I asked after Vickie’s sister. She had tested positive for HIV but she had adamantly declined to come to the clinic and be examined. I asked Vickie if Clyde was aware that he had infected her sister? Had that fact sunk into his brain?
“Oh, I’d say he knows. Hell, I told him more than once. Matter of fact, when he first started to drive, first thing he done is go over there. I asked my sister the other day, I said, ‘Has Clyde been by?’ She said he had. She said he was banging on the door, he was after something, but she wouldn’t open. I asked her, ‘What did he say? What was he after?’ She said, ‘He wanted sex, but I wouldn’t let him in nohow.’ Clyde said to her, ‘I have the virus and you have it, so it’s OK.’ ”
“OK what?” I asked.
“OK to have sex I guess!”
There was hurt in Vickie’s eyes and her chin quivered once after she told me this. “Can you believe him?”
“Did you say anything to Clyde about it?”
“Hell, yes! I confronted him. I said, ‘Clyde, did you go to my sister’s? Did you do such and such and such?’ He said, ‘Yes.’ Just like that: ‘Yes.’ I’m telling you, he’s like a little kid! He don’t understand nothing about right or wrong.”
UP UNTIL THIS POINT, most of the HIV patients, who slipped in and out of my office as discreetly as they could, had no awareness of the others in town who had the virus. They might have spotted each other in my waiting room, made informed guesses, but that was it. By February of 1988, however, TAP—the Tri-City AIDS Project—was holding regular meetings and many of my patients were attending. They spoke to me about it often.
Bobby Keller, after his period of mourning over Ed, was back in full form, a one-man blitzkrieg of outrageous repartee. He seemed determined to find the irony in every situation, sound out every double entendre, every pun, find the mot juste for each occasion. He was a compulsive performer. He could make us laugh, but then he seemed desperate to keep us laughing, to remain in the spotlight. The jokes continued in rapid-fire succession until, inevitably, they lost their power and grew hollow. Sometimes Bobby got scolded for talking too much and his cheerfulness dissolved quickly into tears.
Ethan Nidiffer despised Bobby Keller and Raleigh; they were the epitome of the “flaming queens” he so detested. Ethan had gone very reluctantly to his first meeting, and when Bobby Keller had attempted to make him the butt of a joke, Ethan had cut him down and Bobby’s chin had started quivering. Ethan may have been long in the tooth, betrayed by a pharmacist, denied by his dentist, breathless from emphysema, but he could still act the part of the disapproving father with some expertise. He seemed to feel it his role to settle things down, keep the kids in line.
Raleigh, however, was not to be kept in line by anyone, particularly anyone who tried to assume a patriarchal position. “Are we to assume that you’re just a visitor here?” he asked Ethan at one point. “That you don’t have the virus? I’m over you and that attitude. I’ve got one good nerve left. Don’t play with me.”
Ethan mellowed. As the months passed, he became a sort of straight man to Bobby, subtly turning his sidekick’s less successful cracks into crowd-pleasers with his dry deadpan retorts. When Raleigh rode in with his “don’t fuck with me” attitude and extra long Virginia Slims menthols, the threesome became a force of mutual protection.
Otis Jackson—Fred Goodson’s lover and companion—resisted the whole idea of support group and the fellowship to be found there. Otis sat distant, surly and removed. Thanks to his years in San Francisco, he favored the Castro look: close-cropped hair, jeans, black lace-up workboots and a white T-shirt. He dressed carefully for the meetings, proudly, as if flying the colors. Otis watched jealously as his lover, Fred Goodson, presided over the support group. When Raleigh cast a flirtatious glance in Otis’s direction, Otis ignored him.
Fred, the bear, brought a taste of big-city activism to the meetings. He was a pro with a political agenda and not much patience for small talk. Like no one else, he understood the dynamics of support groups and could see the patterns beneath the seemingly random back-and-forth that went on. He laughed at the jokes but had a sixth sense for when a one-liner was concealing something bigger, more heartfelt. Fred was about “being real.” He refused to accept aimless chatter and had no time for politeness. It was Fred who made Bobby Keller stop joking and really talk about how much he missed Ed. He made each person speak about how they broke the news of their HIV to the person closest to them. He was the first to talk openly about how often during the day his thoughts turned to dying. Left to their own devices, good country boys like Bobby and Raleigh could spend the day talking about everything but what they had in common. Fred never let the conversation drift too far away. He always made a beeline for what wasn’t being said.
