“You are monogamous—with your wife?”
“The only woman for sixty-one years.”
An hour later, Lyle had been over the man head to toe. He’d looked at the chart, read the CT scan. He’d looked in the man’s eyes, causing the minister to recoil, confirming the light sensitivity. He cocked his head back and forth, like a metronome, lost in rhythmic thought.
Back in the auditorium at UCSF, the audience hung on his story, much like Lyle had the minister caught up in the examination. It had been an act of trust building.
“I explained to the minister that I thought we needed one more test,” Lyle told his audience of med students. “Would anyone like to guess what that test was?”
Lots of looks down by students at their laps. Even in an audience this big, many students felt like they’d not like to let down Dr. Martin with a flier, a wrong guess. From the back, a hand rose.
“Yes,” Lyle said. “No hands needed here. Just let ’er rip.”
“An MRI of his brain,” said a woman’s voice. “With contrast, I’d guess.”
“Very good.” Lyle nodded approvingly. “Just what I told the minister. Almost my exact words.”
The minister said, “Sure, yes. If you say so. What will that tell us, Dr. Martin?”
“The MRI is going to show us your brain. I suspect, strongly, it will show us a fungal infection. Crypto meningitis.”
“So that’s what I have? Meningitis?” The minister pushed himself up on his bed, his gown back on, his face strained with pain he struggled to hide.
“Yes and no.”
“Which is it: Yes or no?”
“The fungus is a by-product.”
“Of what? Of the MERS?”
Lyle felt it had gone on long enough. “I’d like to talk about your sexual history.”
“I told you already. I’m married.”
“And you’ve never been with another woman.”
“You are testing me?”
“You’ve been with a man.”
“Excuse me?”
“I believe you’ve got HIV, on top of MERS. It would be simple enough to give you an HIV test to prove it. But I bet your doctor wouldn’t even allow himself to think about such a test. It would insult you and even be dangerous. I hear they flog people here for that sort of behavior.”
“What sort of behavior.”
“Homosexual.”
“I flog people for that sort of behavior.”
“Well, Minister, I think you’re going to want to change your policy or your own practices.”
“You’re a quack!” His words exploded in a hacking cough. He doubled over.
“Minister, let me add it up for you. You haven’t responded fully to MERS treatment. You’ve got cognition issues and light sensitivity. Pronounced stomach issues, a lung nodule. All of that says to me that your immune system is compromised. On top of that, you sent your people out of the room when it was time to talk to me—”
“So.”
“Maybe nothing. Maybe that you wanted privacy. And I can see why, given the marks.”
“What marks?”
“You’ve got several areas of light purple skin on the back of your neck.”
“I’m getting older. It’s my skin.”
“You know the term quack, Minister, so I’m guessing you are also familiar with the term ‘hickey’?”
The minister glared at him. “This is a joke. Are you the best that the United States has to offer me?”
“I’m definitely not the best. But I have had my share of hickeys, and I’ve given a few too. I know what they look like. And I have seen my share of men die terrible deaths from HIV. Most of them contracted it through sex with other men.”
The minister clenched his jaw, now seemingly to calculate.
Back in the auditorium, Lyle leaned on the lectern. “Nothing special about the diagnosis. In fact, I suspect his personal doctor knew what it was and was looking for someone from the outside to take the fall. In the end, they left the official diagnosis as meningitis and gave the minister an antiviral cocktail that just happened to be the same thing they give for HIV.
“The minister died nine months ago. His condition wound up being widely speculated about. He also spent the last few years of his life intensifying his attacks on homosexual behavior. His rage at his own condition, his hypocrisy, amplified. I mention this, and the story, to impart a particular idea about pathologies, diseases. They are, in their own way, straightforward. They aim to kill an otherwise healthy body. They have a deadly agenda but they don’t hide it. Pathology is not duplicitous. It does not discriminate. It doesn’t choose. It is precisely what it represents itself to be. The same cannot always be said of people.”
At the edge of the stage, Emily, Lyle’s intern, tensed. Dr. Martin was out on that Dr. Martin ledge again, heading to parts unknown. In the back of the room, Dean Thomas had a similar but less generous version of the thought: The asshole is going to get rave reviews again, and for what, storytelling?
“Hickam’s dictum,” Lyle continued. “Patients can have as many diseases as they damn well please. Implicit in the phrasing is that people choose illness. This, of course, is utterly false on its face. They don’t choose. But they can reveal. Even inadvertently, often, in fact, inadvertently. I urge you, when you sit at the bedside, to think about the person, the individual. Consider his or her history, habits, as well as the larger context of culture, constituency, demographic. Think about what makes a person tick. What separates a good doctor from a great doctor, in my opinion, happens outside the pages of the book.”
In the back of the room, the man in the too-tight suit smiled. He thought, Dr. Martin is brilliant, just as advertised.
“Dr. Martin,” Emily called quietly. He turned to the side. She pointed to her watch. He nodded and turned back to the stage.
“Having said all that about going beyond the book, I’d like if everyone could read the next three chapters of infectious disease principles and practices. If there are any questions, I think we’ve got some office hours set up in the lounge.” A smattering of applause accompanied the sound of students standing, packing up, hustling on. Lyle could feel his heart working double time with the pulse of dehydration and still metabolizing sleep drugs, and from stress toxins left over from his fight with Melanie. He let his eyes wander to the dean and her guest. Whatever they wanted to talk to him about, he’d seen enough to know. Someone was dying.
Nine
Dean Thomas marched up the aisle, looking ever the headmistress. She made a beeline for Lyle. Trailing her, a foot behind, more measured, walked Michael Swateli, a Tanzanian attaché to the CDC. Lyle ignored the both of them and followed Emily to an adjoining conference room they sometimes used for office hours. It was antiseptic, just a rectangular table made of cheap wood and, on the wall, a whiteboard. A yellow sheet of paper tacked inside the door indicated the place was not to be used for study.
Nearly two dozen students showed up. Lyle sat on the edge of the table and the students mostly stood, a few taking the nearest chairs. The dean stood near the door, resigned that Lyle appeared to be going through with his office hours. She was in a bit of a tough spot in that she had just a few weeks earlier urged him to show up for all his obligations (by which she mostly meant his faculty obligations) and couldn’t now easily yank him from his scheduled office hours. Even though a foreign governmental official stood nearby with an urgent request.
“Mr. Swateli,” she said in a low voice, “I do think Dr. Sanchez could be a great alternative for you.”
“We had this conversation, Dean Thomas.”