Kirkepiscatoid

VA internal medicine, 3rd year medical student, 1989. I picked up DW as an admit. The only thing my resident told me was, "Be careful...he's got the butt flu."

Butt flu. That is what we called AIDS behind closed doors, in those dark, rude "House of God" moments where we could not bear to show compassion for anyone or anybody b/c we were stressed and had a job to do. Oh, we had a lot of rude terms for AIDS, most of which I won't repeat here. Even though the year before, I, as a post-sophomore pathology fellow, had performed the first post of an HIV positive person who was not "posted" by the medical examiner, and knew better about its origins (the victim was a 70 year old piano teacher--that story in itself makes a blog entry all its own, but I'll save it), I committed the sin of commission--I played along, did not stand up to the dark humor and the rudeness.

I remember the first time I met DW for his admission physical. He was every bit the stereotype. Small. Effeminate. Had a bit of a lisp. Big fraidy cat--even venipuncture made him cry. Denied every question about sexual activity vehemently, sometimes with anger, sometimes with tears. I knew there was a story there but that story was never told. Didn't matter. He had the bug. He was male, smallish, and would be lumped in with "them" regardless. But unlike the usual VA patient at the time, he was young. He was not an aging vet of WWII/Korea. Don't ask me how, but somehow his HIV was "service connected" so he had full disability.

Somewhere in that admission physical, the realization that we were the same age hit me--so weird for a "VA patient"--and we clicked--beginning a 3.5 year journey of constant intersections. You have to remember--this was a time health care people were scared to death of HIV. Some even left the profession, or kicked patients off their rolls, referring them to "specialists"--infectious disease docs tended to end up being their family physicians.

I became the only person he trusted to stick him for blood. I became the only person he wanted in his room some days. Even when I had long left the VA medicine service, word always got back to me that he was "in house" and I still ended up taking time for him. I slept in a chair beside him when he thought he was dying of pneumocystis pneumonia even though we were pretty sure we were going to pull him through it. Sometimes I would see him and his dad doing clinic visits together--his dad was a Korea vet, and they both lived in the same town, so they had a habit of "doctoring" on the same day. They both drove 120 miles to go to the doctor, and there was not a "fast" way to get to Columbia from their town.

He started looking better. He started gaining weight. Retrovirals had just hit the scene in the AIDS pharmacology world, but we still did not understand "viral load"; we followed them by their CD3 T-lymphocyte counts to see "how they were doing." We spent my clinical years and internship crossing paths repeatedly. He called me "his" doctor. The last time I had seen him, he was at a clinic visit and he was looking as good as ever.

Then one day I saw his dad sitting in clinic by himself. I said, "Where's your sidekick?" thinking he was in the cafeteria or already in his clinic visit. His dad's eyes welled up with tears. "We lost him two months ago. He got 'the pneumocystis' and ended up in the ER, at our hometown hospital, and he was gone in two days. We wanted to bring him here but he said no. I think he had been doing so well, getting back to remodeling his house a little, and when he got sick again, I think it just devastated him so, he wanted to leave. He was tired of always being thrown down every time he got back up. I miss him so much."

It was everything I had not to burst into tears. I held his dad and mumbled some vague crap about being sorry for his loss. His dad said, "I know you can't be upset out here in front of everyone. He was worried you'd be mad at him for not being able to say goodbye, but I told him you'd understand. My wife and I are so glad you were in his life. Don't you ever forget that."

A year later the AIDS Quilt came to town. There was a square where you could write something that would be added to the quilt. I wrote: "DW--thank you. I am not mad I could not tell you goodbye, but you have to know I still miss you."

Once in a while, the right kind of small, slight men on the street remind me of him--and I still miss him.