“Danielle was an ambitious, outgoing young lady with a bright future,” Mrs. Rogers said, suddenly beaming. “She was employee of the month three separate times. She led Bible study every Saturday morning. She only missed one Saturday, and that was to come be with me after I had surgery.”
It seemed important to Mrs. Rogers that I knew her daughter had been a good girl, that she hadn’t always been sick. I nodded and smiled, trying to imagine the vibrant young woman Danielle used to be, but I could think only of what this tragedy had wrought. The nervous system, including the brain, is the body’s hard drive, and damage to it can quickly shut down primary functions, like walking, talking, or thinking. The damage is often debilitating and permanent. For Danielle, there would be no more nights out with the girls, no more job promotions, no wedding, no children. She would have to live the rest of her days trapped in childhood, without the innocence, the fun, or the hope. Unprotected sex had cost her much of her future and had altered her mother’s life as well. If only Danielle had protected herself, if only she had gone to a doctor when the first blisters and swelling appeared, but it was too late for that now. All I could do was treat the symptoms that had brought her to the emergency room that afternoon. I glanced down at the form the triage nurse had prepared and asked Mrs. Rogers about Danielle’s fever.
“She felt warm to me,” her mother said. “And when I took her temperature, it was high. Her doctor always told me to bring Danielle to the hospital if she has a fever or isn’t acting her normal self. Since her disease, she isn’t as reliable with how she feels. Most of the time, I have to guess what’s wrong with her … Danielle used to be so independent. Even as a child she wanted to find her own way. I remember she would pick out her clothes for daycare when she was three. She always wanted to wear her pink rubber boots, with any outfit at all.”
As with my pediatric cases, I had to rely fully on Mrs. Rogers’s description of Danielle’s symptoms to come up with a game plan. The fever had lasted a couple of days so far, and Danielle, who didn’t eat much on a normal day, now ate nothing at all.
I kept probing: “Anything else going on—any vomiting, diarrhea, cough, congestion?”
“Well, she has been pointing to her bladder area, saying it burns,” Mrs. Rogers said. “I’ve noticed she moans when she goes to the bathroom. There also seems to be a strange smell to her urine, which is new.”
It sounded like a bladder infection. I explained to Mrs. Rogers that I was ordering blood work and a urine sample to be sure. Usually, that would have been my signal to move on to the next patient. In emergency medicine, there’s little time to linger, because a new crisis is always waiting. But I pushed aside the hurried feeling in my gut and stood there, in awe of this mother’s dedication. I sensed, too, that she needed a sympathetic, non-judgmental ear.
Doctors had recommended an assisted living center for Danielle, Mrs. Rogers said. But no way would she put her baby girl in some wretched place, where people might not take care of her. Mrs. Rogers reminded me a bit of my own mother, who had been protective in that way, too, when my older sister Fellease got sick.
I was in college when I figured out Fellease had AIDS. Back then, the early nineties, it was still largely viewed among African Americans as a gay white man’s disease (even though the statistics were beginning to tell another story), and there were plenty of examples in the news of victims who were ostracized and mistreated. The not-so-subtle message was: If you had AIDS or knew someone who did, you didn’t talk about it. But turning her back on anyone in a crisis has never been part of my mother’s makeup, especially not her own flesh and blood.
Once, when growing up, I counted fourteen people living under our roof, that small two-bedroom house with just one and a half bathrooms. All around me were sisters, brothers, nieces, nephews, uncles, cousins, in-laws, and close friends, all struggling in some way—either through unemployment, marital issues, drug addiction, or alcoholism—and in need of a place to stay until they could get on their feet. At night, I’d see Moms tossing pillows and bed linens into every open space in the house, even the dining room. Likewise, she ignored relatives or friends who wondered aloud whether you could catch “the AIDS” from a toilet seat or a clean spoon or fork that hadn’t been sterilized in bleach. Her baby girl was welcome, sick or not, and if people had a problem with that, they need not visit.
