By Stephen Surace, Writing Competition Honourable Mention 2016

Topic 1: Write about your experiences studying medicine with a disability, mental illness or as a part of a marginalised group

At first I was excited by the opportunity to write about being a minority in medicine. Finally, a chance to release all the drama and excitement that I must surely have bottled up. However there was just one problem: except for one noteworthy time, I have kept my sexuality very separate from medicine.

Telling people you are gay often requires a bit of bravery, because you don’t know how they are going to react. That’s why I have never told my dad. There’s always the chance it might put you on the wrong side of a patient, or an employer, or a colleague. Rule number one, don’t offend the consultant. So even though I am lucky enough to have the option to be out and proud, rather than risk facing the stigma I choose the safer route. In professional settings especially I try not to be upfront about this basic fact about myself, and instead have mastered the casual lie and the rapid topic change. Since people are afraid of offending you, they will rarely bring it up anyway. Rambling story short, I keep my personal life and my sexuality out of medicine, and it’s on the whole far easier and less confrontational. But what’s the point of a boring story about that?

So what about that other time I hear you say? Well I couldn’t tell that story, it’s a secret. It’s too personal, too filled with guilt and shame and my own mistakes. I wasn’t going to come out of it looking like the effective, perfect and well put-together person I like to pretend to future employers that I am.

Here’s the thing though, I think that this is a huge problem in medicine. As medical students and doctors we are often afraid to share our differences, our sexualities, our challenges, our mental or physical health problems and our mistakes for fear of tarnishing our professional personas. Even if you aren’t a minority, when you are trying to hide these things it is very easy to feel like you are alone. I have always believed that to counter this we need to create a culture where people feel they can share and be honest if they want or need to do so. But was I brave enough to encourage it myself?

So this is me practicing what I preach, and telling my big secret. This is me talking about the time I had to get PEP after a potential HIV exposure.

For context PEP — post-exposure prophylaxis — is a month-long course of anti-retrovirals usually acquired from a major hospital ED. It is taken by HIV-negative people after an exposure risk to reduce the chance of transmission.

So, a few years ago I was exposed to a risk of transmission of HIV. The thing was, my exposure wasn’t some accidental needle-stick injury; it was the outcome of my own poor drunken decisions and some unprotected sex. HIV is of course not exclusively a LGBTIQ thing, but being gay was undeniably a part of the event in my case. Afterwards, the sensible part of me knew I wanted to face the consequences of my actions and get PEP. The less sensible part of me wanted to have a nuclear-level meltdown while I did it.

Now I knew that my transmission risk was overall low, especially since I was seeking treatment. I also knew that today HIV is a manageable chronic disease and that most of the duties of a student or doctor aren’t limited by having blood-borne viruses. But did I approach this like a calm and well-informed individual? No. I wracked myself with feelings of shame and guilt. I was a medical student; I was supposed to be smarter, be safer, be better. I thought about how I was such a gay stereotype, and I panicked a lot. I worried about my career and about how everyone would react and about telling the uni. I mentally ran full-tilt through all the anxieties and fears the fuel HIV stigma. It wasn’t particularly pretty.

Still freaking out, I dragged myself in last night’s clothes to the ED triage desk for a taste of the patient experience. With another ED triagee less than an arm’s-length away, I began to give my story. I was there for PEP. It was a sexual exposure. It was gay sex. I didn’t want to make a rape or sexual assault charge.

My private life was getting very public.

Then after triage, I used my waiting time to think up some lies. Lies to tell to my parents and friends about where I had been and some lies to tell any med student I might run into why I was there. Lucky I was used to lying. But because I was too ashamed to tell anyone the truth, I had to sit there and go through the waiting alone. I was waiting for five hours.

So this is all sad and traumatic and all that but you must be thinking, how does it relate to being gay in medicine? Well then came telling my story to the doctor. Even though I didn’t know them, it was still excruciating to tell a potential colleague about how I was a medical student, and yet still carrying out these drunken mistakes. It also meant talking painfully openly about how I was a gay man doing gay things. The next follow-up appointment was even worse.  While I had been lucky enough not to get the consultant with a medical student, the one I did get was a consultant I had been under for a rotation. Even better, we hadn’t gotten along. Despite their professionalism throughout the consult, I still had to sit there and relay to another medico and potential superior, and this time someone who knew me personally as a med student, the finer details of my failings, my HIV risk exposure and my gay sex life. No matter who you are, being this upfront with a colleague is never easy, and I was glad when my treatment was over.

Now, I don’t want to overly dramatise this experience or put people off PEP, and I especially don’t want to contribute to HIV stigma. I did something stupid, and then I sought treatment, and I am glad that I did. However, admitting I had to seek help and feeling like a failure was hard. The embarrassment of being forced to reveal my sexuality in front of doctors was hard. Talking about my own mistakes was hard, and being a medical student only made it harder. Talking about it now is still hard.

But in the end, I hope writing this will help people. No-one should ever feel they have to tell their story, but I want to help build a profession where people always feel they can. So I admit it, I am in a minority, I am gay. But I am also someone who makes mistakes, and needed to seek help, and was afraid to say anything because it made me look like less than a perfect medical professional. I’m sure many of us can relate to that.

Featured image by user Montecruz Foto at Flickr.