Tales from the office


His name on my schedule surprised me that morning. I figured it must be him, because even in NYC there can’t be that many people with his name and general age. When he showed up my suspicion was confirmed.

Barnaby was a friend of mine. Not a close friend, but we had hung out a few times, and I had been to his house for a group dinner followed by board games. That counts for something. I wondered what he was doing in my office until my mind suddenly flashed back to a random conversation when he told me he didn’t like his current doctor. He was considering switching to another. I hadn’t imagined it would be to me.

When his appointment arrived, things went well enough. We had a warm greeting and I could tell he was excited to have me as his doctor. He just needed a routine checkup. It seemed simple. But things never are so easy. Of course, I tried to treat him like any other patient and asked him all the routine questions, including about drug use and sexual practices. He used more alcohol and cocaine than I thought. And I didn’t realize that he and his boyfriend loved picking up other guys for threesomes. Granted, all this may have eventually come up during the course of our friendship, but probably while drunkenly sharing colorful stories, not as a clinical one-sided interrogation about risky health behaviors.

The exam went well. It’s actually not considered routine practice to perform a genital exam on a healthy thirty-something male without any specific complaints. So I didn’t have to take our doctor/patient (and friend/friend) relationship to that physically intimate level. The visit eventually winded down, I answered all his questions, and he left. We ended up seeing each other socially the following week. Although I felt somewhat awkward, Barnaby immediately addressed the elephant in the room and introduced me to everyone as his new doctor. I think he was proud of the fact. And it was a good conversation starter.

But things deteriorated. He saw me a few months later for routine STD testing. He tested positive for HIV. It was unexpected.

He would probably say that he was glad to have me, as his friend, give him the bad news. And I was happy to make myself constantly available to answer all his questions and those of his partner.

But his new diagnosis accelerated a change in our relationship. And it was probably me who was changing, not him. I suddenly became self conscious about our contact. If I called him to hang out, would he wonder if I was just doing it out of pity for his new diagnosis or because I enjoyed his company? Was he a project now, or a friend? I couldn’t always determine the answer.

Moreover, I had a hard time separating out my roles. When we were shooting the breeze as friends, the conversation could suddenly shift to HIV. Was I now a friend who simply needed to offer support, empathy, and a listening ear, or a doctor and authority figure who could give him health statistics and remind him that he was late for routine labs?

The diagnosis also changed my relationship with our circle of friends. Of course, I could never divulge to anyone that he had HIV. But he had already told some of his friends. Could I acknowledge to those people that I knew the diagnosis as well? Could I join in their conversation about how HIV was affecting his relationship with his partner and his performance at work? I wasn’t sure what information he told me as his doctor or as his friend. I felt the need to censor myself and change my interaction with our mutual friends so as not to betray his confidence. And I worried that he still might question my ethical commitment to his privacy. Was even hanging out with our mutual friends creating the appearance of evil?

Our relationship was worsening and I felt helpless. But of course, even now, I realize how ridiculous I must sound. I mean, I’m lamenting over the “difficult” situation of shifting friendships in which I found myself–while he’s the one living with the reality of HIV. But my discomfort was my reality, no matter how insignificant.

Our contact continued to shrink. Eventually, per medical protocol, I shifted Barnaby’s care to an HIV specialist. And soon after that we essentially lost contact in our roles of doctor and patient, and also in our role of friends. I don’t even mingle in his social circle anymore.

I often wonder if Barnaby and I would still be friends today if he had never been my patient. Life might have pulled us apart in other ways. Who can say? But I still feel twinges of discomfort that I may have let him down as his doctor, or friend, or both. I sometimes wonder what he thinks about our interaction, and what could have been different.

9 responses to “Tales from the office”

  1. Scott Godfrey says:

    Holy crow! This is a great post.

    As a doctor, is it common or ethical to deny your professional care/advice to people you know? It seems like opening that door would mean a potential burden on you every time you saw the person socially.

  2. MarleyFan says:

    I wondered the same thing, unless (of course) you lived in a small community.