Fel was a crack addict who moved from place to place, but Moms cooked for her every day, in case my sister swooped in and wanted to eat. Moms also knew right away who the culprit was when things of value suddenly began disappearing from the house. Though my mother fussed and cussed about it, she never shut her doors to her child. I’d see the worry all over Moms’s face when Fel mysteriously disappeared for days at a time.
As for me, I worried about my mother almost as much as I did about my big sister. And it was Moms’s strain I saw in Mrs. Rogers’s face. The puffy, dark circles underneath her eyes announced clearly that she wasn’t getting enough rest.
“Mrs. Rogers, all this must be hard for you,” I said, acknowledging that I saw her suffering, too. She nodded, and tears pooled in her eyes.
“She was in love,” Mrs. Rogers said, as though she could still hardly believe it all. “The boyfriend left as soon as he realized what happened. I called his family, but there wasn’t much I could do.”
Her daughter had been planning to wear her mother’s wedding gown when she walked down the aisle. “If her father was alive today, I know Eddie would beat that boy’s behind,” Mrs. Rogers said. “Look at my poor baby. Never did I plan on this. What mother could plan for this?”
I absorbed her heartbreaking words, letting her talk.
Danielle had been a military brat. The family had traveled the world with Eddie, who’d been a soldier in the U.S. Army. “She wanted to be just like her daddy. That’s all she talked about,” Mrs. Rogers said.
Danielle loved the uniforms, the stripes, the decorum of the army, and as early as high school, she began mapping out a plan for her military future. She enlisted right after her high school graduation, determined to make a career in the U.S. Army, and was well on her way. Sadness and resignation seemed to settle on the mother’s face when she got to this part of the story. It wasn’t supposed to end there. Mrs. Rogers grew quiet.
“I’m so sorry about what happened to your daughter,” I said.
She thanked me. I handed her the urine cup and pointed the way to the bathroom. “The nurse will be in when you get back.”
Within an hour, I had the test results and returned to the room to talk to Mrs. Rogers. Danielle indeed had a bladder infection, I told her. I explained that I was prescribing a regimen of antibiotics that Danielle would have to take twice a day for seven days, but that the two of them should follow up with Danielle’s doctor. The mother seemed relieved by the diagnosis; at least her daughter would soon be out of this particular misery. I wished I could have done more than just treat the bladder infection, but the damage had already been done.
No way should Mrs. Rogers have been taking care of her daughter a second time around. While herpes encephalitis is extremely rare, it can be devastating to those it attacks. I wished in that moment that I could show Danielle’s face and share her story with every young lady out there making bad decisions about sex, often in an empty quest for love and validation—especially African Americans. They’re not the only ones having unprotected sex, of course, or the only ones contracting sexually transmitted infections. But the prevalence of these diseases among black women has been disproportionately high.
Educators report that sexual activity, from oral sex to intercourse, is beginning as early as middle school. My guess is that African American females are no more promiscuous than their peers of other races, but they do, unfortunately, have less access to good healthcare—nearly one-fifth of African Americans have no health insurance, statistics show—sex education, and reliable information, and thus are suffering more.
A study conducted by Dr. Sa
mi Gottlieb, M.D., at the University of Colorado in Denver, showed in the mid-1990s that African American women were at a higher risk than any other group for infection with herpes simplex virus type 2, the most common type of herpes. It was one of the largest studies of its kind, involving questionnaires and blood tests from more than 4,000 people who visited STI clinics in five cities, including Newark, between July 1993 and September 1996.
Most times, when I asked the young women I treated why they didn’t insist on a condom, they said they thought they could trust their partner. It never seemed to occur to them that their partner might not have known he was infected—or worse, just didn’t care. I’ve seen that, too, like the two teenage boys who showed up in the E.R. together one evening for treatment. Both were experiencing penile discharge, and they laughed when I told them they had contracted an STI from their sexual encounter—presumably, from their banter, the same girl. There seemed to be a weird man-code thing going on, because they asked to be treated together. Then, as if it was some kind of honor, they smacked each other high fives when the nurse appeared with a needle and syringe to administer the antibiotic. I told them their partner needed to be notified so she could be treated, too, but they shrugged it off. Their response angered me.
