“Oh, by the way?"

Hand on the door. Office visit thought to be completed.

These words are code, which every physician understands to mean: “Here is what I really want to talk about.”

On your best days you sit back down and say, “Yes?” -- knowing the line of patients not yet seen will now be pushed back 20-30 minutes more. These ‘best days’ are, more and more, a casualty of the 15-minute-or-less time allotment now ruling the doctor-patient encounter, thanks to managed care.

“Oh, by the way,” Larry said. “I’m worried I might have AIDS.”

Larry was an acquaintance who had become a patient, a political science professor whose life had taken an abrupt turn when he found the courage to admit that he was gay. He had left his 20 year marriage, and was determined to maintain a healthy relationship with his adolescent son.

I arranged for him to be tested.

When the tests came back positive, I suggested that I refer him to the AIDS clinic at the University (the easy solution for me). He objected.

Larry was my first AIDS patient and I was afraid. I was afraid I wouldn’t be able to give him good enough care. I was afraid I’d make mistakes. I was afraid that this disease was more than a Primary Care doctor could handle. Part of me was also struggling with the irrational fear of the disease itself.

“You are my doctor, “ he said “You know me. I don’t want to go through this with a stranger, as a number. I’ll help you. We’ll do this together.“ And we did.

Once we got started I realized that this was exactly where his treatment should be managed: in a family physician’s office. He’d been my patient for years. I could get whatever consults were needed for him through my network of specialty colleagues. I could study. I could learn. Most importantly, I had a relationship with him that preceded his disease, so he remained essentially Larry – not an AIDS patient who happened to be named “Larry.”

For 10 years. We both learned. We both watched each other grow. We both asked for help when we needed it – he from his family and friends, me from my specialist colleagues. Just before his death, when the final course was clear, we both agreed we would not have done things differently.

I know this experience was a gift to me. A gift that began the moment I heard the code words.