  3. ssw says:

    Great post! Much more to say on this than I have time to fit in, but I just want to respond to the friendship angle–everyone–and this should include doctor’s too with some exceptions–should be able to “hang up their professional hat” socially. And, friends should not overburden their friends anyway–it’s just not nice. Cedric has good boundaries–I don’t think he’s ever been relegated to sit in a corner and address everyone’s medical concerns (am i wrong cedric? When I think about sitting in a corner with you, I think about you knocking my knee and getting that involuntary reflex going though–but that, that’s just dirty fun). Ehem. I’m getting carried away with myself here. Most of us grapple with professional lives that are intertwined with “who we are” and carry a certain amount of social responsibility along with it. I would hope my friends feel safe enough to ask me my opion, and allow me to do the same, especially in times of need. Sorry about the loss of this friendship Cedric. There’s surely a lot going on for him he’s lived with for a long time that has nothing to do with you, and it’s not one-sided when friendships/relationships end. And, it’s not your fault. xoxo

  4. Dave says:

    Loved this post. Dr. C. But I’m also interested in your opinion of another hot medical issue: the current E. coli outbreak at your favorite restaurant.

  5. i thought of you and taco bell together this week too, you naughty dr.

    this was an intense post. and reminds me that i’m not sure how i feel about the fact that you steadfastly refuse to be my dr. you would be so good, and i already ask medical advice in social settings, so how awkward could it be?

    re: marleyfan’s comment about small town doctors not having the luxury of professional anonymity — when i was in highschool i had my doctor (who also happened to be a family friend) remove an obnoxious oil cyst. later he took the stitches out too early and it made a nasty scar. that’s what sucks about friends for doctors. you can’t sue.

    your posts always make me admire you (and my other dr friends) more, cedric.

  6. Cedric Cedarbrook, MD says:

    In response to some questions:

    Scott: I don’t think many doctors would deny their services to friends–especially, of course, if that doctor is the friend’s only option (in that case it would be clearly unethical). Some doctors I know have their friends as patients. Others discourage it. I think I’ve come to realize that for me, it’s simply too hard to separate the two roles. I guess other doctors are much more adept. It’s certainly my issue. But in a big city, with a ton of doctors, it just doesn’t seem necessary to have to confront it.
    Moreover, it rubs both ways. When I randomly run into patients in public (e.g., in line at the post office), many of them are very uncomfortable. (Others have yelled, “I got your letter than I don’t have chlamydia! It made me so happy!”)

    MarleyFan: I guess the issue extends to other professions as well. I don’t know how a religious leader in a small town could hear intimate/disturbing confessions from a congregant and then try not to under- or overcompensate in future interactions.

    SSW: Your patellar reflex is hot! And, by the way, I actually love giving medical advice at any time to any friend. I just don’t want to be their doctor and have responsibility for my treatment plans.

    Dave: If an upscale restaurant chain like Chi-Chi’s can have a hepatitis A outbreak (Pennsylvania, 2003), then even a chain of delicious Taco Bells can have a little E. coli once in a while. You know it tasted good before it caused the explosive diarrhea.

    Bryan: You can still sue. I know a good lawyer.

  7. Tim Wager says:

    As a literary agent I run into situations all the time in which friends or friends of friends want me to read their stuff and consider representing them. I never refuse, just because that’s the nature of the business; I have to be open to books coming from any direction, and word of mouth has already brought me books I’ve sold. Sometimes I even ask friends I know who are writers to show me what they have, because I’m genuinely interested and think they might have something good.

    In that I pass on about 99% of the things I read, though, chances are slim that I’ll want to represent these friends and/or their friends. I always make that as clear as possible up front, but awkwardness often follows when I tell them that I’m not interested. Of course, I always try to do it in the best of ways (not right for me, the market for fiction is very tough (which it is), etc.) without lying or being phony.

    A few months ago I met a woman at a party. Over the course of our conversation it became clear to me that she was a friend of a friend whose novel I had read and passed on some months before that. (She has a common first name, as do I, and we didn’t use surnames in introducing ourselves.) I felt bad not telling her, and she was telling me about how excited she was about her novel getting picked up by a literary agent. We were getting along fine, and she was cheery due to her recent success, so I thought it would be okay to say something (and I also felt bad about not giving full disclosure). When I told her who I was and that I’d read her novel, she instantly became very frosty and didn’t speak another word or look at me the rest of the night. It’s difficult when people respond like this, but such are the risks.

    In reference to this case, Cedric, I wonder if you think that Barnaby was looking to you, as a friend, to be less disapproving of his high-risk threesomes than his previous doctor may have been. Do you think he may have felt that it would be harder for you to caution him in a way that he would have to take seriously?

    And . . . Taco Bell? Really? Come to LA and go to some good taquerias. You’ll never go back to the TB again.

  8. Scott Godfrey says:

    Isn’t taqeuria what you get when you eat at Taco Bell?

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