Memory

“I’m really sorry to reach out like this, David, but I’m worried about my brother. I think he has AIDS.”

I wasn’t prepared for that call from your sister. She was only 11 years old when we were together. She’s 40 now.

It had been a year since you and I last spoke. I was driving back to Atlanta from upstate New York. You told me you were recently discharged from a hospital for what you described as blood clots and an allergic reaction. Your voice, weak and raspy, reiterated repeatedly that you were on the mend and didn’t need help from anyone, particularly your family. You came from a strict religious upbringing. I knew what that meant.

I asked you if the hospital staff had tested you for COVID-19.

“Three times. All negative,” you told me.

I asked about HIV testing. Again, you stated the testing was negative in the hospital.

I believed you and tried my best to be supportive. I don’t know how successful I was.

Over a year later, your sister was reaching out, worried that you were at the end stages of HIV. The apartment manager had contacted her about finding your unit unkempt and you in a deteriorated state. Feces and food were scattered on the floor. They offered to bring you to the hospital. When you refused, she called me. I told her to push the apartment manager to get paramedics and a social worker to bring you to the emergency room. She did, and they admitted you for pneumonia and dehydration.

I rearranged my schedule and drove ten hours to the hospital. I had to see you.

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Hospitals were once places where I enjoyed working. Now, I hate them, as the only times I find myself there is when visiting loved ones who are ill or dying. I got my visitor’s wristband from the front desk and made the pilgrimage through sterile corridors to your room. Was this HIV as your sister suspected? And if so, why did you let it get this far?

You weren’t there when I arrived. The nurse told me you were getting a bone scan, something about ruling out metastatic cancer. I imagined you may have told them that, the same way people used to throw around the terms “meningitis” or “pneumonia” when the weight of a three-letter acronym was too heavy to bear. She placed a chair by your bed for me. I sat down and surveyed the room.

A urinal containing tea-colored liquid hung on the hospital bed rail. A venous compression device to prevent blood clots sat lonely at the foot of the bed. Uneaten food took occupancy on a plate, stale and cold, wasting away on a food tray. Your name was printed on the paper describing the contents of the meal. This was all real. Sadness filled that space.

Moments later I heard your laugh from down the hall. It floated into the room, sat beside me, and flooded me with reflections of our early days together: Our meeting at a New York City club and how both our hearts leapt out of our chests on sight; the endless nighttime phone conversations, only interrupted by the sun signaling to us that it was time for a new day; the road trip to Savannah beach where the ocean whispered in our ears that the fun would never end. Four years in total. A lifetime of youthful remembrances.

Suddenly you appeared at the door, lying on a stretcher. I stood up and moved to the other side of the room so the medical assistant could wheel you near your bed. As the stretcher passed, your eyes squinted hard, fixed on my face.

“Who is that?” you asked.

I pulled down my mask and mustered the flimsiest smile I could.

“David!” you exclaimed. “You came.”

The assistant and one of the nurses transferred you onto the bed and got you tucked in. I returned to the chair and moved it next to you.

“It’s so good to see you,” you said, shooting me a nostalgic look. “Have you seen my baseball cap? I may have lost it like I did one of my ear buds.”

I retrieved your ear bud from under the bed and handed it to you. You beamed with excitement before continuing to fumble through your bedding, searching for your cap. I could see why your sister was worried. Your typical 210-pound frame had been whittled down to 140. Your temples were sunken in like moon craters. Your hair, once a rich tapestry of course curls, looked thin and wispy. Your once smooth chocolate skin was now blotchy and deprived of melanin. Your face boasted a messy salt-and-pepper beard that sprouted like weeds. The man I knew wouldn’t let himself get to this point.

I studied the floor, not wanting you to see how jarring your appearance was to me. When I returned my gaze on you, the red baseball cap was fixed on your head.

“It was under my sheets,” you muttered.

