I entered the room and saw that Carol had exposed and cleaned with peroxide an ugly V-shaped cut on the third knuckle of Vickie’s right hand. The skin hung down in a flap.
“That’s my cousin Grace’s tooth what done that.”
Carol and I waited for the explanation.
“Andrew and Grace, my cousins?”
Vickie saw that this was hardly an explanation and so she sighed and said, “You all are going to think I’m awful. But what the hell. See, there’s someone what works at the Medical Center—a relative more or less, you could say—who done told a bunch of folk in Tester Hollow that Clyde and I have AIDS. You know people around here are so damn inquisitive they wouldn’t hesitate to stop a funeral to ask what deceased the corpse! But whoever he didn’t tell, Grace, my cousin, did.
“Grace and her husband, Andrew, go to this Holiness church, just a little ways from the house? I never go no more—I can’t take all that babbling in tongues and holy spirit stuff; scares the shit out of me. But Clyde, now that he’s sick, has been wanting to go to church. Well, my big-mouth cousin stands up in church and tells the whole goddamn church that Clyde has AIDS and would the church be willing for him to come there, cause he very much wants to.”
“Did you or Clyde ask her to do that?”
“Hell, no! She just took it on herself to do it! And by the way, the church congregation said No! When I heard about it, I called her on the phone and said, ‘You little dumbass, who told you to go talking like that? How would you feel if the shoe was on the other foot? Don’t you ever step in my house again or I’ll kick your ass till your nose bleeds.’
“Well, Andrew gets on the phone and says they would come and see their cousin any time it pleased them. I said I’d like to see him try. Can you believe it, they came right over! And when I picked up a poker and went after Andrew, buddy, he just lit out like his pants were on fire. Grace was just standing there. I got so mad just looking at her face. I dropped the poker and just let her have it with my fists. I dropped her with one shot and then I sat on her and just done give it to her, bust a few teeth I reckon.”
As Vickie said this, she made the motion of cupping one fist into the palm of the other. It was a powerful little gesture; there was nothing dainty about it. Clearly she knew what she was doing.
“The only reason I stopped was because Clyde was weeping and crying from the sofa, begging for me to quit. By then I had whopped her good.”
I trimmed Vickie’s wound and dressed it. I decided against suturing it because these sort of closed-fist injuries commonly get infected. I made a mental note to prescribe an antibiotic for her before she left.
I began to examine Vickie with Carol in attendance. This was the first time I had needed a chaperon with an HIV patient.
I went through Vickie’s social history and family history and past history, much of which I already knew. Vickie had been under treatment off and on by a local psychiatrist for “nerves.” She was taking a blood pressure pill. Despite that her blood pressure was high. I looked carefully into her retinae to see if she had narrowing of the vessels or hemorrhage that might suggest the high blood pressure had been present for a long time. Her retinae looked normal.
Vickie balked when I asked her to remove the bandanna knotted over her scalp and low over her brow. I told her I needed to go over her head to foot.
Her lower lip began to tremble and tears formed in her eyes. “I’m real ashamed about this.” Very reluctantly she began to unknot the bandanna, pausing once, as if she had changed her mind. I could see beneath the bandanna that she was totally bald.
Carol looked puzzled.
“I did it,” Vickie said.
Vickie had picked out every hair on her scalp herself: trichotillomania, a compulsive disorder, an indication of her extreme psychological distress. Sometimes these patients would also develop trichobezoars, or large hair balls, in their stomachs from swallowing this hair. Carol and I were affected by this sight: this outwardly tough woman who had picked herself bald because of the hell she was going through, a hell that had preceded Clyde getting ill. We reassured her, told her we understood; I was pleased to find that she seemed in fine physical health except for the elevated blood pressure. Carol and I stood by as Vickie retied the bandanna.
When her CD4 lymphocyte count came back, it was over a thousand—just about normal. Clyde’s CD4 count in the hospital had been 7!