“What if this was your mother or sister?” I asked, hoping that might get through to them.
Smirking, one of the teens responded: “Please, Doc. That ain’t my problem.”
I thought of my own sister and felt a strong urge to smack both of them. I left the room wanting to run to the hospital rooftop with a megaphone, yelling to the young women in my community: “Take control of your own sexuality! Protect yourselves! You’re suffering, dying needlessly!”
Surveillance reports from the Centers for Disease Control and Prevention show significant racial disparities in the rates of sexually transmitted infections. It is worth noting that the source of the CDC’s data is local and state health departments, which tend to base their reports on information from public health clinics. Since such clinics are used more often by minorities than whites, the differences in rates may be skewed. But other population-based surveys also confirm striking racial disparities. The point is, there’s much work to do in convincing young men and women of color that this is a crisis that doesn’t have to be, that they have the power to protect themselves and their partners. Here are the facts:
• In 2010, the rate of chlamydia among black females ages fifteen to nineteen was nearly seven times the rate of white females in the same age group; the rate among black women ages twenty to twenty-four was more than five times the rate of white women the same age; the rate among black males ages fifteen to nineteen was thirteen times that of their white peers; for black men ages twenty to twenty-four the rate was almost eight times that of white men the same age. Among Hispanics, the rate was three times that of whites; for Native Americans and Alaska natives, four times.
• In 2010, 69 percent of all reported cases of gonorrhea occurred among blacks. The rate of gonorrhea among blacks was nearly nineteen times that of whites. For black men, the rate was twenty-two times higher than that of their white peers; for black women, sixteen times. The rate among Hispanics was two times that of whites; for Native Americans and Alaska natives, nearly five times.
• In 2010, the rate of syphilis among black men was seven times the rate of white men; the rate among black women, twenty-one times that of white women. The rate for Hispanics was two times the rate for whites.
• Despite making up only about 14 percent of the U.S. population in 2009, African Americans accounted for 44 percent of new HIV infections that year.
• Compared with other races and ethnicities, African Americans account for a higher proportion of HIV infections at all stages of the disease—from new infections to deaths.
By the end of 2000, my sister Fellease’s health had begun a rapid decline. I’d watched AIDS whittle her down from a robust 160 pounds to less than a hundred, mere skin and bones for a woman her height. She’d lost her teeth and developed vitiligo, white blotches like bleach stains all over her cinnamon-colored skin. Through it all, though, she never lost her zest for life—or her smile.
“I’m still pretty,” she’d say, flashing that big, toothless grin at me, even as AIDS was ravaging her once beautiful face and frame.
“We’re twins.”
Actually, fourteen years separated us. But of my five brothers and sisters, I was closest to her. I was the baby boy Fel never had. When I was growing up, she helped take care of me, bought me treats on demand, and talked the belt out of my parents’ hands many times after I’d misbehaved. She was the cool big sister who kept me up on all the latest music and dances and even covered for me a time or two when I was hanging out somewhere I shouldn’t have been. She always tried to tell me the right thing to do, even when we both knew she didn’t make the best choices herself. When I heard the police were looking for me after I’d been involved with the robbery in my senior year of high school, I called Fel. Terrified that I’d probably just blown any shot at a real future, I anguished over whether I should turn myself in.
“We’ll figure something out,” Fel assured me. She drove me to the police station and talked mightily, trying to persuade the officers to release me into her care since I was a juvenile. Even though they took me into custody anyway, I never doubted that turning myself in that day was the right thing to do.
