Tell them to be compassionate...

"Doc, you don't want to go into that room" The nurse was giving me heads up. I was about to do my rounds, and although the comment was welcomed I still had to see my patient. As we walked towards the room I tried putting away any prejudice.
So I put on my mask then walked into the room; after all, this was the isolation ward with numerous TB patients. Soon after my entry, I realized that no amount of cover-up could mask the stench that filled my nostrils. I walked to the patient's bed. Her very massive left leg, oozing foul-smelling pus, immediately caught my attention. She was there, seemingly clueless as to what was happening to her body so for her to keep whatever was left of her dignity I had to act normal (even though my nose was having a heart attack). I inquired about her life and the course of her illness. I turned to her husband who'd been standing there the whole time. I had a mask and was complaining about the smell yet this man hadn't left his wife's bedside.

Characteristic KS lesions: violaceous plaques 

This wasn't TB; it was Kaposi Sarcoma, a common condition in AIDS patients. She was 23-years-old and had four children at home. Uneducated, she could barely keep her story straight. Her husband, a farmer twice her age, filled in the blanks often. I was touched by their humility but saddened by reality. So much that I asked Mr Sam, her husband, to test for HIV. When he declined I realized he too must have been dreading the same thing. After addressing his concerns, he finally took the test and..........was HIV positive as well. Giving him post-test counseling was difficult and emotionally draining, but his wife was very sick and needed our complete focus.
Kaposi Sarcoma is a cancer caused by the human herpes virus 8 (HHV8). There are four different forms of KS, but the AIDS-related variant is most likely what my patient had. KS is an AIDS-defining illness meaning that its diagnosis along with a documented HIV infection is conclusive for AIDS. KS can also affect HIV-negative people (as is the case for other forms of KS), but it tends to be more aggressive lethal even in HIV-positive people especially if their immune system is very compromised (CD4 count below 200).
AIDS-related KS isn't curable but the lesions will regress if the immune system is reconstituted with Anti-retroviral therapy (ART). Chemotherapy could be of additional benefit if the disease is widespread as was the case with my patient.

So the cancer team came in and wrote my patient up for chemotherapy. Mr Sam, with a lot of difficulty, managed to pay the 1st of four rounds of chemo needed for his wife's regimen. Unfortunately, she died before we could even administer it. I felt a deep compassion for Mr Sam and his bereaved children.



References:
1) Image1:"<a href="http://commons.wikimedia.org/wiki/File:Kaposis_Sarcoma_Lesions.jpg#/media/File:Kaposis_Sarcoma_Lesions.jpg">Kaposis Sarcoma Lesions</a>" by OpenStax College - Anatomy &amp; Physiology, Connexions Web site. <a rel="nofollow" class="external free" href="http://cnx.org/content/col11496/1.6/">http://cnx.org/content/col11496/1.6/</a>, Jun 19, 2013.. 
2) Image2:"<a href="http://commons.wikimedia.org/wiki/File:Kaposis_sarcoma_01.jpg#/media/File:Kaposis_sarcoma_01.jpg">Kaposis sarcoma 01</a>" by M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara - M. Sand, D. Sand, C. Thrandorf, V. Paech, P. Altmeyer, F. G. Bechara: Cutaneous lesions of the nose.