Two Primates Conversing

litbonanza.jpgI could sense her behind the door. She was cowering and exposed on the highly perched examining room table. Her head was lowered in shame, her eyes were wet with horror. As I swung the door open I saw what I had sensed. I wanted to be a good doctor for her, brimming with good news, smiling as I pronounced that all the tests had come back normal. How tempting and easy it would have been to reverse what I had to tell her. She might have leapt off the table and hugged me, her heart pounding with relief as I guiltily admitted I had no pull with Fate. But instead I greeted her in a solemn sort of way. Her heaped shoulders drooped forward on her spine, and I feared my words would snap her.

“Thanks for coming in today,” I said. “I wanted to see you in person because unfortunately… your HIV test came back positive.”

Over the last two days I had practiced how I would say those hideous words. There were gentle, long-winded iterations and harshly blunt versions but none seemed good enough. In the end I decided to get to the point as quickly as I could, even if it was clumsily terse. Still, it felt like I was smearing shit upon a Matisse.

She smiled. It was the insuppressible and wretched smile that every now and then creeps onto the face during a loved one’s funeral. Or perhaps it was the grin of a chimpanzee, one that clearly expresses fear instead of joy. Her teeth were bared defensively – primal weapons of physical and social self-preservation.

“Oh my God,” she crumbled.

I leaned forward and offered her my hand with its opposable thumb. We sat there, two primates conversing. Amid the tears there were questions, confessions, and more questions. I answered them. I tried to frame them in the context of the chronic disease that HIV has become, instead of the inexorable death sentence it used to be. How long do I have to live? Will my insurance company drop me? Does the government know I have this already? When do I tell my parents? What do I tell my partners?

I felt horrible. I was weaving the first threads of her new existence, altering her identity with some abstract concept called human immunodeficiency virus. She had no concrete symptoms from the infection, only nausea, pain, and fear from the idea of it. Science could describe the reverse transcriptase now inside her lymphocytes as it stitched mindless, mirrored copies of itself ad infinitum. Books could portray the genes of the virus: gag providing the physical infrastructure of the virus, pol providing the basic enzymes by which the retroviruses reproduce, env supplying the proteins essential for viral attachment and entry into a target cell, and all the other genes for the myriad accessory proteins that, when summed together, constitute fully formed viral particles that exist on the edge between life and non-life.

But none of that seemed even remotely related to the macroscopic world we sat in. The padded table under her buttocks was green and sterile. The walls were thin and cream-colored. Her bangs were curled in wet coils on her forehead and cheeks, and she looked exhausted. HIV was infecting every future relationship in her mind. It was spreading backwards through past lovers who would soon be showered with fearful news as it radiated from their cell phones.

I talked with her as long as she wanted. By the end of the visit she had accepted her diagnosis. I suspected it was not entirely a surprise. She had friends with the disease, friends that she would now be joining in a bittersweet fraternity of sorts. There was a lot of hope, actually.

“Are you going to be okay?” I asked her.

“Yes,” she replied, taking a deep and shuddering breath as she stood up. The burden on her shoulders looked a bit lighter, or perhaps she was gaining strength in her bipedal stance. “I think I’m going to be okay.”

“I’d like to see you back in one week so we can talk some more. I want to make sure you’re coping. Please call me anytime this week. You’re going to do well. Really.”

And then she thanked me, and all at once I felt like the most wicked and the most beneficent person on Earth for the experience I had just shared with her.

Related Topics


Aidan Charles is the pseudonym of a practicing family physician whose writings regularly appear on his blog, The Examining Room of Dr. Charles (