“Doon, doon, doon…” – a soft alarm sounds. An IV pump needs attention.

“Click. Tap-a-tap.” – a resident types.

“Coming through!” – an EMT navigates.

“When did this pain start?” – an attending physician interviews.

Phones ringing, printers printing, beepers beeping, and patients losing patience. This is the sonic world of the ED. To some, noise pollution; for others, an almost comforting hum.

I walk the aisle and find my next patient. I draw the curtain closed between him and the adjacent patient.

“I’m José. This is my fiancée Sheila.” Sheila is on her laptop and seems barely present. José looks apprehensive but is in no distress.

“What brings you to the ED?” I ask. An animated young man in his early 20s, José launches right in. He has had chest pain for 2 days. He’s worried. After what I think is a good history, I transition into past medical.

“Any medical problems? Asthma, diabetes …” I sense something is amiss. I look up from my notepad and find José staring intently, his eyes wide open trying to get my attention. He draws three big letters in the air with his index finger and mouths those same letters: H.I.V.

He stares at me, as if asking, “Do you read me?” I give a slow nod and continue. He knows the message was received. I glance at Sheila, who is buried in her laptop. She doesn’t know her fiancé is HIV positive? I play it cool. We complete the conversation and begin the physical. During the exam, I improvise. “José, I’d like to do another test down the hallway. Sheila, you can just stay here.” José and I walk to a quieter area.

“So,” I whisper, “when were you diagnosed?”

“I was born with it.” I suddenly remember that vertical prophylaxis was not yet standard when he was born.

“What’s your T-cell count? Your viral load?” “Like 100. My virus is immune to all the drugs now. I’ve had official AIDS or whatever for a long time.”

“Ok.” I think for second. “Listen, you should consider telling Sheila so that you guys can be as safe as possible.” He looks at me like I’m crazy. Then he gets it.

“Oh! No, it’s not like that,” he says. “Sheila knows. She has HIV too! She was born with it too.” Now I am floridly confused.

“Then why all the secrecy?”

“The guy in the next bed. I know I’ll never see him again but … you know.” José explains that he gets embarrassed. He notices that when people hear he has “the virus,” they become uncomfortable. They ask the nurses to move beds. They give him strange looks. He feels … judged. Even in the “public” ED, José just wants to maintain his privacy.