158 Becoming a Patient
On the plane, he was very sick. He went to the hospital. I came in
to work at 9:00 A.M . At 9:30 A.M . he died. I couldn’t take the
day off, and worked that whole day. I couldn’t say, ‘‘Can I have
another week off ?’’ I was angry: if I had a wife with breast cancer,
I wouldn’t have had to go back.
Both gay and HIV-infected, Jerry faced double stigma.
Secrecy may impede the start or maintenance of needed treatment.
Since Larry, who had HIV, was starting a fellowship, he feared that ini-
tiating treatment through his insurance would ‘‘out’’ him, so he did not
take meds. In the OR, he feared he would be unable to hide side effects.
‘‘Things are stressful enough without having to deal with diarrhea. . . .’’
Yet, in the case of disorders or treatments that cause immuno-
suppression, nondisclosure can prompt situations in which one is ex-
posed to potentially lethal infections. Such exposure led Roxanne to dis-
close her cancer, but left Larry working in constant fear. He felt helpless,
scared of discrimination and added disease. He highlighted tensions be-
tween professional responsibilities and personal needs that extended
well beyond HIV alone.
Hepatitis C and TB are my two main concerns. One patient needed
to be intubated because of multidrug-resistant TB. I just put my
mask and gloves on. What am I supposed to do? I can’t sit there
and say, ‘‘We have to call someone else because I’m HIV-positive,
and am putting myself at risk.’’ I showed up. This person was dying
of TB, looked terrible. Under my breath, I said, ‘‘fuck!’’ Patients
who need a lot of transfusions or have hepatitis B are my other
concern. I try to keep my gloves on at all times. But powder from
inside the gloves gets everywhere. It sounds silly: hepatitis B or
dry skin? But after I’ve been in the OR for twelve hours, powder
covers my hands. That can drive you crazy.
Fears of being outed led some ill physicians to hide their diagnosis even
from the doctors who treated them. Larry was hospitalized at his insti-
tution when he developed a blood clot, but he felt he couldn’t tell the
physicians there that he was HIV-infected, so he didn’t. A colleague re-
commended such silence. Before Larry was admitted, this friend and co-
worker paged him to warn him:
He said, ‘‘Unless you’re convinced that the HIV has something to
do with this, don’t say anything.’’ He knows this department better