Among his laboratory-based duties, he was responsible for the firm’s small fleet of cars that picked up specimens every day from doctors’ surgeries and delivered the printed-out results. Inevitably, the cars suffered small knocks and scrapes and often needed the services of a panel-beater. Luke had found an obliging small business nearby and had become friendly with one of the panel-beaters. This young chap had casually asked a couple of weeks earlier if Luke could arrange for him to have an HIV test. Luke had explained that only doctors, or nurses deputising for doctors, could order HIV tests in Victoria. He would have to go and see his doctor about it. The young panel-beater had been insistent though. ‘You do them at your laboratory, don’t you, Luke?’
‘Yes, we accept them from doctors, but we send them to the laboratory at Fairfield Hospital, which is the only laboratory in Victoria licensed to perform HIV antibody tests at present.’
‘And you know how to take blood, don’t you?’
‘Yes, I do it every day.’
‘Well then, couldn’t you just take some blood off me and slip the sample in under some phony name, then watch out for the result when it comes through and let me have it? I’ve done lots of favours for you, you know mate, getting a job done quickly on your cars.’
Paolo, the panel-beater, had assured Luke he was at no great risk for HIV, saying, ‘I’m not one of those poofters, you know mate.’
He had been with a few girls and just wanted the test for ‘peace of mind’.
Against his better judgement, Luke had agreed to Paolo’s request. To Luke’s dismay, Paolo’s blood sample came back positive. Sensibly, without notifying Paolo, Luke had gone at once, cap-in-hand, to his boss and confessed his error of judgement. His boss had been angry but asked Luke if he knew a doctor in the HIV field who might agree to help them in their dilemma. The boss’s idea was that Luke should tell Paolo his test had come back with an equivocal result and that the Fairfield Hospital laboratory had requested another sample to help sort out the real result.24 Luke would have to persuade Paolo that the repeat test could only be ordered by a doctor, but that he could take Paolo to a helpful one, who understood HIV testing.
I had little option but to agree to Luke’s request, although it was indeed a big favour to ask. It meant I had to go along with a lie by agreeing with Luke’s story that Paolo’s first result was equivocal, when it clearly was not.
Luke duly brought a very apprehensive Paolo to see me and, at Paolo’s insistence, Luke sat in with him during the consultation. Paolo was short, but Luke wasn’t lying when he’d said at our earlier consultation that he was ‘built like a brick shit-house’.
It was a highly accurate description of Paolo’s appearance. But, Luke had gone on to confess, ‘I have to say, David, I do find men like Paolo very attractive.’ I’d given an inward sigh at that revelation. Here was the real reason Luke had gone along with Paolo’s request – because he fancied the young panel-beater.
I devoted an hour to the appointment so I could be sure Paolo was properly counselled about every aspect of HIV testing. I went to some length about equivocal test results. I asked Luke to go out of the room while I quizzed the patient about his sexual history over the past year or two, and whether he had ever injected intravenous drugs. He gave nothing more away than he had already admitted to Luke – just a couple of occasions of unprotected sex with casual female partners and no drug injecting ever. He agreed to a repeat test, so I took the blood sample and sent it off, legally this time, to Fairfield Hospital. I arranged to see him in two weeks’ time, and suggested he again bring Luke for moral support, in case the test proved positive.
Of course, the second test came back unequivocally positive, consistent with the earlier result. After meeting Paolo, I had assessed his coping mechanisms as fragile at best, and I foresaw that his reaction to a positive result was likely to be dramatic. I therefore scheduled his follow-up appointment as the last of the day. It was just as well. His reaction, when I broke the news of his positive result and showed it to him in writing, was loud, hysterical and desperate. Luke and I had tremendous trouble calming him down. Rational discussion was out of the question. The pharmacist in the shop below the surgery told me the next day he had heard the howls of anguish clearly. He had wondered if I was okay, or whether he should come up and intervene. It was a wonder to me people couldn’t hear Paolo in Sydney, 900 kilometres away!