Fel had dropped out of high school to get married. She then divorced, remarried, and moved to Hawaii with her new husband, who was in the army. There she earned a high school equivalency diploma. Unfortunately, that marriage didn’t last either. I was in the ninth grade when she returned to Newark, got a job, and lived at home on and off. The two of us grew even closer, staying up together many late nights, talking about life and playing board games.
But the streets had already started to claim her. In her room at our parents’ house, I once discovered a burnt spoon and a tiny nip bottle of Bacardi rum that she had transformed into a crack pipe. I never told a soul, but it confirmed what I’d suspected: She was a crack addict. I just kept hoping she’d turn her life around, get a stable job again, find a great guy, have kids. Instead, she became more unreliable and unstable, moving from job to job, living here and there, and disappointing Moms and me again and again. When I discovered one day that money I’d been saving from my part-time job to repair my used car was missing from its hiding spot at home, I confronted Fel. She denied stealing it and denied using drugs, but I knew she was lying. Exasperated, I didn’t speak to her for weeks.
Fel wasn’t an IV drug user, but she was involved with men who were, and one of them undoubtedly infected her during sex. Maybe she didn’t think her man needed to use a condom because she trusted him, as so many women claim. Or maybe, as an addict, she was just doing what it took to get the next high, and safety was the least of her concerns. But anytime you make the choice to practice unsafe sex, you’re vulnerable; you’re taking the risk of sharing whatever infections and diseases your partners and your partners’ partners may have.
Fel didn’t look sick right away; oddly, her hair texture was the first noticeable change. It became suddenly fine and silky. In the hood, the sudden emergence of “good hair” on a person with risky behaviors is suspect.
“She’s got the package,” we’d say, talking in code about one woman or another we suspected was infected with AIDS. Yet, despite the many times we said and heard that, it never occurred to us that AIDS had taken a deadly turn into urban communities. Poor black folks were dying at rates that nearly rivaled that of gay men when the disease first struck, and black women were being hit disproportionately hard. By 2001, AIDS had become the leading cause of death for African American women ages twenty-five to thirty-four, according to the Centers for Disease Control and Prevention, and most of them were being infected through sex with men who had been IV drug users or had sexual encounters with other men.
Fel denied my suspicion about her illness, ju
st like she’d denied the theft and her drug use. I hinted one day that she had “that good hair,” and she knew instantly what I meant. She snapped back that she didn’t have “no HIV.” But time revealed the truth. Back in the early 1990s, before drug cocktails made AIDS more of a terrible chronic illness than a death sentence, the virus killed slowly. Its victims had a certain look: emaciated bodies, sunken eyes, and sometimes even distinctive lesions. They were like walking ghosts with the dreaded “A” on their foreheads. In medical school, I’d fantasized about finding a cure. I wanted to save my sister, and it hurt deeply that I couldn’t.
Just three months after I began my residency at Beth Israel, Fel started showing up in the E.R. with various AIDS-related ailments. She was loud and brash, demanding that the hospital staff bring Dr. Davis, her little brother, to her side. My colleagues thought it was a joke, that she was just another patient from the neighborhood claiming to be related to me to get quicker service, which sometimes happened. Surely, I could practically hear them thinking, Dr. Davis doesn’t have a sister like that. For most of the doctors and nurses, Newark was just where they worked. But for me, it was home, and those people were my mother, my sister, my cousins, my friends. Moms had shown me that you just don’t turn your back on your people. And when I looked at Fel with that silly, toothless grin, what could I do but claim her, love her?
There were days, though, when I just couldn’t tolerate what my sister was doing to herself, and I had let her know it. One evening I was driving her and Moms home from a shopping trip when Fel kept nodding off to sleep. By then, she was gravely ill, but it was obvious to me that she was currently high. She’d slipped off to get her fix and didn’t even care that our mother once again had to witness the aftereffects. I reached over to the passenger side, where Fel sat, and squeezed her hand, hard.
Living and Dying in Brick City Page 8