168 Becoming a Patient
wouldn’t ask. They were just waiting for him to tell them. After
he was hospitalized, people started to come forward and ask.
But the staff wouldn’t answer. It might have been their denial, too,
even though the guy had lost thirty pounds and looked like hell.
In fact, Stuart continued, this hospitalized doctor went so far as to lie
to everyone about being sick. ‘‘He denied all this: ‘Why do people keep
thinking I have AIDS?’ He had been hospitalized for CMV, a fairly AIDS-
specific opportunistic infection.’’
Patients, sensing implicit norms and taboos, may reveal their concerns
only indirectly. Ronald, the suburban radiologist with HIV, reported,
‘‘People have said things without asking. One woman said, ‘Doctor, I’m
so glad: you look so much better. We were really worried that something
really bad was going on!’ ’’ Here again, this case elucidates broader issues:
that patients may know or suspect a physician’s illness, but feel that
unstated professional-client rules deny them the right to possess that in-
formation, or even to broach the topic. Patients acquire their own sense
of professional norms, even if physicians do not explicitly communicate
or instill these.
Patients want to feel they can depend on their doctors, and generally
desire to establish long-term relationships with providers. They wish to
assume their physician is healthy, and can’t quite imagine he or she is not.
Indeed, when Stuart retired to teach, he sent a letter to patients to inform
them of his HIV. Many utterly misconstrued the message.
I wrote a letter to introduce the subject that three months later, I’d
be leaving, and that my associate was going to take over. . . . I
thought: the next question they’re all going to ask is ‘‘What are you
going to do next?’’ So I just wrote that I’m going to retire, spend
more time relaxing and traveling, and . . . spending some time
teaching at the university. In my mind, that meant that I was going
to be volunteering . . . to teach. Almost universally, that phrase got
interpreted as ‘‘He is a professor at the university now. He doesn’t
have weekend call.’’ They did not scratch their heads over this
forty-five-year-old guy going from working ten to twelve hours a
day to sitting in a cabana with a lemonade. They answered the
question themselves by filling in the teaching at the university as a
full-time job, with some free time to travel. . . . They’d ask, ‘‘Can we
still come and see you there?’’ I’d say, ‘‘Well, I won’t be seeing
patients.’’ I found it easier not to challenge their concept of what