No one ever said Frank was dying of AIDS

September 05, 1991

FRANK never said he had AIDS, nor did his doctor tell me, nor did his social worker, nor the admitting nurse at the hospital, nor the account representative of the company who handles our health insurance.

No one ever said he had AIDS or might have AIDS. So no one can be sued or blamed, and we can all pretend it isn't happening.

Lately, it seems, more commercials have been aired encouraging people to talk about AIDS. Condoms are displayed more openly for sale. Even prostitutes in many cities are being counseled by local police departments in the practice of safe sex. We are talking more about AIDS prevention, but when it strikes, the talking stops and with the knife of silence we excise AIDS in its human form.

Frank says that his doctor has been treating him for lung disease and that this accounts for his periodic hospitalizations for pneumonia over the last several years.

Last spring, the man living with Frank died of "lung disease." Frank was upset and afraid and fighting pneumonia at the time. When he returned to work after a month's absence, he was skin stretched on a slow-moving skeleton.

He coughed and spit into a tissue, which he tossed in the nearest trash can. He hardly ever ate, had diarrhea frequently and continued to lose what little weight he could carry.

He fell asleep at his desk, in the cafeteria, on the commode in the men's room. As weeks went by, none of his co-workers nor I, his boss, doubted he was dying.

In all this time, I couldn't understand why his doctor hadn't arranged for Frank's hospitalization. When his doctor called at work for Frank one day, I let him know of my concern as Frank's employer and friend. The doctor was deliberate in his response to me, as though reading from a prepared statement.

"Frank is exhibiting symptoms which are consistent with his condition at this time," he said calmly.

"But he's dying in front of our eyes," I insisted.

"I cannot discuss the patient's diagnosis without his written permission. I hope you understand."

I was beginning to.

Frank continued to decline until one particular day his hands and legs were shaking more than usual. With his shoulders slumped, he appeared not to have the strength to hold up his head. I felt an elevated temperature on his sweaty brow. "We're going to the hospital," I told him definitively. Too weak to protest, Frank obliged.

"What is your doctor treating you for?" the admitting nurse asked at the hospital.

"Lung disease," Frank said without lifting his head.

The admitting nurse looked at his hospital record and asked me to take a seat in the adjacent waiting room. I could see her question him further. I watched his head nod several times.

After Frank's admission to the hospital, the same nurse stopped me as I was leaving. "Have you talked with his doctor?" she asked.

"Not at great length, but a little," I said.

"Then you have an idea of what's going on?"

"Yes," I replied. It was a conversation which told me so much by what we were not saying.

"And you're taking precautions?"

"Yes," I said again, not willing to admit I wasn't sure which precautions she meant for the diagnosis she was not revealing.

Our health insurance company must have heard from Frank's doctor, who had authorized his hospital admission, because a representative called me at work the next morning.

"Do you have any questions about Frank?" she asked, then added before I could speak, "You understand we must observe strictly the doctor-patient confidentiality at issue here."

Saying that, she evaded my questions before I could ask, so I made a statement.

"I think this man has AIDS," I said. The ensuing silence spoke for her and extinguished the hope I could be wrong.

She said finally in that familiar, dreaded, measured tone, "Frank's social worker will try to secure his permission to discuss his diagnosis with you. Until then . . ."

"I know, 'Doctor-patient confidentiality must be observed strictly.' "

No one told me Frank has AIDS. I, too, have played it safe -- pretending to believe his story about lung disease, changing his name for this article, hiding who I am and where we work. I would like to say we are protecting his privacy, but more honestly, we are protecting ourselves from possible lawsuits. It might appear Frank is responsible for everyone's reticence. After all, "Without his written permission . . ."

But what about our permission? People like Frank know they cannot speak out without risking their jobs, their health insurance, their families and friends. Keeping his diagnosis a secret, Frank avoids the wall of words, words like "queer" and "junkie," which separates the individual with AIDS from the compassion afforded anyone else with a deadly disease. But in its place, he has found a barrier of silence constructed by the law, our own ignorance -- and fear. It is a silence as impenetrable for Frank as it is for me.

I really don't care how Frank got AIDS. I do care that in his time of greatest physical and emotional vulnerability, he is too afraid or embarrassed to let me know what's wrong, and I am afraid to tell him I know.

That is a shame -- on all of us.

The writer is an employer in Maryland.

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