This OSP Journal of Case Reports section is a vignette almanac whose purpose is to provide a record of the emotional climates of the general practitioner, expressed as metaphors of landscapes, geographical features, atmospheric data, lunar phases, sunrises and sunsets, beginning and end of the seasons of the year, winds, tides, etc., when dealing with different clinical cases, with the aim of achieving a greater understanding of what we are and what we do as doctors, and then achieving greater empathy. Here, a vignette of a case of AIDS and related and unrelated diseases in an elderly person with adherence problems is presented. This situation creates an emotional climate in the doctor that suggests the patient seems to be surfing in the water line on the beach with waves that are formed indirectly by the wind.
Emotions; AIDS, Old people; Metaphor; General practitioner
[Long-periodic oscillation of the water line on the beach]
Vignette
Pierre, 63 years old, of Belgian origin, widower - his partner died of cancer two years ago - speaks a mixture of English and French...
He has AIDS [1], type 2 diabetes mellitus, high blood pressure, chronic renal failure and chronic inflammatory bowel disease, liver disease...
He is seen in the infectious diseases department of internal medicine.
- “The tablets they prescribed me in internal medicine... Oh non non non, mon dieu ! I can't take that… non non non mon ami… parce que je vais bien…” [no no no my friend… because I'm fine…], dice Pierre.
-” Je ñ'ai pas eu de coloscopie parce…” [I didn’t have a colonoscopy because…], he explains to the general practitioner (GP).
-”Quand j'ai la diarrhée… [When I have diarrhea...] I eat Camembert cheese and drink Coca-Cola..."
-”When I was in France, I consulted a doctor... eh well, there was a paramedic ... Les gouttes de cannabis sont très bonnes pour moi…”
[cannabis drops are very good for me…]. In internal medicine they tell me that I cannot drink alcohol…, mais par Dieu, comment puis-je ne pas boire de bière quand je regarde le football!” [but by God, how can I not drink beer when I watch football!].
The GP thinks Pierre is a vulnerable patient with suboptimal adherence [2]. He seems to have his own priorities, perhaps as a form of defence, making his own decisions independently of the specialist who treats him, and later seeks the complicity of the GP. Pierre is optimistic despite the fact that he is ageing with AIDS and has been hit by various health problems, which have been successively complicated by AIDS over the last few years with diseases directly related to HIV or its treatment, and by others with no direct relationship [3, 4]: diabetes mellitus, high blood pressure, inflammatory bowel disease, chronic kidney failure, anxiety..., and family problems (death of his partner...) of vulnerability and stigma, and also living in a country that is not the one of his birth.
The GP thinks that Pierre is "surfing" in that area between the coast and the outermost limit of the wave break; a place where the waves break on the coast and on the reefs. Pierre glides, keeping his balance, over the crest of the waves, over the front face of the moving waves..., trusting that they will take him to the shore.
The GP feels that Pierre has prolonged periodic oscillations, as if he were the water line on the beach where the waves break. The oscillation of the water line on the beach is related to waves which are indirectly formed by the wind. Their creation is linked to the presence of short-wave groups with slightly different wave lengths and frequencies. When the waves are in phase their amplitudes are added, and when they are out of phase their amplitudes damp each other out. This results in a wave group structure, which is irregular in shape due to the various frequencies present in a natural wave field in the surf zone [5].
During the consultation with Pierre, the doctor felt that the wind was blowing from the southwest and the water was brown. Chocolate brown. The rough sea was almost completely swallowing the sand and almost pinching the flattened dunes of the place, where some waves bounce off the few and timid sand banks.
-Surfing is a sport for optimists [6], thought the doctor.
- NHS (2024) Overview HIV and AIDS.
- Bouabida K., Chaves BG., Anane E (2023) Challenges and barriers to HIV care engagement and care cascade: viewpoint. Front Reprod Health 5: 1201087.
- U.S. Department of Health & Human Service (2023) Other Health Issues of Special Concern for People Living with HIV.
- Mouzo J (2022) [The challenge of aging with HIV: “People with long-term illnesses suffer from depression, anxiety and cognitive decline.”] El País; 01 DIC.
- The Coastal Wiki (2024) Definitions of coastal terms.
- Castells M (2023) [Surfing is a sport for optimists]. Duke.