There were tensions: Petie Granger (the young man whose parents had experienced rejection at the hands of their family doctor and surgeon) tried to browbeat the group into adopting his upbeat, optimistic attitude. He was settled at home in the very same bedroom he had grown up in and was back eating his mother’s cooking. He had regained not only the weight he lost but also his voice. He could go on and on, often prefacing his remarks with “back in Baltimore” and pouncing on anyone who, in his perception, was whining about life’s misfortunes. He had said “accentuate the positive” so many times that Ethan Nidiffer finally told him that if he repeated that one more time he personally would get up and slap Petie silly, to which Petie had rolled his eyes and said, “Promises, promises . . .”
VICKIE MCCRAY missed the first couple of sessions. “Clyde wasn’t feeling well,” she said. “But we went two weeks after Christmas—it was the first week in January, I believe. I asked Clyde if he wanted to go and he says ‘Sure.’ Of course, Clyde would go to a nude picnic in a field of fire ants if’n anyone invited him. Anything, rather than sit at home—that’s just the way he is. He was getting bored in the trailer, wanted to be out on the road.
“The meeting was in that church meeting room right next to ETSU. I was nervous as hell. I kept thinking, am I going to run into someone I know getting in and out of this place? And what in the hell am I going to say? We parked the car—I drove—and Clyde and I stood out on the porch watching guys go in. Clyde looks around and says, ‘This must be it,’ and just marches in. I was shocked at his boldness! But I went on in with him. There was a big old Christmas tree in one corner and a bunch of chairs in the middle in a circle. Everybody, me included, was standing outside this circle of chairs, all of us smoking like sieves. I mean to tell you, we were sucking on them cigarettes as if it was the only thing keeping us alive.
“Bobby Keller was in one corner, licking his tongue and rolling them big eyes and making faces and chatting up Petie Granger—see I didn’t know who anybody was at the time. Bobby was all dressed in leather—I mean he even had on a leather hat and a leather bracelet with metal thingies sticking out of it. See, I didn’t realize that he had done that as kind of a joke—Petie had dared him to do it, or something like that. I just took one look at Bobby and, I tell you what, it scared me to death. I was ready to run out of there as fast as a scalded dog except I knew I’d have a time getting Clyde out of there. To look at Bobby Keller frightened me. I was watching him, but not watching him, know what I mean? And I was listening to him and Petie go on about the Christmas parties they had been to and what they wore.
“Picture this: I was the only woman in there. I looked around and I was saying to myself, ‘My God, Vickie, what in the world are you doing here with a bunch of queers?’ I wasn’t even sure that Clyde and I were at the right place. Then one guy walks in—Jacko—only I didn’t know him at the time [Jacko was a patient of mine who had Kaposi’s sarcoma], and his face has these god-awful things on them, like lilacs growing out of his face. He was about the only one that looked sick—he warn’t thin; it was just these . . . things on his face. Then Ethan Nidiffer came in and he just looked real serious and he talked with Clyde and they were next to me, chatting, and it got me
to wondering did Clyde maybe know this guy? What in the world was Clyde saying to this guy who looked kind of like an ex-president of the United States or a senator or something. Then Raleigh comes in—my God, Dr. Verghese. I took one look at him and said to myself, ‘What in the hell is that?’
“Fred got us all to sit down and I still hadn’t decided if I wanted to leave or stay. People were settling down. Then they did what they do every time there is a new person: they went round the room and asked each person to say a little bit about themselves. Well, I don’t even know what I said—I think I said my name, is about it. But when it comes to Clyde he just says—as normal as you please—that he is Clyde McCray, that he was my husband, and that he contracted AIDS from his male lover. Embarrassed the hell out of me!
“Pretty soon they were having a discussion and, to tell you the truth, I wasn’t even there. I couldn’t even tell you what was said. I felt as if I was standing back there and watching, as if this really was not happening, it was a dream. I was in the wrong place at the wrong time. I had been sent to hell and I had been sent to hell with these people.
