"I've never ridden in an ambulance before"

The reason for appointment read "follow up for cough." Reading through the notes, I see several visits over the last few months for the same reason, cough. Something didn't feel right.

I walk into the patient's room and introduce myself. He looks thin, anxious, fragile. He tells me about his cough, how it's been going for a few months, how thinks he might need some antibiotics this visit. He goes on to tell me how he's developed diarrhea in addition to his cough, how he's lost 25 pounds in the last 3 weeks, how he feels weak, how he has unresolved skin rashes on his sides. Something really doesn't feel right.

I do a physical exam. I don't hear anything in his lungs the first time. Listening again, there is something in his right lower lobe, but it's not typical pneumonia. His chest xray from a week ago was perfectly normal. I continue my exam. He's breathing fast, his heart is beating fast, he is not doing well. I look at his abdomen, the rash is still there. There is fungus on his toenail that just isn't going away. I ask him to open his mouth, so I can look in his throat. My fears and suspicions are confirmed. His mouth is covered in thrush. I try to remain calm and tell him that I will be back in a few minutes with the doctor.

My heart and thoughts racing as I leave the room -- "Oh my gosh, oh my gosh, oh my gosh. My patient has HIV, and he doesn't know." I scan the records looking for a previous HIV test. I don't see one. I tell the doctor about him. We go in to see him together.

She asks some of the same questions. She also asks about his sexual history. He seems uncomfortable talking about it. We measure his oxygen, and it's low. The doctor explains to him that due to his unstable vital signs and low oxygen that we're going to have to call an ambulance to come take him to the hospital. She then tells him that based on his signs and symptoms that he most likely has HIV and a pneumonia caused by the HIV that they will treat in the hospital. She then asks him about which hospital he would like to go to and we leave the room.

I go back in to check on him. I ask him how he feels about what the doctor just told him and if he has any questions, and he replies "Well, I've never ridden in an ambulance before." I don't know if he just didn't process what the doctor had told him or if he was in denial, but he wasn't ready to about it.

Medicine just got real.