Case Studies in Communication and Disenfranchisement

Applications To Social Health Issues

Eileen Berlin Ray

• Publisher: Routledge
• Year: 2013
• ISBN:
  9781136689369
• Edition: 1
• Topic: Languages & Linguistics
• Subtopic: Communication Studies
• Index: Languages & Linguistics

See blurb for Communication and Disenfranchisement. Books will be promoted together.

Part IV
Issues Related to Health Concerns

13 Without AIDS: A Gay Man Dies

Frederick C. Corey
Arizona State University

Six days after our third anniversary, my partner was diagnosed with cancer. Eighteen days later he died. Kim's death reorganized my entire life. My being gay, once an immobilized position of shame, marginalization, and disenfranchisement, is now a point of political departure. In writing this essay, my aim is to present in narrative form the liminality between silence and speech, between privacy and public discourse; and I situate the limen in the context of communication about health, sexuality, and, ultimately, death. I address issues of patient-physician power, family communication, and the conterminous construction of gay men and HIV disease.

Physician, Patient, and the Negotiation of Power

In October 1990, while Kim was doing sit-ups, he hurt his rib. It appeared to be fractured, and he started a sequence of visits to physicians and chiropractors. After 2 months of these visits, I was sick of Kim being sick. I was tired of taking him to the medical offices. I was tired of going to the emergency room. I disliked hearing him moan. The pained look on his face got old. When I would ask what the physician said, he would reply with one word, "Nothing." This is ridiculous, I said, I am going to write a letter to the physician. And so I did:

December 1, 1990

Dear Dr. Fine,

I am writing to you about Kim Bauley, a patient in your office. Kim and I are relational partners, and though he does not know the exact content of this letter, he does know that I am contacting you.

We are not satisfied with his rate of recovery. As you know, on October 19, 1990, Kim was doing sit-ups and he fractured his rib. This was diagnosed almost immediately, and he was led to believe it would heal on its own within a couple of weeks. He has not recovered; on the contrary, his pain seems to be worse than ever, and even the slightest amount of movement increases the pain dramatically.

Three problems beyond the rib have made themselves apparent. First, he has trouble breathing. This problem comes and goes, and though it is not as bad now as it was around November 17, we are worried that his trouble breathing could return at any time, and should this trouble return, we do not know what to do, except perhaps to call you.

The second problem is more immediate. Kim has been constipated since around November 19. On November 28, at 11:30 p.m., he was in excruciating pain, for he was trying to defecate but could not—the feces was like a large rock lodged in his orifice. I took him to the emergency room at Scottsdale Memorial where they gave him an enema and said that this was not unusual for a person taking Tylenol Three. He is still not having normal, healthy bowel movements.

The third problem is more mysterious, and it concerns his liver. He is having tests done on his liver, but he does not seem to have good information regarding the nature of the tests. What exactly is being tested? He shared a drinking glass with a friend who has Hepatitis B last month—should we be worried about Hepatitis?

Four problems, then, are in need of attention: a fractured rib, trouble breathing, constipation, and an apparently symptomatic liver.

Dr. Fine, I am not unsympathetic to the pressures racing physicians. I have seen the effect of stress your occupation involves. I realize that you must have a number of patients with life-threatening or advanced stages of illnesses. I also realize, though, that proper early treatment and detection can reduce the onset of advanced problems.

Kim's problems have advanced. "We would like to work with you to arrest the onset of new problems and resolve the problems which already exist.

I propose a change in procedures at two levels, the first rather general, and the second specific. The general procedures I suggest are as follows:

—If the medication administered has known side-effects, please let us know and tell us what to do should these side-effects occur. For example, if Tylenol Three causes constipation, is it okay to take a laxative with the Tylenol Three? I have discouraged him from taking oral laxatives because I know they can be toxic, but I don't know anything about medications. He seems to be urinating an awful lot—is there a type of diet that would divert the liquid to soften the feces? —When you are conducting a battery of tests, please take the time to explain what is being tested and what might be revealed through the tests. When the test results are in, please explain them thoroughly.

—Please take the time to listen to Kim when he is trying to tell you what is going on inside him. He is not ill often, and he does not normally have aches and pains, so the vocabulary is foreign to him. I took him to an appointment in your office on November 19, and we arrived promptly at 10:00 and waited until 11:30, and then when you visited with him, you were in the examination room for less than five minutes. This is simply not reasonable. Very little communication can occur in a context that involves a 90-minute wait for a 5-minute contact. (I will point out that he is seeing a chiropractor, not because the chiropractor is administering great medical treatment, but rather because the chiropractor is explaining the nature of the fracture. This information should be coming from his primary care physician.)

