Week 6: Allison [A Letter from the Student]
Dear Dr. Glesby,
The gallery label was below at eye level.
Maybe, one of these patients passes by a sign. It reads “Do you have trouble taking your daily HIV pills? Participants Needed for HIV Research Study!” And they might think, yes, I hate taking these daily medications the size of horse tranquilizers. Or so, so one of the enrolled patients told me as I observed his intramuscular injection for long acting cabotegravir and rilpivirine at 24 Baker at Weill Cornell.
You, Dr. Glesby, had explained to me in the weeks prior what drug therapy had consisted of during the early days of treatment: thumb-sized antiretrovirals taken three times a day at strict 8 hour intervals alongside a minimum of 1.5 liters of water to maintain kidney functionality. In comparison, the dosing schedule of Cabenuva was a simpler monthly shot . It had only recently been approved by the FDA and still had other obstacles to face -- setting up clinics for distribution, insurance negotiations, the cost of training and administration by nurses -- but it could also potentially assist in increasing adherence for patients with substance use, mental disorders and improve the experience and satisfaction of medication with others, as well as providing more treatment options. It was a solution supported by the previous use of long acting injectables in psychiatric medications and birth control, medical care that also receives stigma and adherence challenges.
The patient was directed to lay on the exam table, sitting bones and pelvis exposed. As Nurse Rebecca disinfected the area and prepped the site, he told me about he was born at this hospital, his struggles with cocaine use, his wife who got him stable, and how much he hated pills. Nurse Rebecca showed me the procedure, a quick jab perpendicular to the muscle located where the cabotegravir could be deposited and not where a nerve could be damage before slowly squeezing the plunger of the syringe. It was a long needle. He had been through this so many times, he could direct the clinical trial, he joked.
"Filling the gallery with pill-shaped mylar balloons, Magi© Bullet in part functions as a metaphor for seeking a temporary remedy for an illness—physical or social—rather than examining its root causes. As the balloons’ helium levels decrease, they fall; you are invited to take a deflated balloon home with you. The installation thus gradually disappears over time, evoking the lives needlessly lost to aids because of state abandonment—and prompting comparison to the current global pandemic and the harm it’s wrought on our most vulnerable communities."
Though I looked around, no balloon fell for me to take home. Perhaps they wander through the exhibits and galleries , looking for something or someone to catch them.
---------------------------------------------------------------------------------------------
By week six, coming by the Chelsea clinic every Wednesday to observe medical care felt as routine to me as it might for the patients coming into the clinic for their needs and exiting back into the world.
Unlike the clinic rooms in Chelsea, the clinic room used for monthly injection administration had tall ceilings, with a view of the river, Roosevelt Island, and Queens. It also had a wall of binders of clinical trial forms, data, and questionnaires beside the desk that the nurse, Rebecca, manned as she contacted the investigational pharmacy 24 floors and one basement below for the time and order of the intramuscular injectable suspension.
The patient was directed to lay on the exam table, sitting bones and pelvis exposed. As Nurse Rebecca disinfected the area and prepped the site, he told me about he was born at this hospital, his struggles with cocaine use, his wife who got him stable, and how much he hated pills. Nurse Rebecca showed me the procedure, a quick jab perpendicular to the muscle located where the cabotegravir could be deposited and not where a nerve could be damage before slowly squeezing the plunger of the syringe. It was a long needle. He had been through this so many times, he could direct the clinical trial, he joked.
She joked back at him. "You're lucky to not be on the control group, so many people there enrolled wanting to get the injections but now they had to patiently wait for months while remaining on strict oral therapy." And then she jabbed him on the other side with rilpivirine. She was great. He laughed afterwards. It was like catching silver falling from the sky.
-----------------------------------------------------------------------------------------------------------------------------
I have tremendous respect for the doctors, nurses, social workers, and administrators who all work together to assist the underserved, the stigmatized, the newly infected, and the survivors of HIV. It was equally in the big things and little things. How a director of the Cornell Clinical Trials Unit would reserve time each week to continue to see patients at clinic, or voice empathy and reassurance to hospitalized ones. I've been very fortunate in my mentorship to have received glimpses into the clinic, the clinical trials, and to have been mentored by all the wonderful people who have made it their purpose to care for the lives of others.
To those who mentored me, the balloon catchers, thank you.
Allison
Comments
Post a Comment