Both Luke and I were tied up with Paolo for several hours, listening to his wailing, feeding him cups of strong black coffee, lighting his cigarettes because his own hands were so shaky he couldn’t do it himself, and finally calming him sufficiently to allow Luke to take him home to his Sicilian family. I went home exhausted, annoyed with Luke for putting me in such a position and, despite my better feelings, irritated beyond measure with the panel-beater.
Over that last six months, until I left for Cairns, Paolo came to see me at regular intervals. We became quite friendly, but it seemed impossible for him to come to terms with his diagnosis. He soon provided a changed version of his story. His new tale told of a trip a year before to Adelaide where he had become drunk one evening and picked up a girl in a bar. They had got on well and had unprotected sex. Phone numbers had been exchanged. As he was rather smitten with the lady, Paolo had promised another trip to Adelaide to visit her again, and they had rung each other regularly following that. Eventually, nine months later, he’d made the repeat journey. They had spent a pleasant day together, and Paolo had not become drunk on this occasion. Imagine then his shock, when engaging in sex that evening, to discover that his ‘girlfriend’ was a male-to-female transsexual. What’s more, she had undergone no operations. Anatomically at least, she was still undeniably male below the waist. Paolo had realised with horror that on his previous visit he must have unwittingly had anal sex with this person, hence his anxiety to have Luke arrange an HIV test for him.
If Paolo was telling the full truth about his Adelaide encounter, he was quite unlucky. Insertive (i.e. ‘active’) partners are considerably less likely than receptive (i.e. ‘passive’) partners to acquire HIV during anal sex with a positive person, especially if the sexual exposure happens only once.
Although Paolo’s initial tests showed no significant fall in his T cell count and his physical health was unimpaired, I was shocked in the change that he underwent even in the short time I was looking after him. He lost weight as he had completely lost his appetite. He ceased worrying about his appearance and often looked dirty and unkempt. Alone, he brooded unceasingly about his HIV status, but felt unable to share the knowledge with anyone else. He became unreliable and unpunctual at work, and most weekends he drank himself into oblivion. He told no-one in his family about his diagnosis, as he claimed his father would kill him if he ever found out. Luke and I were his only confidants. He resolutely refused to see a psychologist or psychiatrist. I began to feel desperately sorry for him. Unlike the majority of my gay patients, Paolo seemed to have no inner reserves of strength and no ability to cope.
Knowing I was leaving Melbourne, I introduced Paolo to Darren Russell, the other doctor in the practice, and kept Darren informed of his progress until I left Melbourne for Cairns. I heard nothing about Paolo until almost two years later. One afternoon in the clinic in Cairns, I had a phone call from him in Townsville. He was travelling with some friends up the Queensland coast and their next stop was Cairns. Could he come and see me? I readily agreed. He turned up a couple of days later looking a shadow of his former self. No longer could he be described as built like ‘a brick shit-house’. He was only thirty-two, but was thin, gaunt and aged-looking. His clothes merely hung on him. He had oral thrush and extensive, severe fungal skin infections. As well, by his own admission, he was clinically depressed. He said he felt ‘down’ most of the time and was only trying to keep up appearances on this trip for the sake of his friends, none of whom knew he was HIV positive. He was in Cairns for only a few days but said he had not been attending the Carlton Clinic regularly
and that it was ages since he had had a T cell count. I arranged to get that done for him and the results were available before he left. His T cell count was below 150. He was significantly immune-deficient now and thus at risk for an opportunistic infection at any time. I told him exactly what his situation was and discussed starting him on Bactrim and a couple of anti-HIV drugs, but he refused point-blank. When I was insistent, though, he did promise to go back and see Darren when he returned to Melbourne.
He thanked me and shook hands when he was leaving. His parting remark left me extremely concerned. He said, ‘It might just be better all-around, Doc, if I were to get in my car one day and just drive over a cliff and end it all.’
I never saw or heard anything more about Paolo after that. Darren told me subsequently that at some stage, he too had lost contact with him.
