The Skeleton Cupboard (29 page)

I wanted to take Tom, and if I'm honest, myself, away from his thoughts of suicide, so I asked him about his career; anyway, I needed to get to know him. He was an impressive man: talented, beautiful and one of the first “out” gay fashion designers.

“So you're an icon.”

“Oh, darling, flattery will get you everywhere!”

“No, seriously, Tom—what made you come out?”

“I didn't ‘come out.' I was just being me.”

“So why not be you now? Why want to kill yourself?”

Tom stretched his arms above his head and clicked his back from side to side. “I choose to be openly gay as a designer. I didn't choose this disease.”

I couldn't argue with that.

“What would you do in my position?”

“Tom, this isn't about me.”

“Not an answer.”

I had to think here. You don't reveal yourself to your patient, it's all about them, but to push that point home to Tom felt way too insulting.

“Tom, I don't know.”

“Thanks for being honest.”

*   *   *

I continued to see Tom as an outpatient now that he had been discharged, but I had other patients and my list was varied.

I met a number of men, some heartbreakingly young, who were scared to death of death. A few of them had never come out to their families, so they needed support to prepare themselves to disclose two huge and shattering pieces of news: “So, Mum, Dad, I'm gay. And I'm HIV positive.”

There were those who were firmly entrenched in their denial and were doing the rounds of HIV services looking for someone to tell them it was all a big mistake. And then mixed in were a few of my regulars from the DDU who had chosen to inject themselves with infected blood, were happy with their HIV diagnosis and eagerly looking forward to their benefit eligibility.

And then there were the “worried wells.”

The “worried well” was someone with chronic AIDS phobia. Their health anxiety had become so acute that many had become agoraphobic, due to their morbid fear that any toilet seat, cup rim or stranger brushing past them on the street would give them AIDS. After my session with Tom, I really struggled to remain in a nonjudgmental space with the worried well.

Looking back, I realize how revoltingly politically correct I became on that placement. I was so overwhelmed by those facing death that I forgot to remember that psychological distress, however it presented, was real to the person experiencing it and I was privileged to be asked to help them get through it.

*   *   *

Chris and I met in a coffee shop near the clinic. I hadn't seen her for a while—she'd been on vacation—and when I saw her walking toward the table I had been sitting at for about fifteen minutes, I realized that I had missed her.

“Hey, good to see you!”

She dumped her many heavy bags down. “You got a coffee.”

“Yeah. And I got a double espresso for you.”

Chris smiled. “Nicely done.” She took a sip, winced, and then poured in a sachet of brown sugar. “So, I hear you are seeing Tom.”

Does this woman know everything about me?

“Yeah. He's a great guy. I am looking forward to working with him.”

After another sip, Chris added another sachet. “I'm glad. But I wish that you had run him as a possible case past me first, before you just took him on.”

Here we go: placement screw-up number one.

“Well, you have been off on leave. But anyway, why?”

“Because I think he's going to be more of a challenge than you can handle, even at this stage of your training. On top of this final placement, you need to complete your dissertation—I'll want a time frame from you for drafts of each section, by the way. That's a lot to take on.”

I was shocked. How could Tom be too much of a challenge? Lovely, dying Tom?

“What? More than Ray or Imogen? More than Mollie or Harold?”

“Different.”

I spooned off my cappuccino foam and licked it off the teaspoon. I can do cut-off; I can play her at her own game.

“You're going to have to explain this one to me, Chris. This is my final placement. Shouldn't I be ready?”

“Just trust me.”

“I do, but I also need to understand what your problem is here.”

“Problem?”

Shit, Chris looked pissed off.

“All right, I'll tell you my reservations about you seeing Tom.”

“OK. I'm listening, but I have to tell you that I have made a commitment to this man, and seeing as you were off when I started this placement, I really do struggle with you coming in now and taking me away from him.”

Chris smiled to herself. “Don't get too cocky.”