“We’ve been back every week since, and I must tell you, it’s different. I know Bobby Keller now, I know he’s harmless, a clown. He has never worn that leather suit since. And Bettie Lee—Fred’s sister—has started a caregivers support group meeting across the hall: it’s me, Bettie Lee and some of the mothers and sisters of the men. These days I start off sitting in the support group—’cause I am infected after all—and then after about half an hour I go over to the caregivers side.”
“So is support group helpful to you?”
Vickie gave me a sheepish smile. “It’s been helpful. To be around Bettie Lee is great. And I never thought I’d say this—I’d have died if you told me I would do this—but I have come to really know some of the men and they are just as sweet and caring as you please. For a while there, it felt as if Clyde and I were the only two in the whole world—and my sister—who had this thing.
“And Clyde is having a good old time at support group, mostly bitching about me: how I don’t give him money and how I took all his money, and on and on. The group has kind of figured out that Clyde is not quite there. He’ll make sense for a while, then he’ll say something come out of left field, the same weird things he does at home. After the last meeting, old Bobby Keller come up to me and said, ‘Vickie, you be real glad you were over in the other room, ’cause Clyde went on about you. If I didn’t know he had the virus, I swear I would have bust him one for what he said.’ Bobby’s just a big teddy bear. He couldn’t bust anybody if he wanted to. But he was dead serious for a change. You’d have to know him.” She shook her head quietly as if marveling at the things she had come to see and experience in the last two years.
I didn’t tell Vickie that I did know Bobby Keller and everyone else she had mentioned. She went on.
“It’s something I’ve been meaning to tell you about Clyde, Dr. Verghese: he’s been cussing something awful. Every other word of his is the G.D.M.F. word. He says it to anybody. I mean, poor Danielle, if she walks in front of the TV and plonks herself on the carpet, he’ll cuss her for having her leg in the way. She’ll go crying to her room.”
“What do you do when he does that?” I asked.
“I go to Danielle and tell her that he isn’t in his right mind. ‘Danielle,’ I say, ‘did he ever do this before? Before this virus got around to his head? No? Well, you see, it’s not him. It’s the virus what’s doing it to him.’ Then I make her come out and I confront Clyde. I say, ‘Clyde, you’re not going to sit and cuss your daughter like that. She is your daughter and you will say sorry to her!’ Well then he puts on this real pitiful expression on his face and says, ‘I’m sorry, Danielle.’ Like a child. But five minutes later he can do it all over again. Say the G.D.M.F. thing.”
MY DUTIES AT THE VA had taken on a new twist: Brian Smith, one of the two pulmonary physicians at the VA, had decided to leave. Brian performed all bronchoscopies (the examination of the inside of the bronchial tree with a flexible fiberoptic instrument) at the VA. And a good many bronchoscopies were needed every month because of the huge burden of lung cancer. Brian had been teaching me to perform bronchoscopy for a reason not related to lung cancer: to obtain samples of secretions from deep within the lung in patients with pneumonia. Now, with Brian’s leaving, I was called on to do bronchoscopy for the many lung cancer workups generated by each ward. At least until a pulmonary physician could be recruited.
Over a hundred persons with lung cancer were cared for each year at our VA. It seemed to me that, unlike AIDS, there was no shame in cancer, not lung cancer, not in Tennessee. The patients were in a curious way prepared for it. Anand, my oncologist friend, who was overwhelmed and perhaps slightly disillusioned by the amount of lung cancer seen at the VA, said to me: ‘it’s a bloody badge of honor. I happen to be here some Sundays and I’ll see whole families, several generations, around the patient’s bed, with the patient in the center, on the bed, kind of in the role of hero. You fought for your country, you smoked tobacco that the army gave you—the same tobacco that your father grew at home, that you helped harvest and put on stakes and hung up to dry, the same tobacco that John Wayne and Bogart smoked. Then you got lung cancer years later—it’s a goddamn war wound.”
