The priest had just died of AIDS and David desperately wanted to know if he too had AIDS. This is an important case study that took me 10 years to solve the riddle. This case illustrates on how important COGNITIVE (CLINICAL) MEDICINE is in contrast to procedural medicine.As a child, David was once severely punished when some hay by the barn was set on fire. His father said to him, "If the barn had been burned, I would have hung you!" David had no fault since it was another kid that had poured gasoline over a cat and lit it on fire. The cat ran into the haystack. The animal perished.David recalls getting sexually aroused when his parents were having sex. At age 8, out of curiosity, he was examining his little sister's body. When his father discovered his activity, David received another severe beating.David went through a period of bestiality. That is, he had sex with animals.Besides putting him down and calling him dumb, his father used to routinely beat him up for wetting his bed. At age 16, he outgrew his bed-wetting. He recalls that his mother was always depressed.I met David as an adult in his 30's. Clinically, he was very flat, anxious and suspicious of authoritivative figures, like a doctor. He'd come to see me with little ailments that he would call, "gastritis, prostatitis and itchy skin (neurodermatitis)." For his "gastritis," he was subjected to the usual treatment. He had an upper endoscopy and was told he had "Esophagitis, Acute Gastritis, and Duodenitis." He was, as is often typical, treated against Helicobater pylori infection with Nexium® ("The Purple Pill") and an antibiotic, but he failed to improve. Little by little, I kept trying to help David. Once he saw me for hiccups. He agreed on this occasion to see a psychiatrist and get counseling. The psychiatrist must've spent less than 10 minutes with David and he quickly prescribed two anti-depressants, Fluoxetine (Prozac®) 20 mg and Trazodone 50 mg. David did not take these drugs.About his prostate symptoms, I never treated him for an infection since his symptoms were due to his high level of anxiety and associated prostatalgia (prostatodynia). No antibiotic was required. As requested, he was checked for "prostate cancer," but his PSA and exam were normal. Once, he showed up at my clinic feeling certain he had acute appendicitis. He had the Irritable Bowel Syndrome with constipation. During this visit, I feared that he might at some point end his life, and I even took his picture.David was a very lonely guy and at one time dated a woman in her early 30's. The woman he dated always had her mother present. David expressed his desired to have kids. His sexual differentiation seemed uncertain, and I could not tell whether he was gay or straight. At age 22, his roommates hired a woman for sex, and David felt forced to "enter her," though he felt no joy.As I treated David, I saw progress. During the late 1990's, he used to earn low wages, and he is now self-employed and makes a lot more money.He expressed guilt for having examined his sister as a child and apologized as an adult.His low self-esteem and lack of a "father figure" that would accept him unconditionally made him vulnerable to be abused by an authoritative figure. It is just like teenage girls who lack a father figure, they look for that parental love in an older male that often gets them pregnant and leaves them.David became close to a priest who used to refer to him as "my son." One day, the priest said to David, "Drop your pants. I am going to cure you of being timid." The priest's treatment was to perform oral sex on David on two occasions. David feared that if he said no to the priest, he would lose what he so badly needed, a parental figure.Later, the priest died of AIDS. That's when David rushed to my office and requested that I check him for AIDS. He's fine.Though David is happier today and takes no medicines, he really wishes that his father would at least say to him, "Sorry son; I love you." I don't know if David is gay or straight; it doesn't matter to me. But I do know that he is happier now and people no longer take advantage of his skills. He needs my being there for him as a physician. This case underscores the importance and benefits of Universal Healthcare through an optimal provider of Medicine.I'd like to make a closing comment regarding procedural doctors. These doctors have earned an easy living at the expense of complex and suffering souls. We must change healthcare for the benefit of humanity and society.Luis Lomeli MD

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