What’s the 411?

With the curtain closed I turn and face my patient. I walk to his side, lean against the bedrail and lower my voice.

‘How long have you been sick?’

‘It got bad six weeks ago, after my trip.’

I run the side of my thumb along the belly of his temporal muscle, feeling how thin it is. I repeat the question.

‘How long have you been sick?’

‘I don’t know,’ he says, pausing a bit. ‘A long time.’

‘Open,’ I say. The back of his mouth is covered in white. Thrush.

I place the stethoscope to his chest and look up at him, asking, ‘You have sex with girls, boys, or both?’

‘Boys, um,’ he says, ‘I mean men.’

His lungs are clear.

‘When was your last H.I.V. test?’

‘About eight years ago.’

‘You use condoms?’

‘Usually.’

I close one eye and cock my head. I continue my exam. His testes are mildy atrophied and he has several pathologically large muluscums.

‘You live with anyone?’

‘My friend, Roger.’ He says. ‘We used to go out, but now we’re just friends.’

‘I don’t think this is likely to be needed today, but if it gets to the point that you can’t make decisions, who do you want to make them for you?’

He thinks for a few seconds. His eyes resting on the bag of IV fluids running into his arm.

‘Roger, I guess.’

I have the primary diagnosis already. Everything now is just detail work and protocol.

‘You have much doubt about what we’re going to find when the results come back?’ I ask.

‘Not really.’

‘What do you want me to tell the ladies?’ I ask.

‘Everything.’

As I walk out to meet with the ladies I tell the nurse to put the patient into respiratory isolation.