Finding you were infectious, you would say to the person who wants to marry you: look, honey, I have this disease, and I might give it to you. I love you so much that I don’t want you to catch it, so can we postpone the wedding and honeymoon?
And a normal person, finding their disease could spread in closed rooms, would ask his doctor about wearing a mask at home, about shopping in Walmart (or for Lawyers, Nieman Marcus), and if they could give it to people where they work.
However, legally, a lawyer knows that if a person didn’t sign a paper saying he knew he was infectious, legally that person could claim to a jury that “he was never told” to avoid traveling etc. Indeed, legally even if he signed a paper with all the information, he could go to court and whine he “didn’t understand what he was signing”.
That’s why many police now tape interrogations and even traffic stops: when it’s “he said/he said”, the tapes, like instant replay, don’t lie.
However, most docs figure a patient is a normal human being, who can take responsibility for his or her own life. We figure that a responsible person will keep appointments, take medicine, know that surgery and drugs have side effects, and remember what we tell them.
But none of this is true. People seeing doctors, even rational ones, are often upset or nervous and tend to forget. That’s why we have “hand outs” for disease, diet, and with all the medical side effects, because even if we tell the patient, surveys show that people forget. As for taking medicine, I suspect 30 percent of medicine isn’t taken correctly or for the entire course of treatment. Normal forgetfulness is the reason that most offices call to remind patients of appointments.
I suspect this gentleman “didn’t remember” because he didn’t want to remember. Was it from fear? Denial? Passive aggression? Narcissism? I haven’t the slightest idea. But we docs see all these excuses all the time.
Of course, although the lawyer knew he had tuberculosis and might be infectious, he nevertheless decided to travel.
Yes, it is true he didn’t know he had the multiple drug resistant germ at the time, and how infectious the disease was is unclear from the reports.
Medical note: the danger of spread depends on how many germs are in the sputum, (which takes two weeks to confirm) and in cases where there are only a few germs, you are not considered “infectious”.
As for exactly which strain you have, or for cases where there are few germs, it might take six weeks for the lab to find the germs and identify them.
So by the time that slow test came back, he was already in Rome, and when he heard the news that he was infectious and had a bad strain of the disease, he fearfully flew right back to the USA to save his life, other passengers be damned.
There are also a couple other worrisome details in the case.
The bad news is that he was put on a “stop travel” list, but it was too slow to catch him. Not good news if you are trying to stop terrorists and fugitives.
Also, the newspapers are saying people need to come in and get tested, and one article even quotes a lady who was relieved her “test was negative”.
This is wrong. The skin test takes six to 12 weeks to turn positive, but people with poor immunity (e.g. HIV, cancer, diabetes) could develop milliary tuberculosis (a highly fatal type) quite quickly. But ordinary TB might not show for three months.
The final irony of all this is that wife’s father is a microbiologist who works for the CDC: studying the spread of TB.
Nancy Reyes is a retired physician living in the rural Philippines. She has treated TB in Africa and in the Indian Health Service. Her website is Finest Kind Clinic and Fishmarket, and she writes essays at Heydoc Xanga blog