Monday, March 14, 2005


“So Mr. Flores what’s wrong”
“For the last two weeks I feel like I can’t breath. I’ve been having fevers like crazy doc”
“How about chills?”
“I’m freezing”
“Do you know your CD4 count?”
“No, But it’s low doc”

It was low and quite concerning. The Human Immunodeficiency Virus (HIV) attacks the immune system of its host, eventually rendering it incapacitated. It does this through multiple mechanisms. The most significant of these is its attack of a specific type of immunity cell called a CD4. This particular cell is so important because it coordinates the response of the entire immune system by first recognizing the intruder and then recruiting the appropriate components of the immune system to destroy it. Thus the attack of the HIV virus would be analogous to a football team tackling the defensive coordinator, unfair but highly effective.

The amount of CD4 cells left in one’s serum can give an indication of the viability of the patient’s immune system. CD4 counts of less than 200 are worrisome and signify a progression from having HIV to the Autoimmune Deficiency Syndrome (AIDS). This is an important distinction clinically because the patient is now at risk for infection by other less common pathogens.

Mr. Flores had one CD4 cell. ONE CELL.

This information became available after I drew a whole bunch of test tubes, including two sets of culture bottles, from his arm. As I headed back to our conference room my intern informed me of the meager count.

I imagined this last CD4, fighting for survival, fending off intruders, the last standing Mohican. How valiant he triumphed as he traveled up the Vena Cava annihilating a Staph Aureus Bacterium. Upon entering the right ventricle on his way to the left side of the heart it destroyed a strep colony with a sting of its mighty sword, narrowly saving Mr. Flores from life threatening endocarditis. As it was thrust out to the Aorta it opted to survey the left arm. Making his way down the Axillary artery ready to destroy whatever cellulitis may be brewing. On its way back the heart it stopped at the cubital fossa, just above the elbow, to survey that all was harmonious and to rest, exhausted from his constant struggle. He was tired but gratified at his work, recognizing that he was the only thing standing between life and overwhelming sepsis, fighting to death to save Mr. Flores.

I like to draw my bloods from the cubital fossa.

On my way back to the conference room I heard my intern scream out at me. “Mr. Flores has a CD4 of 1”. Curiously, I raised the serum filled test tubes to my eyes, closely inspecting their inner contents. Could I? Did I?

I could swear that somewhere from deep within my chemistry tube I heard a faint whisper. It was noisy in the hallway and so I’m unsure if what I heard was correct. It was quite low pitched and its tone was that of a defeated exasperated warrior, but it sounded like it said

“You Bastard”