fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

fostering the humanistic practice of medicine publishing personal accounts of illness and healing encouraging health care advocacy

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The Anguish of Ambiguity

Adam, my twenty-five-year old son, died of a heroin overdose two years ago. Several days after his death, and before the funeral, I sat up late one night talking with his ex-girlfriend. She revealed that he had been sexually abused for several years by a close, male family member starting when he was eleven. The perpetrator threatened to harm our family if Adam ever told anyone. Adam told a few people but the secret was kept from me.

This shocking discovery complicated my grief tremendously. It was enough to suffer the death of my child, but then to learn he was abused added layers of complexity to my loss. The only solace it provided was to help me more fully understand the cause of Adam’s addiction. With no genetic predisposition to substance abuse and no previous history of mental illness, it was the missing piece of a tragic puzzle.
I distinctly remember the day Adam, then twenty-three years old, told me he had HIV. Knowing of his intravenous drug use, I assumed the virus was contracted through contaminated needles. Instead, he claimed, he acquired it through a sexual relationship with a bisexual woman. I was puzzled, skeptical even, given his deployment of “smoke and mirrors”–the deceptions and partial truths often embedded in the words of addicts–to which I had become accustomed.
Months before his death, I learned more about Adam’s secret life. One day, a doctor called from a downtown trauma center informing me that Adam had attempted suicide by jumping off a three-story building. High on heroin, he fell like a ragdoll and landed on a parked vehicle, fracturing several vertebrae. By some stroke of fate, Adam survived. While I was at his bedside in the hospital, a man visited him. I asked his ex-girlfriend, who was also present, who this man was. She told me that this was his “john,” someone who exchanges money and drugs for sex. He was a part of the dark world my son inhabited.
When I learned of Adam’s sexual trauma, the cascade of events and behaviors I witnessed over many years all began to make sense. His HIV was contracted through homosexual relationships, likely prostitution to obtain drugs, not from dirty needles. His struggle to understand his attraction to men, despite pursuing romantic relationships with women, was a likely result of the sexual assault he experienced as a child on the cusp of puberty. This is not uncommon among boys abused by men.
At times I’ve wondered if Adam was bisexual. However, his close friends with whom he confided later told me he was tormented by his sexual preferences while clearly identifying as heterosexual. He surely palliated his shame and despair with drugs.
Adam’s life ended before he could unravel all the threads of damage. As a mother, I am left with my own agonizing uncertainty and many unanswered questions. What if I had known? What would I have done? Would it have mattered? Could he have ever risen out of shame to repair his life? 
Sadly, learning of his abuse after his death, I lost the opportunity to ask him what really happened, give him my emotional support, and follow up with legal action against the perpetrator. The impact of abuse upon my son’s life left a trail of torturous ambiguity and uncertainty, sexual and otherwise. Many of the complicated knots in this tragic story, for both Adam and me, will never be untangled.

Alison Hartman

Baltimore, Maryland 

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