I wanted to ask you what had happened but struggled to find the words. You brought up other topics and reminisced about the past. You inquired about my mom three times, forgetting I had already given you an elaborate answer. You kept asking if I was hungry while attempting to order lasagna and a salad from your favorite restaurant on your phone. I didn’t stop you — this was a visit from your long-lost ex, and you were playing the role of good host.

You fidgeted with your blanket often, picking at things I couldn’t see but were obviously bothering you. You put your glasses on and off with a repetitive, obsessive-compulsive frequency. I watched time tick on as we engaged in superficial banter interspersed with pregnant silences.

I asked one of the nurses if they could get the doctor or someone from the medical team to update me about what was going on. A couple of hours later a nurse practitioner walked in.

“What is your relation to him?” she asked appropriately.

“I’m his cousin,” I lied, still protective of your privacy and comfort after all these years.

She asked you if it was OK to discuss your personal medical information with me. You nodded in approval.

“Why don’t we go outside,” I told her. Your blank stare followed us as we left the room.

In the hallway, she didn’t mince words.

“He told us he had cancer when he came in,” she remarked. “We just did a bone scan, but there’s no evidence of metastatic disease.”

“I lied to you earlier,” I interrupted. “He was my boyfriend 30 years ago, and we were together for four years. His sister called me concerned about HIV. I’m an internal medicine doctor who specializes in HIV, so you don’t have to sugarcoat anything.”

“Well,” she sighed, “It is HIV. We have discussed this with him multiple times, so he does know.”

“What’s his T cell count?” I asked.

“Five,” she responded.

The single digit number escaped from her lips and shook the floor beneath me, knocking down all the walls I had constructed prior to my visit. I couldn’t stop the tears from saturating my face mask as I bowed my head and closed my eyes.

“I’m sorry,” she kept repeating over and over when she saw my reaction. Her condolences were meant to be comforting — they felt like a thousand shards of glass in my skin.

She left and I returned to sit with you. Your eyes studied me in a vacant manner, desperately trying to piece together our history.

“I miss you David,” you said as you put your hand on mine. “I’m sorry I was so stubborn.” You spoke as if our breakup was a year ago, not twenty-five.

“She told me about the HIV,” I blurted out, ignoring your attempt to reminisce. “It’s very advanced.”

You looked at me with child-like curiosity. I thought being direct with you would force you to finally let me in about your diagnosis. I understood why you kept your family at arm’s length, but I was hoping your approach with me would be different. I even disclosed my own HIV status to you as reassurance that if I was OK, you would be too.

“Hey, I don’t mean to interrupt you, but are they gonna bring me my salad?” you asked. “I really want that salad.”

You were expecting an answer to that question as you resumed picking at the blanket that covered you. Rational conversations were in the rear-view mirror now.

“It should be coming soon,” I said.

My days of medical training took place in New York City in the late 1990s. As if it were yesterday, I can visualize the faces of all the patients living with HIV who looked like you did at that moment, before treatment was as effective as it is now. Some I could save. Others I couldn’t. None of them were the first love of my life.

Days later your physician assistant told us that the brain MRI confirmed what we had already suspected — you were suffering from HIV-related dementia.

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Three decades ago, we were partners, sharing a young, puppy love that considered neither time nor consequences. The kind you think will never end. When it did, my feelings for you lingered for years. I romanticized the good times and claimed amnesia about the bad. I kept mementos of our years together in a box on the floor of my closet: Pictures, letters, and cards with expressive love declarations; an empty vial of that Egyptian musk oil you used to wear; tickets from the concerts and events we attended together. It was hard getting over you and what I thought we could be. Ultimately, I had to physically throw that box in the dumpster outside my apartment building so I could move on. Seems like ancient history.

I have questions now, and I’m uncertain what will happen next - but I am sure of one thing.

Back then I was trying to forget you.

Now all I wanna do is remember.

David Malebranche, MD, MPH, is a board-certified internal medicine physician with expertise in sexual health and HIV/STI prevention and treatment. He is also a public health official, activist, and educator who resides in Atlanta, Georgia.