The specific actions I suggest are:

—Kim needs to get a second opinion on his general condition, and this opinion should come from someone respected by both of you. Please recommend someone and help us get an appointment with that person within the next day or so. Perhaps an osteopath would be appropriate, given the overall nature of his problem.

—His medications need to be reassessed. The Tylenol Three appears to be hurting the proper functioning of his bowels, and there seems to be some suggestion that the anti-depressant drug is damaging the liver. (It is not helpful, though, to tell him on Friday that he should just stop taking all medications and then come in on Monday. This type of assessment serves to belittle the terrible pain he is enduring.)

Again, let me assure you that I am not oblivious to the demands of your profession, and I realize you cannot drop everything for a patient who just happens to wander into your office with a pain in his side.

I am hoping, though, that you will work with us to get Kim back on his feet. He is under a lot of stress that will not be going away. He had planned on starting design school effective December 3, and he quit his 12-year job in retail management to pursue that plan. Thinking that he would recover by December 3, he submitted his resignation in mid-November. December is here, but he is not well enough to be in school, so he is without a job, and he is not recovering.

Let me close by noting that I am a third party and the content of this letter is, to some extent, beyond my privilege. Kim feels, however, as many Americans feel, that if he asserts himself with the physician, the physician will provide less professional health care. Now, I know this is absurd, and you know this is absurd, but there's no persuading people on issues involving such high-level vulnerability.

Kim has always had an aversion to physicians, but he feels comfortable with you and he trusts your medical judgment. When he broke his arm, I had to drag him kicking and screaming to get it fixed—he wanted to let it heal on its own!

I appreciate his respect for and trust in you, and I am grateful.

Sincerely,
Frederick C. Corey

I slipped the letter through the wrought-iron gate protecting Dr. Fine's office and felt a pang of trepidation. Would the letter blow away? Would the custodian sweep the sealed envelope into the trash? Would the physician read the letter and find it presumptuous? I went home and told Kim about the letter. He did not ask to read a copy.

On Monday morning, Dr. Fine called. He wanted both of us to come in that afternoon. We arrived early and waited. I tried not to be irritated. The nurse opened the door and called our names, and she brought us into an examination room. I was surprised, for I expected to be shown into his office. I asked the nurse if Dr. Fine wanted to see us in an examination room or his office. She assured me we were in the proper room. I sat in a chair, and Kim sat on the examination bed, on the white paper that crinkles and crackles with every turn.

"Let me do the talking," I said to Kim.

"Just don't embarrass me," Kim said, and we both smiled because we knew I would. He looked scared.

Finally, the door opened. Kim was right. Dr. Fine was a handsome man, tall and tanned and confident. I stood and extended my hand. He shook it, apparently under duress, and gestured to the chair. I started to smile, a nervous habit, and I found myself looking up at him. Dr. Fine chose not to sit. "I have never received a letter like this," said Dr. Fine.

"First time for everything," I said. At first, I was not able to read his behavior, but he quickly clarified his overall response. He was furious. Kim and I exchanged nervous glances, and for a moment, I wanted to crawl into a hole and die. Dr. Fine stood over us and slapped the letter with the back of his hand. I sat in the chair and looked at my shoes.

I had dressed for power. I wore clothes that made me feel confident and aggressive. Burgundy loafers, woven socks, navy wool slacks with cuffs, burgundy belt, blue striped shirt, and a tie that was red with large, blue polka dots. I dressed carefully, prepared myself for the negotiation of power between patient and physician.

But I was trumped. Dr. Fine had all I had but more. The way we were positioned, when I looked straight ahead, I was at eye gaze with the cloaked source of his power. When I looked at the floor, I felt defeated. When I met his eyes, I felt beneath him, lower than his position in the hierarchy of the patriarchal pecking order. I was in a no-win situation. I sat in the chair while Dr. Fine used the social economy that was supposed to be on my side as a weapon against me. What was left in my hand was my great disadvantage: I am a fag. I felt powerless.

