Medical Advocacy and Outreach
This essay is part of our series, Flattened By the Curve, which features the voices of doctors, nurses, healthcare workers, and others on the front lines against COVID-19. For information on how to submit, click here.
When I learned to do physical examination in medical school, my teacher told me to breathe along with the patient when listening to their lungs — that way you never have them hold their breath for too long. It’s a habit I’ve passed along to my own students over the years, and one I still practice — my body aligned with the body of the person in front of me for a few beats of a hectic day.
I’m an HIV doctor in Alabama. My favorite part of seeing patients over the last few months is the brief moment when I allow them to take their mask off so I can examine their mouth — crucial for people living with HIV, who might have fungal infections or cancers inside. It’s always a little like unwrapping a present when they pull their mask down — no one ever looks quite like what I’ve expected. And in my mind I pull my mask down along with them, aligning my experience with theirs. But of course I don’t do that — instead I try desperately to smile with my eyes and bridge the chasm between us to build rapport.
These days in my clinic, we’re trying to see as many patients as we can via telemedicine. Our immunocompromised patients generally appreciate being able to stay safe at home, and our providers get the window of the modern-day housecall — a peek at those jumbled medications in a drawer or that rickety staircase can be eye-opening. But patients newly diagnosed with HIV still need to be seen in person. Of course the physical exam is crucial, but more importantly, their initial visits need to be an envelopment of interdisciplinary care. It is all about building connection and trust in those early visits, reframing what still sounds like a death sentence to many patients as a manageable chronic disease.
Now, I practice my best eye smile and try to convey some sense of normalcy and safety without a hand on the shoulder or a hug, fully and painfully aware that the mask I have on and the physical distance I keep perpetuate the stigma that my patients already feel. My patients’ lives have already been forever changed by one virus that takes advantage of structural racism and poverty. This whole new plague is causing anxiety, fear, and mayhem, but it doesn’t seem to have come as a surprise to any of my patients, who are used to the failure of systems that are supposed to support them. Besides, they have more pressing viral matters to deal with.
HIV hasn’t paused for COVID. The youngest newly diagnosed HIV patient I saw last week was 19, and the oldest was 77. No, there is no vaccine. No, there is no cure. I know, it’s confusing because we’re desperately looking for those things for this whole new virus, but I don’t have them for the one that you have. But yes, I can help you live a normal, healthy life with medication. But you have to trust me. You have to come back, you have to take your medication. I would hug you if I could. Can you tell by my eyes that I care about you? I am breathing in when you breathe in.
Cordelia Stearns is an HIV physician in Montgomery, AL. She lives with a baby who hates naps, a dog who loves them, and a husband who is trying to work from home while meeting everyone’s nap needs. She thanks you for staying home and would appreciate it if you don’t go bowling in Georgia for the time being.