In 2002, when I was in my mid-20s, I went down with a severe cold and was in bed for a couple of days. I was feeling lousy, with a headache and stiff neck, so a GP friend looked in on me to check that I was OK. Neither of us recognised my symptoms as anything more than a bad bout of flu.
Eight weeks later, at a routine check-up, I was diagnosed as HIV positive. I felt shocked, although the result wasn't a complete surprise. As a gay man there was a chance that I'd be exposed to the virus, and might acquire it.
My first thought was how the diagnosis would affect my job. I'd been a doctor for only four years. This was something for which I had worked very hard, something I desperately wanted to do. I was terrified I would be told I could not practise any more.
The next day, I arranged to meet an occupational health consultant. It was my responsibility to inform my employers, but I was fearful of their reaction. I hadn't sustained a needle-stick injury while working in the developing world or been given an infected blood product, but had contracted the disease through the potentially more blameworthy unsafe, random sexual encounter.
My trepidation increased when I arrived at my appointment to find a dour Scot, close to retirement age. But he was surprisingly understanding, explaining that, as I was not a surgeon and did not perform invasive procedures, there would be no internal inquiry. In fact, I could return to work straight away, although he did warn me to be circumspect about how, where and to whom I disclosed my diagnosis.
Back at the hospital, we were all studying for exams, so I was surrounded by doctors diligently memorising photographs of different illnesses. It was hard not to feel paranoid that one of them would diagnose me. I'd spend days worrying whether a colleague had clocked the telltale dermatitis I tried so hard to keep under control ,and would do my best to avoid opening my mouth too far for fear of demonstrating my, at times, florid, oral hairy leucoplakia (a mouth disease that leaves fuzzy white patches). My swollen lymph nodes felt painfully obvious.
It was a great relief when I began treatment; I no longer had to worry about looking like a medical school finals exam "case". I was never anxious about passing on the infection to a patient, because I had read available literature on safe practice. What I did decide, however, was to seek out a specialisation that would provide me with the most accepting environment in which to practise.
A few years in genitourinary medicine and HIV culminated in a middle-grade post. Unfortunately, my appointment coincided with a serious depression. I am not sure if this was a natural part of grieving, an inherent part of the infection or something that had started long before, but whatever the cause, my self-esteem plummeted. I felt tired out of all proportion to any physical problems; I began making small, inconsequential errors.
This was the first place that I chose to disclose my HIV positive status, but my admission wasn't received as supportively as I had hoped. Nobody asked about the dilemma of telling my family, or the difficulties of a burgeoning HIV positive/HIV negative relationship. Instead, they described how an ex-colleague had developed an HIV positive-related dementia. At a time when I craved reassurance, the implication was that I, too, was losing my marbles.
Six months after telling my superiors I felt overwhelmed by my workload, I eventually took myself out of work. Even then, I was given no advice other than that maybe medicine wasn't for me after all.
I am pleased to be able to write that my usefulness to the taxpayer and NHS was not over with at that moment. I gradually returned to work (in a different speciality) and have enjoyed robust health ever since. Life as a doctor is good.
You might think medicine would be an enlightened working environment for the chronically ill, but the NHS doesn't do sick doctors very well. The adage "Physician, heal thyself" is, unfortunately, absolutely true. The future? I expect to die with HIV rather than from HIV and Aids, and not for a very long time. I also expect to come out again as HIV positive during my working life, but at the moment that, too, is a way ahead.
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