KEVIN WALKED TO THE clinic waiting room doorway and called the first name on his afternoon schedule, a new patient, Tommy Paulson. A short, slender man with thinning brown hair stood up. Kevin introduced himself and ushered the man into an exam room.
Once they were seated, he affably asked, “What brings you here?”
Speaking to the floor, Mr. Paulson said, “I read about you in the Advocate. You’re the gay cancer specialist, right?”
“I am,” said Kevin, deferentially subduing his usual upbeat approach. “Why don’t you tell me about yourself, where you’re from, what you do, whether you’ve ever been hospitalized or take any regular medications. Then we’ll get into the concerns that brought you here.”
Tommy Paulson was shy. He gave an abbreviated account of growing up in rural Pennsylvania and obtaining an engineering degree in college. He was thirty, lived alone, and worked for a construction firm. He had never been in a long-term relationship. There had been no health problems, other than an episode of gonorrhea, until a flu-like illness began six months ago. The fatigue had persisted. Then he started having diarrhea. He had already been to one doctor who ordered blood and stool tests which failed to reveal a cause for his symptoms. Two weeks ago, he noticed a white substance coating the roof of his mouth and made the appointment to see Kevin.
A physical exam confirmed Tommy had thrush. The lab results he showed Kevin included a lymphocyte count well below the lower limit of normal. There was going to be bad news to give, but this was not the time. Kevin needed to go through the motions of ordering and interpreting more tests. He needed more contact to establish credibility and rapport before Tommy would believe his prognosis and trust Kevin to help make the rest of his life as bearable as possible.
Though pressed by his new patient to make a diagnosis on the spot, Kevin stood his ground.
“There are viral and parasitic infections, some autoimmune diseases too, that can cause a prolonged illness like this. Let’s find out for sure what we’re dealing with, OK?”
Tommy was mollified, which Kevin used as an opportunity to ask what drew him to engineering. Tommy described the blueprints he created, the pride that came from seeing his drawings transformed into office buildings and industrial plants.
Kevin imagined a ten-year-old Tommy spending rainy days assembling an Erector Set. He envisioned a boy so adept with his fingers he wouldn’t be frustrated by working hex nuts onto bolts in a tight space. Kevin had done it as a child. He hadn’t minded the repetitious fabrication—constructing girders, tying and cross-bracing them into a bridge, even adding a second or third tier. Anticipating the completion was half the fun.
Kevin gave Tommy a return appointment slip and was about to say goodbye when he sensed his patient wasn’t finished.
“Any other questions?”
Tommy declined. He started to leave but paused at the doorway.
“I don’t get it. I mean, yeah, I tried the bathhouse scene a few times. It wasn’t for me. I’d only had sex with a couple of people before that, and there’s been nobody since. And I never, ever used poppers. I just don’t get it. There are all these men who’ve been at the glory holes forever. They’re fine. Why me?”
Kevin had no answer.