About 1 week ago a 25 year old man named Isaac was admitted. Isaac was a muscular man with some irrational behavior, headache, fever and numbness on the right side of his body. He was HIV positive so one first thinks of Toxoplasmosis or Cryptococcal meningitis when there are neurologic signs in a HIV patient. HIV itself can cause an encephalopathy. Isaac's spinal tap did not show crypto but his blood test revealed Toxo. He was started on both HIV meds and Toxo meds. He showed improvement for a couple of days but then slipped into a coma with no movement of the ride side of his body.
His mother speaks very good English and yesterday I was able to inform her and his brother that Isaac might not recover. Unfortunately Isaac passed away this morning.
I felt good about the fact we were able to have yesterday's conversation and that the family had some warning. Frequently the language and cultural differences prevent me from communicating well with patients and family. It is a reminder to me to speak clearly with my body language so patients and family know I am trying my best and care.