Susan looked into the lounge. No Luka. Today, for the first time since Luka had come back to work a month before, the two of them were working the same shift. But she'd barely seen him all day. It almost seemed, she thought, that he was avoiding her. Every time she saw him in the hall, he would disappear in the other direction. And since he was still being kept on general medical cases, her time had been largely occupied with several traumas that had come in during the morning.
Still, why was he suddenly avoiding her? She'd hardly seen him for the past few weeks. He almost always claimed to be too busy to see her when she called; sounded tired and distracted when she spoke to him, but had refused to tell her what was wrong. On Saturday she had talked to him, and he'd told her, disappointed, that Kerry had said he couldn't go back on a full schedule yet, but when she'd offered to stop by and chat, he had made an excuse. Could he still be uncomfortable after their dinner a couple of weeks before, when she had hinted moving their relationship forward? Had that been enough to make him back off? Was he trying to tell her, in the only way he could, for her to back off?
Things had slowed down a lot. Nothing the med students and residents couldn't handle for half an hour. She hadn't had lunch yet. Maybe she could get Luka to have lunch with her, talk about this. But where was he?
"Frank, you seen Kovač around?"
"I think he's resting in the on-call room. He said he wasn't feeling well. Didn't look too great either."
Susan opened the door to the on-call room and stopped, startled. Luka was standing in the far corner, looking deathly pale. As she stood there, a wave of coughing - clearly not the first, hit him.
She was at his side in a moment, holding his shoulders, supporting him. She felt him flinch a little at her touch, but he didn't pull away, he didn't seem to have the energy to. She could feel the heat radiating through his shirt, through his lab coat. When the spasm had passed, she said, lightly, "That didn't sound so good, Luka."
"I'm ok... it's just the flu. I was thinking about going home ... it's pretty slow ..." then he choked as another wave of coughing hit - dry, hacking, painful.
"Let's check you out first," Susan said, when he could listen again.
Luka shook his head. "No ... I'm ok ... it's nothing." The coughing spell had left him gasping for air. He looked a little dusky now too.
"You look awful. And you're burning up."
"The flu will do that ... and I've been pushing myself pretty hard ... since I came back to work ... letting myself get run down." He was still breathing too fast.
"You've been working two shifts a week," Susan reminded him gently, trying to hide the fear in her voice. "That shouldn't be too much. Come on, Luka, humor me. I think Exam 3 is open. We don't have to make a big deal of it. Let me just check you out, listen to your lungs, make sure there's nothing seriously wrong."
Luka sighed, and grabbing his crutch, followed Susan into Exam 3. "Slip off your coat, and hop up there," she told him. "How long have you been coughing?"
"Like this, two ... three days maybe. A little bit of a cough for a week ... maybe a little more ... before that."
"Productive?"
"No."
"Any shortness of breath?" Luka nodded, not looking at her.
Susan checked his temperature with the ear thermometer. "102.7," she said. "How long have you been running a fever?"
"I'm not sure. I haven't taken my temperature ... probably just a couple of days."
"Ok... let's hear what your chest sounds like ... deep breath." Susan listened as Luka tried to take a deep breath, but had to cough again. But she had heard enough. "Sounds more like pneumonia than the flu, Luka." Luka just nodded, and Susan knew that she wasn't telling him anything he didn't already know. "Let's check your sats ..." Susan dragged the pulse ox over and put the clip onto the finger that Luka reluctantly offered her. She took a deep breath herself. "Ok... your resps are up around 40 and you're still only satting at 90 on room air. I think a little oxygen would help here ... and you definitely need a chest x-ray, and we should consider admitting you."
"No... I'm ok. Just write me a scrip for Cipro and I'll go home and get some rest. I'll be fine."
Susan looked at him and shook her head. Why were men so damn stubborn when it came to their health? She reached for her prescription pad, then something in his eyes made her hesitate. He looked like a trapped animal. And some instinct made her ask, "Are you on any medications?" Luka stiffened visibly; didn't answer. "I need to know before I can write you anything."
"Yeah ... " he finally answered, barely above a whisper. "AZT ... 3TC ... Indinovir..." Susan felt herself freeze, felt her face pale. Then Luka continued more firmly. "It's just for prophylaxis. I may have been exposed. The first test was negative; I'm due for the 6 month test ... soon."
"Ok..." Susan said quietly, dropping her prescription pad back into her pocket. "I think we may want to do the 6 month test now." Luka's only response was a very slow shake of his head. The bravado of a moment before was gone again. "Luka, this looks an awful lot like a severe case of PCP, and if that's what it is, you need to be in the ICU, on IV antibiotics."
"We can just test for the PCP then ... if that's what you think it is."
"You know better than that. An HIV test is faster and more accurate, and, if it's positive, with the clinical symptoms we can start treatment while we wait for the rest of the lab tests. A test for pneumocystis takes longer, and may not show anything." No response from Luka. "Luka ... I know all about denial, but finding out, one way or the other ... is best, isn't it? If the test is negative, you can stop worrying and we can try to figure out what else could be causing this. Whatever this is, I can tell you it isn't the flu."
"I can't," Luka whispered.
"Ok..." Susan took another deep breath. "Did you know for sure if the patient was positive?"
Luka looked up at her, puzzlement in his eyes. "Patient?"
"The needle stick. Was the patient an AIDS patient?"
Luka shut his eyes quickly. "It wasn't a needle stick."
Susan felt herself blush. "Ah... I'm sorry ... I shouldn't have assumed ... my mistake. " And there was an awkward silence, broken only by the rapid, faintly rasping sound of Luka's breathing. It had been no secret, of course, that Luka had been ... less than exclusive the previous year in Chicago, but surely he knew better than to have unprotected sex in Central Africa."Then what ...?" The question came out before Susan realized it.
"Does it matter?" The hunted animal look was back.
"No, of course it doesn't. You know that you can tell me anything, but you don't have to tell me anything either." A beat. "But Luka, we still need to test you, and we need to admit you. You are obviously really, really sick, and the sooner you start treatment the better. Your sats have dropped to 86 while we've been talking."
Luka looked up, and the pain in his eyes startled her. He was fighting tears, seemed to be falling apart before her eyes. "I can't do this, Susan ... I can't."
"I don't think you have much choice."
"I was just ... I had just gotten to where things were getting better ... I was having mostly good days ... I'm working again ... I ... I can actually walk around my apartment now without this damn stick. Hurts like the devil, but I can do it. I thought ... I thought I had a future again." His voice dropped to a whisper, barely audible. "Every time I thought it was over ... it would start again."
"Luka, you're going to get through this."
A bitter look wiped the pain from his eyes. "You must have been absent that day from your infectious diseases class. Hadn't you heard? AIDS is fatal."
Luka slid off the table and pulled the pulse ox probe from his finger. Picking up his lab coat and his crutch, he started for the door.
"Where are you going?"
"I'm going home. I have the flu. We aren't busy, you should be ok without me. My next shift is Saturday, I should be well by then."
"You're leaving AMA?"
Luka turned from the door. "I don't see a chart, Dr. Lewis. This conversation never happened."
