The following is an opinion article by Doc Martyn from the Pattaya/Buriram Medical Club. His opinions are entirely his own and may not necessarily reflect those of TPN Media, its staff, owners, advertisers, sponsors, contractors, or affiliates. TPN Media publishes a diverse range of opinions and you are welcome to submit your own for review for publishing. As a company, TPN media maintains a neutral and unbiased position on all major and polarizing issues but encourages freedom of expression and opinion.
The following are abridged notes from Pierre, not his real name, a 51-year-old French national living in Paris:
Received May 6, 2023.
- Hi, I just saw your profile on a FaceBook group and I was wondering if you could help me in any way. To be short, I am supporting my friend Ta, not his real name, who is in Nakhon Pathom Public Hospital. He is Burmese and doesn’t have access to free care in Thailand, and I am paying all the fees. He is fighting for his life. It is difficult, with language issues and my lack of medical knowledge, to understand what is going on.
I would appreciate your help with getting more accurate information. I know Ta and I are complete strangers to you, but I am desperate.
I asked Pierre to forward all the details he had about Ta.
Received May 7, 2023, these notes are also abridged:
- He got covid last year and since September 2022, he was coughing and had issues with his lungs. He was told that these were just the long-term effects of covid.
In January, his lung infection got worse, and he was diagnosed with HIV.
In February, he started to lose consciousness and memories.
He had to go back to his parent’s home in Nakhon Pathom. He was admitted to a hospital where was treated for various infections in his body. After 1 week Ta was sent home because his parents (who are poor farmers) could not afford to pay. They are Burmese and don’t have healthcare or medical insurance in Thailand.
I live and work in Paris but managed to get time off work and flew to Thailand in March. Ta was semi-conscious and unable to walk or talk, he required immediate hospitalization. He was readmitted to the local hospital and I covered all his hospital expenses till today.
- He has been in the hospital since mid-March. The doctors diagnosed an infection in his left brain. After different blood tests, MRI, CT scans, and spinal fluid extraction, they could not identify the type of infection.
End of March, he got brain inflammation and swelling (Encephalitis) and was put on life support.
His CD4 count was only 10.
Ta is now under treatment with antibiotics against all types of infections (viral, bacterial, fungal). It is going to be a long journey of recovery as his brain infection is very serious.
Updates throughout April: Ta is managed by a general doctor, a neurologist, and a specialist for infectious diseases. His condition fluctuates:
-Consciousness: He is still unable to talk or follow orders.
-Lung infections: His lungs improved 2 weeks ago and his oxygen was reduced. But last week, he got another infection.
-Liver: In bad condition but better than when he started the treatments.
-Brain: From my understanding, Ta has 2 infections in his brain, one has reduced and one has spread.
- We (Ta’s family and I) were questioned by the doctors about different matters:
-We decided not to resuscitate Ta if his heart stopped.
-Today, the doctor asked us if we agreed to do a tracheotomy. I would like to get your advice on it, knowing that both solutions are risky in Ta’s condition?
-Last week, the neurologist proposed the option to do a biopsy to try to get better results. He told us that the neurosurgeon in his hospital was against this solution. However, the neurologist knows that a hospital in Bangkok can do it. I asked him about the costs and risks of this surgery, but I don’t have a response yet. I have been told that it is very risky in Ta’s condition. Would you have an opinion on it?
- Comment: Ta had been diagnosed with HIV (Human Immunodeficiency Virus), but the aforementioned story indicates that Ta had developed AIDS (Acquired Immunodeficiency Syndrome), the illness caused by an HIV virus infection.
Ta’s CD4 count was only 10.
CD4 is a protein that serves as a receptor for T-Cells, the white blood cells at the forefront of the human immune defense against infection. The CD4 count is an indication of the body’s capacity to react to infection. The normal CD4 count is 500-1600 cells/mm3. Under 200 cells/mm3 is diagnostic of AIDS.
Ta was seriously compromised by his AIDS. He was suffering overwhelming infections in his lungs and brain by opportunistic infections, which gained an advantage due to his compromised immune system. The lung infection aside, Ta had two ‘infections’ in his brain, one which had responded to appropriate treatment and one which had not.
My opinion: The ‘spreading infection’ was not an infection but nascent cancer, a Lymphoma, commonly found in AIDS sufferers.
- My conversation with Pierre on May 8, 2023:
-Ta will inevitably succumb to his illness. Even if he improves and gains a further 6 months of life, his quality of life would be intolerably grievous.
-Ta is suffering; infection of the brain, encephalitis, and cancer of the brain, both of which are painful conditions. Due to his cognitive impairment, Ta was unable to express his suffering.
-Ta should not go to Bangkok for surgical exploration of his brain.
-Withhold the tracheostomy until I review his case.
My position on Ta’s management; despite the wishes of Pierre and Tai’s family, Ta should be afforded adequate terminal care to allow him to die with dignity and in comfort.
- On May 17th I drove to the Nakhon Pathom Hospital where I expected to find a patient in significant distress, which was what I found, see photo. Ta was barely conscious, as he had been for the past week. He would intermittently grimace and raise his left arm to his face, signs that, despite his morphine IV, which was running at a woefully inadequate dose, he was suffering significant discomfort and pain, akin to a continuous migraine headache.
To release the pressure in his brain I gave him parenteral Dexamethasone 6mg.
He was then prepared for discharge; his intubation was removed along with his morphine drip. His nasogastric (NG) tube was left in situ. Once the respirator was disconnected, he was able to breathe spontaneously. He remained on oxygen.
Once home the family made him comfortable. The grimacing ceased and he no longer moved his left arm. It was clear that Dexamethasone had been effective.
Before leaving that evening, I gave Ta an additional parenteral dose of dexamethasone 4mg. As I have discussed in previous MBT posts, Dexamethasone is an extremely powerful steroid, a ‘steroid on steroids’, which reduces inflammation. The purpose of the additional dose was an attempt to increase Ta’s level of consciousness.
The treatment was a success. In the middle of the night, whilst his mother gave him a bed bath, Ta began to smile as he reached out to touch her. The family was overwhelmed with joy.
When I returned the following morning, Ta was struggling to breathe. He was dying. I removed his oxygen mask and gave him alprazolam 0.5mg x 6 through his NG tube to put him to sleep. Having ‘said goodbye’ through the night, he passed at 11.45hr that morning. This was a good death and in accordance with the principles of euthanasia.
- I am quite fond of the sexual fluidity in Thailand. Thais can do as they wish to their bodies, but they are not able to change their original designated sex. Males remain males and females remain females. And nobody cares. It is their body and changes are accepted without criticism and judgment.
In contrast, I (The author) find the LBGTIQ+ movement particularly offensive. In the UK, only 2.1% of the population identify as LBGTIQ+. Yet they persistently force their opinions, their deviance, and their perceived rights upon society, which normal folk is expected to accept unconditionally. The LBGTIQ+ movement is not only about the freedom to do as they wish with their bodies, it is also about liberated sexual freedom.
Ta, casting caution to the wind, became involved in homosexual hedonism, and after 10 months he succumbed to a highly aggressive HIV infection.
Sexual freedom has consequences.
AIDS is: “a terrible illness”.
Ta was 24 years old.
Photo: Doc Martyn, released with permission.