Vickie would be with us a long time. It was unclear about Clyde.
LATE THAT NIGHT, after Steven was asleep, Rajani and I sat outside on the porch swing. The demands of one child so occupied her that we had few moments like this. She sat beside me brushing her hair which she had recently bobbed because it was easier to take care of. I mourned the loss of her long hair which I had always believed she kept for me. But I said nothing. Rajani seemed more efficient and serious now; she was a mother, less relaxed, less carefree. I told her about my day, about how preoccupied I was with my seven patients with HIV infection in our small town, how these seven people eclipsed whatever else I was doing in the medical school.
She asked me, “Why is it different here than in Boston? You saw AIDS in Boston, and I don’t remember you being this involved.”
“I think it’s because I am their sole doctor here; there is no one else following them.”
Out of the blue she turned to me, put down her brush and asked me, “Are you sexually attracted to the gay men?”
“WHAT?” I felt she had entirely missed the point, that she had been waiting for this moment. I couldn’t believe my wife was capable of reducing my complicated feelings to something just sexual.
“I’m curious. You seem comfortable enough with them.”
It was true that I had become comfortable around gay men. I was too interested in them and in their stories to be judgmental.
“In a way,” I said, “these men are more representative of men than heterosexual men, if you know what I mean?”
Rajani looked at me warily.
“I mean to say, with gay men you are looking at men without the confounding influence of women to deal with. You are looking at the behavior of men left to themselves, men not conditioned by what women allow, what women find acceptable, what society thinks is normal.”
“Meaning what?”
“Meaning perhaps, that some of the sexual activity of gay men, their sexual drive, the number and variety of partners, the ready possibility of anonymous sex, might represent what all men want, except that they can’t get women to agree.”
I was pleased with my little thesis. Rajani was not impressed. As she went into the house, I called after her, “By the way, the answer to your question is no.”
8
THERE HAD BEEN some debate when Gordon came home as to whether his nieces and nephews should be allowed to spend time with him. The visiting nurse who had instructed Essie and her mother on the use of bleach for spills, on the need for gloves when handling secretions, was consulted and saw no reason for the children not to be there.
“Has she any experience with AIDS?” I asked Essie.
“No. I guess she just got it from books.”
I was amazed by the ease with which medical services were being delivered to Gordon. A local pharmacist was providing the medications I prescribed, which he had in turn acquired from a distributor in Charlotte; the pharmacist knew the diagnosis. The nursing supervisor at the hospital, a friend of Essie’s, had loaned her some oxygen equipment. This was a time when elsewhere in the country, AIDS had generated some ignoble responses from doctors and other medical personnel. But in Blackwood, none of this was in evidence.
Gordon spent great lengths of time with his nieces. He asked Sabatha to fetch his box collection from the duplex, and he would tell her the story behind each box. He took long naps. He rarely watched the TV in the room, preferring instead the company of visitors, or staring out of the window at the cars driving by or at the mountains just behind the house.
Gordon hated hi
s diapers and he tried his best to use the bathroom himself. It embarrassed him greatly when Essie or his mother had to clean him up. Essie said to him, “Gordon, there’s nothing I haven’t seen. Now you lie back and hush.”
Gordon’s father did not participate in the cleaning up, but was ready to do anything else Gordon wanted. He spent long hours with Gordon, though they rarely had much to say to each other, “It’s come twenty years too late,” Gordon said to Essie about their father’s attention to him.
When it came time for Gordon’s follow-up appointment in the clinic, his father insisted that he would drive him there and back. Essie and her mother could have taken off from work, but the father wouldn’t hear of it.
I WAS IN an exam room with another patient when Carol poked her head in and said that she needed me right away. She led me to the exam room where she had placed Gordon.
I was shocked at Gordon’s appearance. It was not just that he had lost so much weight, or that his eyes stared out of deep hollows, or that the flesh above his temples seemed to have collapsed, sticking to his skull; Gordon was gasping for air at forty-two breaths a minute. His lips were blue. He was sweating profusely, and he had a look of fear on his face.