Or, to the contrary, was I placed within what Foucault (1976/1978) called a "manifold sexuality" (p. 47), a relationship invested with procedures of power? Foucault argued that with the advent of the classification of same-sex desire as "homosexuality," the temporary aberration of incidental sodomy became a human species infused with the power of curiosity and exclusivity. What was once an act that occurred between two people became a genre of human beings, and, from the perspective of medical science, these deviates needed "examination and insistent observation" (p. 44). That Kim and I were brought into the examination room was, from a Foucaultian perspective, no accident at all. Kim and I—two White men who appeared otherwise "normal"—needed to be inspected. Kim and I found ourselves in the examination room with the history of medicine. We found medicine "caressing them [us] with its eyes, intensifying areas, electrifying surfaces, dramatizing troubled moments" (Foucault, 1976/1978, p. 44). Three men in an examination room. Each is tall. Each is White. Each is well dressed. Each is attractive. Each has ego. One is dying. One is a physician. One wrote a letter. All three men in Foucault's examination room are "exercising a power that questions, monitors, watches, spies, searches out, palpates" (p. 45). We evade this power, fool it, and enjoy the pursuit. The scandal, resistance, capture, and seduction are pleasurable.

"I am a doctor," said Dr. Fine, "and I have patients who are dying. If you have to wait, you have to wait." I should have stood up, turned to Kim, and said there was not enough space in the examination room for a patient and this physician's ego. The immediate is not a retrospect, though, and the progression of crisis is incremental.

I sat silently, and Kim entered the panic mode. "I don't mind waiting," he said, and Dr. Fine was appeased.

"Is this all?" I asked, not knowing what I meant by the question. The power relationships were established. Kim and I were subject to the constraints and will of the physician, and, from his domain, we could proceed. The physician relaxed, leaned against a counter, and said, no, this (the exercise of power?) was not all, we should talk.

The textual meaning of our conversation was marked not by what we said, but instead by the amount of tension in the room, and over the next 30 minutes, the tension rose and fell. Dr. Fine set the tone by relaxing and talking to Kim for a few minutes. They liked each other, and I saw their rapport. The tension rose, though, when Dr. Fine turned to me to talk about the constipation. "Is it true," I asked, "that Tylenol Three causes constipation?"

"Not unless he has arthritis. Does he have arthritis?"

"Maybe," I said. "Maybe he does."

"Tylenol Three causes constipation in old people with arthritis." The doctor spoke.

The discussion made its way to AIDS and the HIV test. I had been tested for HIV when Kim and I started dating, and I was negative. Kim had never been tested. He was afraid. "We should get a test," Kim said to Fine. I said we would need to go to the county for an anonymous test, because what with Kim just quitting his job, he did not want to jeopardize his insurability. The physician agreed.

"But I want you to get tested," he said. Kim started to say something, but he stopped when the physician raised his eyebrows, as if to suggest AIDS was really the issue here. I said that I have worked at the local AIDS project for several years, I have seen plenty of AIDS cases, and what Kim had just did not look like AIDS.

"But I want you to get tested, he repeated. "And you should, too," he said to me.

"Let's suppose it's not AIDS," I said. "What do you really think it is?"

"Stress," said the physician.

"Stress?" asked Kim. He lit up for the first time in the examination room. He appeared relieved, hopeful.

"Yes," said Fine, "stress. How's school?"

"I haven't started yet," said Kim, and I refrained from noting that was in my letter. "I have been sick."

"Al Collins is a friend of mine," said Fine, "and—"

"He's not going to Al Col—" I interrupted.

"Well," Kim interrupted, "I might. I haven't decided."

I should have let it drop, but I could not thwart a look of aghast in plain view of the physician. "Where are you going to school?" asked Fine.

"I am going to interior design school," said Kim. "I just don't like the sound of interior design."

With perfect bedside manner, Dr. Fine asked Kim about interior design school and treated the topic without judgment. He and Kim again engaged in a jovial conversation about interior design. When they were through, everyone was in good spirits, relieved to believe Kim's problems were stress related and everything would be fine. As we were leaving, I asked about the second opinion, and the physician said we wouldn't need a second opinion. He'd run some more tests. "And you are going to the county. Right?"

I took the day off work, and Kim and I spent the entire afternoon at lunch, going to a movie, and shopping. It was one of my happiest days with Kim, because we were communicating at a level of honesty two people rarely achieve. We talked about feeling vulnerable in the examination room, being afraid of disease, and reducing stress in our lives. We found the power to be open in the context of the examination; the blush of vulnerability and strength of self-determination coexisted under the careful eye of medical science. "Power," wrote Foucault (1976/1978), "is not something that is acquired, seized, or shared, something that one holds on to or allows to slip away" (p. 94). When I dressed for power, I thought I would seize something. I mistakenly...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• Contributors
• Introduction
• I ISSUES RELATED TO POLITICS AND SOCIOECONOMIC STATUS
• II ISSUES RELATED TO FAMILY
• III ISSUES RELATED TO ABUSE
• IV ISSUES RELATED TO HEALTH CONCERNS
• Author Index
• Subject Index