“I am not going to renege on my commitment.”

“That's OK. I can see him instead of you.”

“No, you can't. He's mine.”

The smile froze on Chris's face. “Tom is end stage. How much do you understand about this virus?”

I took a deep breath. “Seroconversion happens between three and twelve weeks of infection. Early symptoms of the acute retroviral syndrome generally present as an influenza-type fever, some swollen lymph nodes, perhaps a rash on the trunk of the body and mouth and genital sores.”

I paused. Chris had her head down, stirring her coffee, listening.

“Following seroconversion, there is a period of clinical latency—a symptom-free period. But as the CD4
+
T cells decline as the immune system becomes more and more compromised, opportunistic infections start to kick in.”

I paused again; Chris still said nothing.

“So these symptoms would be nausea, vomiting, diarrhea, fever, weight loss, usually lasting between three and six months. Also generalized lymphadenopathy.”

Chris looked up at me. “And that means?”

God, she could be one smug bitch.

“It means that the patient shows unexplained and nonpainful enlargement of more than one group of lymph nodes and—”

“Patient?”

Chris's interruption was abrupt; I felt slightly rattled.

“Yes, patient. And the problem here is?”

Chris smiled to herself. “Nothing. Carry on.”

“Do you want another coffee?”

“In a minute. Carry on.”

God, what was there left to say?

“So, once the T-cell count dips below two hundred, a diagnosis of AIDS is made. Associated symptoms are PCP, cancers, cachexia, which is the term for body wasting”—I smiled to myself—“thrush in the throat, which is called esophageal candidiasis, and also respiratory infections.”

Chris started clapping slowly.

What?!

“Well done. A great description. Shame you're not doing medicine.”

That stung. What the hell was she saying?

“Look, you asked me…”

Chris looked up and she looked pissed off. “Yes, I did. I asked you for an explanation as a psychologist.”

“No, you asked me what I knew about the virus.”

“And I expected you to answer me as a clinical psychologist.”

What did this woman want from me?

“Do you know, I've just had a flashback to your first presentation to me of Imogen. Do you remember?”

I stood up and went to order another cappuccino and double espresso; I needed time to collect myself.

Why did I get so quickly irritated with this woman?

“OK, I'll start again.” I slid Chris's drink over to her. “Tom is end stage. He has recurrent bouts of PCP and KS on his face. He is angry and has left it this long into his disease progression to ask for support to manage what he's facing. He has gone past the denial phase. He is no longer in shock; he's just bloody angry.”

Chris nodded for me to go on.

“Yes, I am flattered that he asked me to be his support. Yes, I am pretty bloody impressed by who he is. But for God's sake, Chris, don't flake on me now. I know I can do this.”

Chris looked straight at me. “Flake on you? A little too much familiarity here, I think. I do not
flake
on you or anyone else I give my time to support. Maybe you want to rephrase that?”

I was stunned. I took a deep breath. “Chris, that term is a colloquialism, right? I didn't mean any offense. I think that is a bit of an overreaction.”

I took a sip of my coffee and avoided her gaze; my heart was beating fast.

She continued, “I think there are some boundaries in this relationship. I think you need to consider your language at times. I think you need to remember my role in your training and that I am ultimately the person who will get you through to qualification. Don't forget that.”

I felt a flame in my stomach, and despite feeling a need to placate my supervisor, I couldn't stop the clearly repressed and still unresolved resentment from bubbling up.

“I do remember all that. I also remember the moment you left me high and dry at a bloody difficult time on my second placement.”

It was Chris's turn to sip her coffee and avoid my eye.

“In fact,” I continued, “I don't recall any explanation of your sudden disappearance. No call from the uni to arrange coverage while you were away. Nothing.”

Chris looked up slowly. Her face was taut and her eyes fixed. “So I have
flaked
on you.” She smiled tightly to herself and shook her head.

What was I doing?
This woman held my qualification in her hands. I needed to backpedal fast.