I asked Carol to give him oxygen and call an ambulance. We would take him over to the emergency room at the Miracle Center. I took his blood pressure; I got a systolic reading of ninety. “How long has he been this way?” I asked the father, who was standing close to Gordon, his hat firmly on his head.
“Oh, he’s fine, he’s fine. He just got a little winded walking from the car to the office, is all.” I wanted to say that there were wheelchairs in the lobby for just that purpose. And how could the father look at Gordon and think he was fine?
“Why do you want to take him to the emergency room?” the father asked.
I asked the father to step outside with me.
“Gordon looks very sick and I’m worried that he might stop breathing any second now.”
Mr. Vines had his arms crossed and was staring at the floor. His jaw was set and he plainly didn’t agree with what I was saying.
In the emergency room, after some fluids and high concentrations of oxygen, Gordon began to look a little better. The expression on his face in my office had told me that he sensed impending doom. Now, this look was receding. An arterial blood oxygen measurement showed that his oxygen level was safe again, although it should have been much higher for a man his age. A portable chest x-ray taken in the emergency room showed a honeycomb pattern to both lungs. It was similar to what he had when he was in the hospital, except now it looked a little coarser, more chronic, as if the interstitium of his lungs was getting thick and fibrous from persistent inflammation.
I called Essie at work in Virginia to tell her what had happened and to find out how recent this degree of shortness of breath was. She said Gordon had not been anywhere as short of breath as I was describing. But he had been puffing ever since he left the hospital; the slightest effort took away his wind. He had been trying to go to the bathroom every other day so that he could stand in the tub while they showered him. But now he was unable to do that because the steam in the bathroom made him suffocate. Essie wondered if the oxygen tank he drove down with had become empty. Or had Gordon and his father forgotten to hook it up?
I described the x-ray to her.
“What do you think is going on in his lungs?” she asked.
I said that I didn’t know. I wanted to put him in the hospital and have the pulmonary physician do another bronchoscopy and try to find out. The last bronchoscopy had not revealed Pneumocystis. It was my suspicion that Gordon had an inflammation of the interstitium or supporting framework of the lung, an inflammation caused by HIV itself. There were a few reports of this in the medical literature. But this was a diagnosis we could only arrive at by excluding other infectious causes of lung damage.
“I’ve got to warn you,” Essie said, “that both Pa and Gordon are determined that he not be admitted to the hospital again.”
“Why? Even if he is suffering?”
“I’m with you, Abraham. But Gordo’s got it in his head that he is dying, and he wants to do so at home, not in the hospital. He’s real worried about running up bills, though he won’t say so. And my father feels that Gordon got worse in the hospital, and he thinks Gordon is getting better at home.”
When I went back to Gordon’s cubicle and suggested admission, father and son declined, just as Essie said they would. Gordon was still very short of breath, but not in extremis as he had been. The father couldn’t wait for us to get Gordon ready to leave. Gordon wanted no medications. What was the point of their two-hour drive to see me, I wondered? We set Gordon up with fresh oxygen, took him in a wheelchair to his father’s van, and sent them on their way.
I called Essie that evening to make sure they had reached home safely. They had. Essie sounded really tired. “But Gordon’s breathing is definitely worse than it has been for some time.”
TWO NIGHTS LATER, Gordon’s mother woke up after hearing a loud thump. She had been sleeping next to Gordon. Now the bed was empty. She found him in a fetal position at the bedroom door. She lifted him back onto the bed—he weighed only eighty pounds—and he proceeded to have a seizure, reminiscent of the “fits” of his childhood. Essie was called and they took him to the local hospital.
The ER physician found that Gordon had had a stroke. He did not move the right side of his body; the right side of his face was drooping. He did not speak.