I often wonder whether Paolo might have done better if Luke had been resolute in sticking to guidelines and brought Paolo to see me for his HIV blood test in the first place. Failing that, if Luke and I had agreed to be straight with him about his first test and had not resorted to the lie about an equivocal result. Being truthful in medical practice is almost always the best policy. But, given Paolo’s personality, it is likely the outcome would not have been much different whatever way he had been managed.
* * *
22Non-Hodgkin’s Lymphoma is one of the HIV-related cancers.
23A Portacath is a small medical appliance inserted surgically under the skin, with an attached subcutaneous catheter that passes into a major vein. It allows easy access for injections and infusions intravenously. However, maintaining good aseptic techniques in accessing it is essential to prevent septicaemia.
24Equivocal results did occasionally happen, and in people at very low risk (as Paolo theoretically was), subsequent testing generally showed that they were negative.
Chapter Fourteen
Cairns
In 1985, for the Easter break, Michael and I visited Cairns for the first time. That long weekend, we made a good friend in Bert Gerbrands, a gay Dutch-Australian working in the hospitality industry. From then on, we visited Cairns every year. Eventually, we purchased a block of land, with a view to retiring to Far North Queensland someday.
By late 1992, working in the HIV/AIDS sector was taking its toll. Although I had a competent assistant, Dr Darren Russell, working with me in the Carlton practice, I was feeling chronically stressed. I spent one Sunday morning in 1992 or 1993 viewing the display of AIDS Quilts spread on the floor of the Exhibition Building in Melbourne. As I walked around, I couldn’t stop crying. All those familiar names. I had known so many men personally – all of them now dead from AIDS. That day, the future looked dark, bleak and unremitting. I had no way of knowing that effective treatments were only three years away.
Two developments in Cairns led Michael and me to consider moving north. Bert had long cherished the idea of setting up a gay resort in the Cairns district. Just before Christmas 1992, Michael spent a few days with him. When driving one day to Port Douglas, they passed a property at a place called Turtle Cove that had recently been passed in at auction. The site seemed ideal. It was set on a beach that was private and secluded, the only access being through the resort itself. Back in Melbourne, Michael and I looked for friends who might be willing to join us, with Bert, in such a financial venture.
By the end of 1992, together with a group of Melbourne friends, we found ourselves part-owners of Turtle Cove, fifteen kilometres south of Port Douglas. We planned to open an exclusively lesbian and gay establishment by the next Easter. Bert immediately set about reno-vating the run-down resort. He wanted Michael to join him, and then for him to continue full-time as marketing manager.
A few weeks later, I heard that Cairns Base Hospital was seeking funding for a new position: Director of Sexual Health for the region. They were looking for either an infectious disease physician, or a sexual health physician with considerable experience in HIV/AIDS. The successful applicant would have responsibility for sexual health in Cairns and for the whole of Cape York Peninsula, as well as for the Torres Strait Islands. They were hoping to advertise the position in March 1993.
In due course, Cairns Base Hospital obtained the necessary funding and the position was advertised. I applied, and was successful – truth to tell, there wasn’t much competition, as I was the only applicant! Turtle Cove Resort opened on schedule at Easter time and we sold the Carlton practice and our Richmond house without difficulty. I moved to Cairns in July, a few months after Michael, and started work a week later. The most difficult part of the move was leaving patients in Melbourne. Many thought I was deserting them, and I couldn’t help feel that in some ways I was running away.
One patient with AIDS, whose health was precarious, summed up how some patients were feeling. ‘Doctor, what you are doing is not fair. We know you won’t last in Cairns. Pretty soon you’ll realise you’ve made a mistake and you’ll come back to Melbourne. But that won’t help some of us, because we’ll be dead.’