I had already seen two patients on other wards and scheduled them for bronchoscopies when I went to Ward 8. The third patient was not in his bed. I walked to the back of the ward, to the smoking room, where a number of patients were watching Wheel of Fortune. I had always thought the walls of the smoking room were painted yellow; however, whenever the maintenance men came to take the clocks down to reset them for daylight saving time, I would see a perfect pink circle left behind, a tribute to the original color of the wall. I was greeted with a “Who do you need, Doc?” by the man nearest the archway. When I said, “Jimmy Roach,” a tall, gangly man with dark hair stood up and came toward me. “Don’t worry, J.R.,” someone yelled after him, “we’ll keep Vanna warm for you.”
J.R. and I walked down the ward until we came to his bed.
His neighbor in the next bed was a scrunched-up old man who appeared to have had a stroke. A woman, the patient’s wife, I supposed, was sitting next to him, and she looked at us through lenses as thick as soda bottles. She was spoon-feeding him ice cream, and either because one side of his face was palsied or because her aim was poor, much of the ice cream was coming out the side of his mouth, and a big glob of it hung precariously on the tip of his chin. Neither of them seemed aware of this, and she kept pushing more ice cream into his mouth.
I drew the curtain around J.R.’s bed and pulled up a chair and sat in front of him. “Where are you from?” I asked J.R.
“Over near Middlesboro, Kentucky. Know where that is, Doc?”
“Sure. Right next to Tazewell, Tennessee, right?” I had moonlighted in Tazewell, about an hour-and-a-half drive from Johnson City.
“You know your chest x-ray showed a small growth on your lung. The reason I am here is your team of physicians wanted me to see if I could do a bronchoscopy—that is go down into your lungs through your nose with this lighted tube—and get a piece of the tissue in that growth.”
Even as I recited this, I was alarmed by something I had heard: J.R.’s voice was raspy and hoarse. The vocal cords are innervated by the recurrent laryngeal nerves which run through the chest to reach the cords. J.R.’s hoarseness suggested the cancer had spread in his chest to entrap one of these nerves. I examined J.R. for lymph nodes in his neck. I felt a rock-hard mass in his neck, just where his sternomastoid muscle joined his collarbone. This was almost certainly a malignant node, the cancer having spread to the neck. I called the intern, had him feel it with me. He was sheepish. I suggested a much more direct way to make the diagnosis: we would aspirate the node with a fine needle and get an exact tissue diagnosis. Even now I was sure the node in the neck together with the hoarseness meant the cancer was inoperable.
I exp
lained to J.R. that instead of the bronchoscopy we would biopsy the lymph node in his neck. He fingered the node with his fingers. He looked straight at me, and asked without any fear:
“You reckon it’s cancer, don’t you, Doc?”
“It’s possible that’s what it is, J.R. Let’s hope it turns out to be something else.”
“But right now it’s looking like cancer?”
“It’s very possible.”
“Well,” he said with a wry smile, “if that’s what it is, that’s what it is.” He stuck his hand out at me. “I appreciate you coming by, Doc, I really do.”
I promised to return.
As I wrote out my consultation, I saw him head off to the smoking room, his hand reaching for the Marlboros in his dressing gown. A chorus of male voices greeted him. He fired up his cigarette and took his place next to his mates and watched Vanna spin the wheel again.
Yes, I thought. Death is not new to me or to any doctor. But nowadays, you get cancer and you die with honor, often after having lived an almost full life span. With HIV infection, you have to fight to salvage your honor, and for the most part you die young. But at least with HIV you buy some time—five to seven years even after the diagnosis. I had a feeling that not just J.R. but the other two patients I had scheduled for bronchoscopy would turn out not to be candidates for curative surgery and would die within six months. As I made my way to clinic, the prospect of seeing HIV patients that afternoon seemed positively uplifting after a whole morning spent with lung cancer.
20
AFTER CLINIC, I was still thinking of the metaphors of disease—honor versus shame—as I looked over the ultrasound of a patient’s abdomen with a radiologist. As we put the films up on the screen, I told the radiologist—one of a group of four congenial radiologists who covered the Miracle Center—that the patient had AIDS. I described the location of his pain over the gallbladder area. We were at the very back of the radiology suites in a plush office. Pictures of the radiologist’s family and his mentors from his training days covered the walls. The lights were dimmed the better to see the view boxes. The sumptuous leather chair he sat in probably cost more than my Z. This radiologist was the consummate jester, quick-witted, a good ole boy who immediately put you into a good-ole-boy mode and sucked you into his banter.
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