I sighed and sat back in my chair to look at the gaunt, scruffy, but surprisingly still handsome, man in front of me. Surprisingly because the skin of his face was red and flaky with seborrhoeic dermatitis, his cheeks were hollow and he wore a sullen, pissed-off expression. Why had I thought that tackling tricky cases would be a nice change of pace? This guy was just depressing. When I’d seen that his second name was Lucas, I’d felt like it was a cosmic sign of how well my day was going to go. I wasveryinto cosmic signs. For me, daydreaming about a guy called Lucas and then seeing that same name on a set of notes in front of me was a good one. I was now realising that my theory had some holes.
“Mr Lucas . . . Henry,” I said, noticing a flinch at the use of his first name, but still no attempt at actual eye contact. “Since your hospital admission with PCP you’ve been on antiretrovirals for a good few months.”
Henry had had a dry cough for long time which he had ignored until it became difficult for him to breathe. He was admitted to hospital a year ago and his chest x-ray showed diffuse shadowing, suggesting Pneumocystis Carinii Pneumonia, or PCP – a marker of the immunosuppression associated with AIDS. An HIV test was requested in his first set of blood tests and the result had been positive. The pneumonia was treated with antibiotics and he was discharged with antiretroviral medication, but he’d missed two follow-ups in clinic since then. The one time he had actually attended, Prof had described him as having a ‘flat affect’, meaning he’d appeared emotionless. Prof had been concerned, but his attempts to contact Henry after his subsequent missed appointments had been unsuccessful.
“Your CD4 counts and viral load aren’t improving. I . . . there doesn’t really seem to be a reason why they’re not getting any better. We’d expect at this stage for there to be a drastic change in the numbers.”
Henry shrugged and scuffed his feet on the floor. His hair looked greasy and he had a good few days of beard growth on his face – not in the nice, trimmed and trendy beard way, more like the homeless person way.
I cleared my throat and tried again. “Do you . . . Henry, do you actuallytakethe meds?”
I waited and watched as he shrugged his thin shoulders, before giving a short nod: not altogether convincing.
“I mean, if you weretakingthe antiretrovirals your CD4 count should be almost undetectable and I just –”
“You done?” he cut in, scraping his chair back and pushing up as if to leave.
“Uh, I –”
“Because this was supposed to beProfessorPatel’sclinic.” He flashed me a brief unimpressed look. “Not sure I’m up for a lecture from one of his minions, to be honest.”
I took a deep breath in through my nose and let it out again slowly. It wouldn’t do to punch one of the HIV patients in the face.
“For fuck’s sake,” I muttered under my breath.
“What did you say?” he asked, eyes wide and no longer looking down at his feet.
“I said . . .” I paused to reflect on the consequences of expressing my real opinion. All too often I’d landed in hot water for just that. But nothing was getting through to this guy. Prof had been trying to contact him for weeks and he’d only gone downhill. I decided to take a chance. “I said, forfuck’s sake.”
Henry’s mouth dropped open. At least I had his attention. “You can’t speak to patients like that! Who the hell do you think you are?”
“Er, well the swearing police haven’t exactly broken down the door so, I’m gonna take a guess and say yes, yes I can. Or rather yes, if the patient in question is a misogynistic dickhead.”
“Excuse me?”
“Listen, I amtryingto help you here. Do you think I sit around in clinic waiting to talk lying wankpuffins into taking their life-saving medication that the NHS is providing for them for shits and giggles? Do you have any idea what someone in Sub-Saharan Africa would do to get their hands on these meds? Well? Do you?”
I had full eye contact from Henry now.
“You-you called me awankpuffin. . .” he spluttered, looking a mixture of shocked and bizarrely ever so slightly respectful. “What does that even mean?”
“I’m sure that in other areas of your life, Henry, you’re a perfectly reasonable human being,” I told him. “But as far as this clinic goes and this treatment, youarebeing a wankpuffin. Now, do you want to tell me why you’re not taking the medication?”
“You can’t speak to me like that.” His tone was angry now and he was leaning forwards in his chair towards me. “Are you even a bloody doctor? You don’tlooklike a doctor.”
That, I thought, was a fair comment. I was wearing a pair of loose sarong trousers I’d bought at the Full Moon Party in Thailand, and a gypsy top complete with tiny mini mirrors around the hem. My earrings were long and contained the odd feather. I also had flip-flops on.
“Henry, I assure you I am a qualified doctor. I–”
“So what are you? First year or something?”
“I’m a registrar.”
He looked genuinely shocked and swiped his hand through the air in dismissal. “No way. No way in hell.”
“When I was applying for training, I would not have got away with wearing this. Not much they can do about it now though. As you can see, we’re not exactly overstaffed. The first thing I did after the interview for my training scheme was give away all my stud earrings. So, now that we’ve established my credentials, let’s get back to the task at hand. Why aren’t you taking your meds? No bullshit this time.”
“Ugh!” Henry flung his hands up and slouched back in the chair. “What’s the fucking point? They won’tcureme, will they? There’s no goddamn cure for this bloody disease.”
