‘‘Coming Out’’ as Patients 157
My friends might guess. They look at my eyes, and there is a
common understanding that I might not be telling the truth. I
might describe my husband’s neuropathy as a complication of the
chemotherapy, not HIV. But I think there was a sign of agree-
ment between us: that I would say what I wanted, and they would
not ask.
In essence, Mathilde communicates: I know that you know that I am not
divulging the whole truth.
In various social contexts, norms prevail against prying. Boundaries
and mild violations are recognized; and a certain level of trust remains.
Still, prevarication required constant vigilance, and even performance.
Mathilde continued,
We were great actors. I could put on such a face! My dearest friend
would sit next to me, and I found myself saying things that might
raise a suspicion, and immediately had to put the defense up. I gave
the most incredible explanations about what was going on. I needed
to tell people that this was happening to me, but I had
to hide.
These doctor-patients thus revealed a wide spectrum of approaches to
disclosure, shaped by a range of factors. In general, those who disclosed
diagnoses fully had fewer fears of discrimination, because of the severity
or type of the diagnosis, the type of workplace, or the sense that they had
less to lose. Other doctors faced troubling moral choices, and often opted
for closetedness—though at a cost.
The Costs of Silence
Silence could serve as an alternative to disclosure, but carried a high price.
As suggested, concealment of an illness could hamper seeking care. HIV
raised these concerns dramatically, but was hardly unique. Those ‘‘in the
closet’’ about a diagnosis encountered difficulties going to medical ap-
pointments during the day. Psychosocial stresses could increase. For ex-
ample, as a surgeon with HIV, Jerry could not ask for time off when his
partner was sick. Jerry worried he would lose his job, and didn’t even call
in sick during a crisis—when his lover became acutely ill on an out-of-state
vacation.