The ER doc called me. I suggested that he perform a CAT scan of the head. The hospital did not have a CAT scanner, and it would be a day before the mobile scanner that served the area came by. If Gordon was stable to be transported, I said, I would be happy to receive him in Johnson City. He said the family did not want that. In that case, I recommended they begin treatment for toxoplasmosis—the commonest cause of seizures and strokes in AIDS. Other infectious processes seemed less likely. During Gordon’s previous hospitalization we had treated him presumptively and intensively for neurosyphilis based on some abnormalities in his spinal fluid. The spinal fluid, bone marrow and bronchoscopy specimens had not shown any signs of tuberculosis. Toxoplasmosis was a likely cause of his problem.
Essie came on the line. “Abraham, if you tell me that bringing him there will make a real difference, I’ll bring him there myself even if I may not have a family left when I get back.”
I could not say that bringing him to me would make a critical difference. We might learn exactly what Gordon’s problem was. But I doubted that such knowledge would increase the quality of his life, or even extend it.
Gordon was taken home from the ER. The next day he was able to open his eyes, though nothing else moved. Essie, on her way to work in the morning would look in on him. She would wave when she left and call out, “Bye, Bugsy. ‘Vive gwot to go earn me a viving.” She thought Gordon smiled and tried to move his good arm to wave back.
WHEN HER MOTHER CALLED Essie at work, five days after the stroke, to say she thought Gordon was dead, Essie shouted into the phone: “Don’t touch a thing! I’ll be right there.”
“Gordon’s gone,” she said to her supervisor as she hung up the phone and grabbed her jacket. She was at her mother’s house within twenty minutes of the call. She found her mother sitting bent over in her armchair, wringing her hands. Essie’s father stood by the west window, his cap on and his hands deep in his overalls. Essie wondered why she had risked her life in the little pickup, hurtling down the mountain road to get back to the house. Her parents wouldn’t have done anything till she came anyway.
In the bedroom the curtains were drawn and the scent of menthol liniment was still strong. She pulled the covers back and watched Gordon’s belly, as if, just to prove his parents wrong, he might suck in a breath. His belly was scooped out from rib cage to hips. His eyes were shut. His mouth was closed. Her brother did not move.
She peeked under the edge of his diaper as she had done that morning before
going to work: he was dry. There was nothing for Essie to do but cross Gordon’s arms over his chest.
She came out to the living room, picked up the slim telephone directory for Wise County, Virginia, and dialed A. J. “Doochie” Jones’s funeral home. Her mother said, “Essie . . . ?” but Essie shushed her as Doochie came on the line.
“Doochie? This is Essie Vines. My brother Gordon done passed away. You knew he was sick? . . . That’s right . . . for a long time. Now, I’m going to tell you the honest truth: Gordon had the HIV factor. That’s what killed him.” Here she took a deep breath to keep her words from running into each other. “Now you just tell me, yes or no. Can you take care of him?”
There was silence on the other end, and when he started with “Lord ha’ mercy, Essie. I’m real sorry to hear it,” she could hear the fear in his voice. She could feel her anger rising.
“Just yes or no, Doochie?”
“Now, Essie, I got to tell you, I never studied how to prepare that kind of a body . . .”
“You buried everyone else in this family that ever died. That’s why I called you. Yes or no?”
“I want for us to do the service, Essie. And all the other arrangements. It’s just that I got these cuts on my hands from where that formalin dries me up? And I worry, you understand?”
“I understand where ignorance could lead you to believe that,” Essie said before she hung up on him.
Her parents stared at her, her mother about to say something. Essie said, “Now hush, Mama. I said I’m going to take care of this, and that’s all there is to it.”
She dialed George Wiseman in Norton, ten miles away. She knew George from church. What would she do if George said no?
George came on the line. She told it to him just as she had told Doochie: Gordon had died, Gordon had the HIV factor. “AIDS,” she added for emphasis. Her parents winced when she said the word. In all the time Gordon had been sick, Essie had never heard her mother or her father say “AIDS” or “gay.” Not once.
My Own Country Page 17