160 Becoming a Patient
could influence work performance. But due to closetedness, not all sick
doctors could have themselves watched in this way. Suzanne, with bipo-
lar disorder, said sadly, ‘‘It would be nice if somebody knew, because it
could really take a load off me: What if I decompensate’’ (that is, become
significantly less able to function)? ‘‘It’d be so much easier if someone knew.’’
Colleagues ignorant of a physician’s diagnosis could unknowingly be
insensitive. For example, colleagues commented harshly to Suzanne about
her weight gain. ‘‘One resident is a real pain in my ass. Every day: ‘Did you
go to the gym?’ ’’ Another supervisor thought Suzanne was just slothful.
Again, she felt powerless to unveil the truth. ‘‘I was sleeping fourteen
hours a day, and was hypothyroid from the lithium. He just thought I was
lazy, and treated me poorly.’’
Silence about one’s diagnosis can be used against one. Suzanne wanted
to tell her supervisor that she was dealing with other stresses besides
those of residency. But she felt she could not let him know.
Sometimes it’s right on the tip of my tongue. The program director
says, ‘‘You’ve been a little impulsive.’’ I want to tell him that my
level of functioning is actually pretty miraculous.
Reticence can also foster isolation. By not disclosing to his coworkers,
Ronald, the suburban Connecticut radiologist with HIV, felt ‘‘separated’’
from them. Ironically, this distance became reinforced—partly self-
imposed: ‘‘they don’t really know who I am.’’
Maintenance of secrecy consumed enormous energy. Mathilde de-
scribed the devastating fallout:
It erodes you: You have to hide it, as if you had committed a
sin. . . . There was a curse upon us: we couldn’t tell our friends.
Keeping it hidden stressed our kids, too.
Again, the information, as a secret, assumed a force and life of its own.
‘‘Secondary secrecy’’ can result, keeping others’ awareness of the con-
cealment itself hidden. At his hospital, Larry now had to make sure that
people were not cognizant that a coworker knew.
Just one person in my department knows. I go out of my way to
protect him, because if people find out, they could go after him:
‘‘How could you encourage him to join our department, knowing
his diagnosis?’’