bad,
he lost weight, and it was suspected that he was suffering from an HIV
associated encephalopathy, the viral load was more than 1 million copies/ml,
and the CD4-cell count 20.
Because of his bad condition, the patient
decided in December 1999 to start with an antiret-roviral therapy. At first
he took his medication irregularly and not as recommended by the doctor.
Due to the fact that he was rapidly wasting away the regional “AIDS-Hilfe”,
an ambu-lant care service and psychocsocial homecare service were asked
to support the patient.
Up to the point when the patient decided
in favour of taking an antiretroviral therapy, his con-sumption of tabletts
(barbiturates and benzodiazepine) had increased drastically, and had even
resulted in neurological disorders. Since December 1999 the patient took
“his” ART, Combivir and Abacavir, regularly.
At the beginning of the year 2000 the
viral load had dropped to 1,900 copies/ml and the CD4-cells had risen to
150.
But the patient became gradually more
and more desoriented. When he was talking, he for-got what he had wanted
to say, he lost weight, a.s.o.
He neglected himself, lost his apartment,
became homeless, slept in shelters and lost his social competence. He was
put under custody and the ART was discontinued. It is not known whether
he realized what a situation he had brought himself into and whether he
was suffer-ing because of it. His appointed custodian was a lawyer who
represented his interests very well and managed to find a room in a boarding-house
for him temporarily.
Then NN was admitted to a psychiactric
clinic and transferred to a regular medical ward in May 2000. After his
release from hospital he comitted minor thefts, and slept again in shel-ters
for homeless people and drug addicts in the Schielestraße and Ostpark.
He still came to the meetings of the
self-help-group and stole food and Alcohol that was available in the center.
Neglecting himself he lost his values, had minor accidents, skin abra-sions
and bruises. He was regarded as a tramp by the group but his presence was
tolerated. The group represented the only social contact he still had and
they didn´t let him down.
For a short time he was imprisoned
on remand because of a theft and stayed in the prison hospital shortly.
Death
On November 19, 2000 he was found dead
next to some train tracks. It is not known whether he had crashed against
a moving train, had fallen out of it, had comitted suicide or... His fa-ther
organized the funeral.
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