“No. Well, listen, Chris—”

“Point taken and will be considered. Let's move on, shall we?”

Her tone was chilling. Now I really understood how I'd overstepped the mark.

There was an uncomfortable silence as Chris drained her coffee.

“OK, then,” she said. “Back to Tom. So, what are you going to do? This man has no intention of accepting his death. There are many others you could help.”

“I'm going to do the best I can to do what he has asked me to do.”

Chris smiled to herself and shook her head. “You are so bloody stubborn.”

I attempted a smile back, although she wasn't looking at me. “Takes one to know one.”

Chris made to leave. “Fine. Honor your commitment, but make sure you keep me in the loop, because this one will not be easy.”

Thanks for telling me, lady, because after Ray, Imogen, Harold and Mollie, I expected this placement to be a walk in the park.

But my victory felt hollow. That was one holy screw-up of a conversation.

*   *   *

Despite being a place where people went to die, the ward often had a real party atmosphere, and never more so than when some of the big names in entertainment—singers, actors, comedians—some themselves infected with the virus, would give an impromptu performance. It was so surreal to be in a place of immense sadness and loss yet enjoy the company of the most enthusiastically vibrant people.

Some of the best live gigs of my life happened on that ward.

During one especially great afternoon performance by a singer whose concert tickets I couldn't afford, Pete asked me to come into a room where a young man was about to die.

“You're the only female available. Do you mind coming in? His mother is distressed.”

I nodded but didn't move from my seat. I couldn't believe my luck as I sat only feet away from one of the most iconic musicians of the time, a man who, at least twice during his set, made eye contact with me as I sang along. I knew that I wasn't moving fast enough—the thought of being with a dying man seemed worlds away from the exclusive party I was attending and I didn't want to leave.

I jumped as Pete tapped me on the shoulder.

“Come on, sweetheart. I really need you here.”

Guiltily, I leaped up and pushed myself through the throng, and as I turned back to take a last look at the singer, he blew me a kiss. I felt dizzy and couldn't stop smiling as I followed Pete through the double doors and down the long corridor, the music fading fast behind me.

The room was quiet and full of people all focused on the skeletally thin young man in the bed. Lying next to him and holding him was another young man whom I presumed was his partner. His mouth was up close to the dying man's ear; he was whispering to him.

On the other side of the bed was the only woman in the room. She sat ramrod straight in her chair, and her eyes were intently focused on the young man's face; she held his hand and stroked it with her thumb. I walked toward her and she, catching my eye, nodded before returning her gaze to her son. I tried to stand discreetly some distance behind her.

At the base of the bed were three other young men, all with their arms around each other, one sobbing silently into the chest of another. The dying man had his three boys there like one day I hoped my three girls would be there for me. The room was almost silent, but the anguish was palpable.

The patient was struggling to breathe. His breath was erratic, sometimes deep and slow, and at other times shallow and fast. On occasion he would struggle to take a deep inhale followed by an excruciating pause.

Pete leaned over the young man and gently moistened his dry lips. His partner looked up questioningly and Pete nodded. The partner looked to the young man's mother, who also nodded to him.

What were they doing?

The three friends at the end of the bed came forward and in turn leaned down to kiss their friend. One sobbed; another rubbed his friend's head while kissing him on his half-open mouth; the last put his arms around the dying young man's fragile body and laid his head on his chest.

It was then the turn of the young man's mother, who stood and leaned over her son while his partner slid off the bed and stood respectfully away. As she cupped her hands around his face, her voice was the first I'd heard in this still, calm room.

“My darling boy, I don't want you to fight anymore. I think it's time for you to go.” Her voice cracked, but she carried on. “My darling Richard, I have always been so proud to be your mother. You have given me so many years of pleasure and I shall always cherish our Devon holidays and crabbing together and watching you graduate, the wonderful plays you took me to and the many brilliant articles you have written. You are the most wonderful boy, and I promise I shall always look after Joel.”