He was very well dressed, down to the neat pressed suit coat and silk tie. He carried an expensive tooled briefcase and a Blackberry prominent on his hip. He checked in at the front desk, and sat in the waiting room. When I first saw him, he was a ripple of fashion in a world of stained tee shirts, flip flops, and worn stained jeans. He sat and texted and emailed until he was called. He looked the picture of a well put together executive.
I took him back to triage, and quite another story emerged. He had just been to the AIDS clinic to get his next round of cocktail meds. “I can’t accept the insurance at my new job, because then they’ll know about the diagnosis, they aren’t supposed to….but….they just fired another employee who signed up for the insurance and told them he had the dreaded disease.” He said he went to the free AIDS clinic in the city as “the only way I can hope to stay alive for long”. They had taken his blood that day, and called and sent him to us with a dangerously low blood count. He cried big, heart-wrenching tears- “I guess this might just be the end…I always wanted to be old, but I’m not going to get the chance”.
His story was more tragic than most. In his teenage years, he had been struck by a drunk driver one night while driving home from a business conference. During the ensuing days and weeks in the ICU he had received many, many units of blood. One of those units wasn’t properly screened, and he had contracted HIV. He was beating the odds so far, had made it to middle age without too many complications. He looked fairly healthy, but then he took off his jacket and rolled up his sleeve for the BP; and another story came out. He had the tell-tale end stage purple lumps, he was almost nothing underneath that coat, and a strong wind could carry him to China if he wasn’t careful. His mouth was all sores inside, the tongue eroding, the gums bleeding. He told the story of sleepless nights, incessant coughing, and massive diarrhea.
Despite all this, he had remained optimistic. He had managed to not only keep his job, but hide his diagnosis. He said his coworkers wondered sometimes, wondered why he never dated, wondered why he left at lunch each day. He said he had never dated “cause I just couldn’t take the chance of giving this horrid disease to someone I loved, I just couldn’t do it”. He left at lunch each day to go swallow a massive amount of meds in private, and try to eat something nutritious, even if it didn’t look good.
He was at the top of his company, when I saw his name I recognized him as a prominent business man in the city. He lived in one of the nice houses, in a nice neighborhood. He said he had just “had to move, cause my old neighborhood learned about me, and nobody would talk to me anymore”. He loved kids, and said “so far, I’m allowed to play with the neighborhood kids, and even eat with people again”. He wasn’t sure it would last, but stated he was enjoying what he could while it lasted.
I took him straight back to a room, with his WBC count of almost nothing he didn’t need to be exposed to the contagion rolling around the waiting room. I went back later to check on him.
I found him, almost nothing under the blanket, crying on the phone. I left him alone for privacy, and came back a few minutes later. He said that the doctor was admitting him for intensive treatment of his massive pneumonia, “but it doesn’t look good”. He called his work and told them some excuse so he wouldn’t have to show up the next day.
2 days later, I was perusing the obituaries when I was shocked to recognize his picture. The picture was taken before the disease had gained so much ground, and he was a different person. The obituary only said that he died of pneumonia, no word of the true cause. I heard he had a large funeral, with most of the people in attendance ignorant of the courageous battle he had fought, totally alone, for over 25 years. The disease had won again, had won in secrecy and stigma.