154 Becoming a Patient
embarrassed him. He was weak, had urinary incontinence, lost a tremendous amount of weight, and had that typical cancer complexion.
Individuals may also refrain from disclosing their illness because they have trouble accepting it themselves, minimizing or denying it. Denial is difficult to define. Used by Freud to denote a psychoanalytic defense mechanism, it has since been widely and more loosely adopted and employed in society at large. Many of these ill physicians used the term in describing their own behaviors and reactions.
Being‘‘ Outed’’
Though a doctor may seek secrecy, nonverbal communication or visible symptoms can occur. Those who display apparent,‘‘ public’’ symptoms may be particularly vulnerable to discrimination.
Codes and gestures can indirectly disclose diagnoses. Deborah did not tell anyone until her symptoms became evident: when her hair fell out. She then wore scarves, only to have people ask her about them.‘‘ I didn’ t want to wear a wig. Everybody said,‘ Is this a new style?’ People knew, but didn’ t say much.’’ People may‘‘ know’’ but feel awkward talking about it, either because it makes them uncomfortable or because they are not‘‘ supposed’’ to know.
Medication can also expose. Consequently, some felt compelled to divulge their illness only at the point at which they started treatment. Jerry, the surgeon-lawyer, feared that filling prescriptions in the pharmacy would unveil his diagnosis, so he‘‘ came out’’ and retired at the point he needed drugs.
I was getting my T-cells done anonymously. But once I needed to start getting prescriptions filled, the only way to do that and still work would be by disclosing, because people in the pharmacy would see. Someone would find out.
Medications that involve complicated regimens( i. e., dosing during the day, ingestion with or without food, or refrigeration) forcefully challenged the maintenance of privacy. Fears of these logistics can delay treatment initially. Steven, the suburban endocrinologist with HIV, started meds, but in his office he had to hide them. Unfortunately, secrets assume power in one’ s life.