Red Ribbon

Figure.

“… for the secret of the care of the patient is in caring for the patient.”

—FWP

I wear a red ribbon on my white coat. That is not unusual. As an infectious diseases physician, I am one of many who wear a red ribbon as a symbol of support for those living with acquired immunodeficiency syndrome (AIDS). I wear my ribbon in support of all those nameless patients, but mainly I wear it for Laurence.

Laurence was a patient at the human immunodeficiency virus (HIV) clinic where I trained. By the time he became my patient, he had battled HIV for many years. He was a product of the years of experimental antiretroviral drugs and the early process of adding the latest, greatest medication to a failing regimen. As a consequence, by the end of the 1990s, Laurence was on an antiretroviral regimen that was fraught with a high pill burden and numerous side effects. Despite this, his viral load remained high and his CD4 level stayed rock-bottom at a count of 1. He trooped on with this low number for months, and we often joked that he must have had some “kick-butt neutrophils” that were taking up the slack for his failing CD4 cells.

In addition to being a patient, Laurence was an employee at our clinic, one of those invaluable people who could find the exact chart that you needed among a room overflowing with files. He was a fun, open person who was just as likely to show up for work in a pair of black boots and fishnet hose as he was khakis and a polo shirt. He liked to laugh, and he loved the cherry nut fudge that I brought into the office every December.

As time went on, Laurence became tired of the persistent, never-ending battle for health, and, without informing his providers, he stopped taking his prophylactic medications. I'll never forget the day we admitted him as he desperately struggled to breathe. He knew the path that he had chosen and refused to be intubated. I also knew the path that he was on and found myself fighting with the residents to make sure that Laurence had enough morphine to make him comfortable. I'll always remember that last kiss I placed on his sweat-drenched forehead. Laurence died the horrible death of Pneumocystis pneumonia, but in the end, he was surrounded by his friends and coworkers who loved him.

A few days later, groups of colleagues from the clinic carpooled together to Laurence's funeral in a rural area of the state. Stories were shared and tears were shed among the companions during the long drive. When we arrived at the funeral home and were greeted by his family, we heard very different stories. They were clearly embarrassed by their son and never mentioned the boyfriend he had left behind. They told their friends that Laurence had died of cancer, a much more acceptable death to them than the reality of suffering from AIDS and its lethal complications. They worked tirelessly to protect themselves from the stigma surrounding his life and illness. At the end, had it not been for our shared friends and coworkers, I would have thought that I had attended the funeral of a stranger. Clearly his family did not know and respect the man that we, his friends and colleagues, had known and adored.

That was a decade ago, but now, as an infectious diseases physician specializing in orthopedic infections, I still wear my red ribbon. I wear it hoping that we will continue to fight against the prejudices that surround HIV and those who live with it every day. I wear it for Laurence.