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My Patient Didn't Let Dying Get in His Way

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When I first met Truman, we both knew he was dying, but neither one of us said anything about it. It would be a slow death, much further in the future than the day we met, but he was dying nonetheless. He was a gay man living in San Francisco in the mid-1980s, and he was HIV positive. I was a third-year medical student at the University of California. There were many people in the city who were dying like Truman. He was just one man, but he was my patient.

As a third-year medical student, I was on my internal medicine rotation at the university hospital in the spring of 1988. Pre-rounding on my patients early in the morning, my face was often the first my patients saw each day. Often, I would check on them later in the day, too, when the rush of rounds and conferences was over, in the slow afternoons common on a hospital floor. It was during those times that I really got to know my patients. We’d share stories about our lives away from the hospital, and the paths we each took to get to where we were. I didn’t have a lot of medical expertise to offer, but I lent a receptive ear. Sometimes, I could offer information about their disease or treatment, but I was mostly a compassionate companion, closer to the life of the patient than that of the doctor.

Truman came into the hospital, as many of those men did, with a cough and fever. His breathing was shallow and rapid. He was thin but not gaunt, and still in high spirits. Fatigued from the work of breathing, he needed extra oxygen. He knew his HIV status, and a chest X-ray in the ER showed the usual markings associated with Pneumocystis pneumonia. He needed to spend several days in the hospital to get IV antibiotics. As part of his care, I had to get an arterial blood gas. This piece of “scut work” fell to different members of the health care team at first, but Truman quickly realized that I had a soft touch, and he asked me to perform all his arterial jabs. He always thanked me; he was unfailingly polite. Honestly, I think he just liked to talk to me. I had more time than anyone else to listen, and I always laughed at his jokes.

Truman was tall and thin, with a closely cropped beard and scalp, dressed crisply and cleanly. He had a keen eye and often delivered wry quips about the vagaries of hospital life. As his health improved, his cheeks blossomed with color, his robust laugh returned, and he was nearly always smiling. One day, during one of those slow afternoons, there was a commotion from Truman’s room: people were talking loudly as if at a party, festive music was playing, the whole scene punctuated by a riot of laughter. I went in to see what was going on and found Truman surrounded by half a dozen other men.  

“Queen for a day!” Truman shouted. His friends had tried to recreate the old ‘50s TV show, and they did a marvelous job of it. Truman was wearing both a boa and a tiara. The room was filled with balloons and streamers and presents. This version, however, had some decidedly raunchy humor and a few sex toys, as well. Truman introduced me around, and I stayed for a little while, but it was a party for Truman and his friends, so after mingling a bit, I left them alone.  

Truman’s raucous gathering was the epitome of all the best things about being gay in San Francisco in the ‘80s: the grab-life-by-the-balls attitude, and the pure celebration of who you are, damn whatever anyone else thought. Some of the resilience I like to think I’ve demonstrated in my own health struggles I learned first from Truman.

At his party, Truman seemed full of life but the reality was much different. Although Truman would recover from his pneumonia, I knew his destiny, and I’m sure everyone in his room that day suspected it, too. In fact, I think they knew it far better than I did. They were the ones going to the funerals. They were the ones watching loved ones die with increasing regularity. They were the ones there for the horrible end: the retching of bile; coughs that produced blood-stained sputum; voluminous diarrhea; the wasting, confusion, and altered mental states; sickening Kaposi’s lesions on the skin; the astonished look in the mirror. It was commonplace at that time to watch a strong, vital man become a skeleton of his former self, brought down with awesome efficiency by a microbe lacking a nucleus.

The destruction caused by HIV was often compared to a killer on the loose, a mass murderer, the Black Death, or some sinister evil. But as a son of the Midwest, I compared it to the most destructive force of nature that I had ever personally seen: a tornado. The HIV epidemic was a lot like a tornado, with its seeming randomness, its complete destruction, and its ability to telegraph itself and still destroy those on the ground who couldn’t get out of its way. And after a tornado, the looks on the survivors’ faces are similar. How do we move on? What do we do now? In the Midwest, people often rebuilt in the exact same place, after their homes and lives had been devastated. The people who lived in San Francisco did the same: they became advocates, engaged in public education, spread the message of how to avoid the virus. They took up the cause.  

For me, twisters have other similarities to the gay culture of the 1980s. At that time, gay stores were full of T-shirts emblazoned with the line, “We’re not in Kansas anymore, Toto.” And the whirling dervish of the lifestyles of those men were reminiscent of the spinning cyclone. That is what I remember: lives like tornadoes — deaths like them, too.

I’ve seen countless sick patients since the ‘80s, some of them dying, and I’ve thought often of Truman. I remember fondly his grace under fire, his optimism, humor, and ability to laugh at himself. And I’ve seen others display some or all of those traits, though perhaps not as boldly.

I don’t know what happened to Truman. After a week or so, he was better and left the hospital. I never had any contact with him again. But still, I know how that story ended, as they all did at that time. Now, the cocktail of antiretrovirals dramatically extends life for those with HIV. But back then, at the beginning of the epidemic, there was no cocktail, no miracle drugs. There was only the waiting. I hope Truman’s friends were with him at the end, loving him and celebrating him, making him feel, once again, like a Queen for a Day.

A practicing pediatrician for over 26 years, Dr. Ruben J. Rucoba currently serves as Director of Medical Services for PediaTrust, a large pediatric "supergroup" in the Chicago area. He also established his own thriving medical writing and editing business in 2010. He has no conflicts of interest to declare. Dr. Rucoba was a 2019–2020 Doximity Op-Med Fellow and is a 2020–2021 Doximity Op-Med Fellow.

All names and identifying information have been modified to protect patient privacy.

Illustration Collage by Jennifer Bogartz / SiberianArt / gettyimages

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