I expected my new position in Cairns would be challenging, but I did not grasp how challenging until I had been there a few months. The patients were as different as the climate. There were fewer HIV positive patients – at most, seventy-five compared to 300 in Melbourne. My Melbourne practice had been predominantly gay men. The HIV positive patients in Cairns were diverse. There were several heterosexual men who had acquired HIV in various ways: one through injecting drug use, one elderly chap through a blood transfusion in 1983 when he had heart surgery, and a couple through sex with bar girls in South East Asia. There were two young men who claimed that their only source of HIV was through blood contact when ‘gay bashing’ at ‘beats’, in toilets or parks around the district. These two were rather unpleasant characters when I first arrived in Cairns, but as their disease progressed they gradually mellowed. One even accepted help from a Queensland AIDS Council team, consisting of gay men and others, that allowed him to die peacefully at home. There were two young women; one was from Thursday Island, and had acquired her infection from an African seaman when his ship had been forced to anchor for repairs in the Torres Strait. The other was a local girl who had acquired her infection from a visiting American sailor when a US navy ship had spent a couple of days in the port of Cairns.
Many of the HIV positive Cairns men who admitted sex with other men were markedly different from my out and proud Melbourne patients. For some, their male contacts were clandestine and anonymous. Several spent their lives trying to pass as heterosexual, a few being in relationships with women. There were five urban Indigenous patients attending the clinic, all of whom had acquired their HIV infection through homosexual contact, although only two of them were ‘out’ gay men. There was a range of sensitivities and nuances for me to acquire in history-taking and in management of these diverse patients.
It was difficult adjusting to being one of the hospital Directors. Once a week there was a Director’s meeting, chaired by Dr Wally Smith, the District Manager, a bluff, no-nonsense, ex-RAAF medical officer, with whom I immediately established good rapport. My reputation had gone before me. There had been a short article about Turtle Cove in the Bulletin some months before, where my name had been mentioned. So, all the directors knew I was gay and part-owner of Turtle Cove. At my first meeting, some looked at me as if I had arrived from another planet rather than from Melbourne.
With some hospital staff, my patients were not popular. At the time, the hospital had no Infectious Disease physician, the specialist that would normally accept responsibility for inpatient care of an AIDS patient. A couple of the other physicians had no wish to care for people with AIDS or HIV infection. These doctors took me aside privately and told me that if an AIDS patient was admitted under their care when they were ‘on take’ for a night or weekend, they would tell their registrar to call me. I could take all the responsibility for the patient’s care, as they wanted no part in it.
With time, most of my fellow Directors at Cairns
Base Hospital came to accept me. Some were allies from the start, while others more slowly and grudgingly decided I was a reasonable clinician. A couple continued to regard me suspiciously until I retired from full-time work. Far North Queensland is like that; it takes time to be accepted there.
The clinical facilities allocated for sexual health at the hospital were inadequate and my staff was small. The clinic, just outside the main Emergency Department, consisted of a cramped reception area, a wide corridor with a few chairs which served as a waiting room, two doctor’s consulting rooms with paper-thin walls, and one larger room with a couple of comfortable chairs for the full-time HIV nurse, Barbie Brayshaw. I was the only full-time doctor, but I was helped by two part-time assistants who did afternoon clinics between them. Sexual Health shared the area with ATODS: the Alcohol, Tobacco and Other Drugs Service. The combined area was euphemistically called ‘Special Health Services’. Generally, ATODS occupied the area in the mornings, and Sexual Health held sway in the afternoons. For us, the only constant was the full-time receptionist and Barbie Brayshaw, both of whom were there from 8am to 4.30pm.
In addition, there was a sexual health office at Shields Street in the city, two kilometres from the hospital, where the rest of the staff was situated. When I wasn’t at the hospital, I spent my time at Shields Street doing administrative work. Paul Stephenson was based there – a highly competent and efficient administrative and clinical nurse, who reminded me of my medical sergeant Bob Allen in Vietnam. The only difference was that Paul was gay and Bob had been straight. Additionally, there was a receptionist/admin officer, another clinical nurse, and three Aboriginal Health Workers. These five shared responsibility, with me, for the entire Cape York region. My other team members were based 800 kilometres away on Thursday Island: Kel Browne, an enthusiastic male nurse, and two lovely female Torres Strait Islander health workers, with whom I was in frequent contact by phone.
Tell Me I'm Okay Page 19
