Each of us suffer from denial – at least to a certain extent. Some of us may be in denial about our poor eating habits, work-out regimens, daily faith, over-consumption of alcohol, a loved one’s death, etc. And, though we may occasionally endure critiques from close friends or loved ones, society leaves us to our own devices and grants us the freedom to believe what we may. That is, until our denial becomes dangerous to others. A classic public health example of society encroaching on individual liberty is the case of Typhoid Mary (denial and education played equal roles in Mary Mallon’s defiance of NY officials).

Today, Carolina and I encountered a man in complete denial about his HIV status. Though he had received a positive screening result in 1998, he refused to follow-up with further tests, treatment, etc. Now, hospitalized for TB and receiving PCP and other opportunistic infection (OI) prophylaxis, he still won’t believe he has HIV. Here’s how the end of our conversation played out:

Sir, it’s written here in your chart that you’re HIV+.

Oh, that’s just because I told them I tested positive in 1998. I took the drugs for a month, but then I got better and didn’t need them anymore. I told them about that, so they (the doctors) wrote it down. I’m still waiting on my test results, but they won’t be positive. I feel fine. Besides, if I ask God, he’ll make sure I’m fine. I don’t know why they wrote that down…I don’t have HIV.

Earlier, we had confirmed that this patient’s western blot (confirmatory test) returned positive with the laboratory personnel. After speaking with his attending physician to ensure we weren’t over-stepping our place, we returned to the patient in another attempt to educate him about his illness.

Sir, we just spoke with your physician and recently spoke to the laboratory staff. Your confirmatory test was positive. You are HIV+.

I don’t believe that. Let me ask my doctor (referring to the medical student taking care of him). She hasn’t mentioned anything.

Sir, that sounds like a great idea. You should ask your doctor more about your results and what they mean. We are glad to answer any questions, too, if you would like.

Are you scared? Can you imagine the consequences of this one man’s denial?

Though some denials are more grave than others, we wonder: is all denial the same? Could my tiny denials in self-perception have huge, but unperceived, consequences on my relationships? Could my denials have a greater effect on others than I think?

The root of all denial is an unwillingness to see ourselves as we are. To stare at yourself in the eye in the mirror. To stand bare before your Maker.

Today, we were reminded of the value of education, honesty as physicians delivering bad news, and the value of self-reflection.

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