Kevin met Herb in the cafeteria. On sitting down, he handed Herb his revised protocol, fifteen pages long. While Herb read, Kevin concentrated on his sandwich.
When Herb turned the last page, he said, “This is perfect, Kevin.”
He thumbed through his leather-bound pocket calendar.
“We have plenty of time before the submission deadline. I’ll just add a little more background, tidy up the rationale, reference a few of my own papers, put in preliminary data from the patients we’ve scoped so far, stick in some boiler-plate text and window dressing…Oh, the budget. What do you think, how about thirty percent of your salary for three years?”
“Is it OK to ask for that much?”
“If we ask for less, the reviewers might not believe you’re committed to doing the work.”
“Herb, that would be fantastic! I could quit doing general medicine clinic and just see immunodeficiency patients. That would give me enough time to do this study and get other ones started.”
“Good. That’s what NIH salary support is supposed to do. Thirty percent it is.”
Herb scribbled numbers in the margins of the document then looked up curiously.
“Other ones? Do you have any specific ideas in mind?”
“Actually, there is one I’ve been meaning to run by you. It’s for an interventional trial.”
“Really?”
Herb chuckled to himself, thinking the hook had indeed been set.
“Tell me about it.”
Kevin pitched a proposal for treating GRID patients with interferon, a molecule naturally made by human white blood cells in response to viral infections such as influenza. Herb knew that a biotech company had devised a method for synthesizing interferon and was developing it as an experimental treatment for cancer. He liked Kevin’s idea. It made sense to explore whether the agent could reverse the progressive loss of lymphocytes in GRID.
“It’s a plausible hypothesis. It ought to be tested. But you’ll need a different mentor than me. An oncologist experienced in treating cancer with interferon, like Sprinson at the VA, would be a good choice.”
“I’ll call him.”
“And you’ll need a lab-based collaborator, an immunologist who can measure helper T cells in blood samples.”
“Yeah,” Kevin muttered, frowning. “That might be a problem.”
XXI
LAURIE HAMPTON, THE NEWEST nurse on the ICU staff, noticed Herb enter the unit. She looked at her watch. Ten minutes, she thought, before he starts rounding with the residents.
Laurie had met Herb in the ER a year ago when a heroin overdose arrived in cardiac arrest. The resuscitation wasn’t going well, and the ICU team had come to assist. Laurie suggested they try a different medication. She had mentioned it earlier to the ER attending who hadn’t bothered to respond. Herb not only agreed, he punctuated his approval with a thumbs-up sign, rare praise coming from a doctor, which was why eleven months later, desperate to leave the ER, she arranged to be transferred to the ICU.
More than a tad overweight, Rubenesque according to her lover Tanya, Laurie was from southern Illinois. She had worked in a Carbondale hospital and lived alone for twenty years before admitting to herself that she wanted to be with a woman. Not possible, she felt, in small-town Illinois, so she moved to San Francisco. Now in her forties and in love for the first time, she had never been happier. Until a recent flail in the ER with an intoxicated, combative patient.
An intern had drawn blood and was holding the uncapped syringe when the man swung at him. The intern jerked back reflexively. The uncapped needle jammed into Laurie’s thigh, an inch deep. There were rumors the patient had the new gay-related disease, that it might be transmitted by infected blood. She had been sent to Employee Health, given vaccines for tetanus and hepatitis, and advised to return if she became sick.
She had to talk to someone soon, she realized. The fear was paralyzing her. She couldn’t keep working in this state. Transferring to the ICU had helped, for a while. Then the nightmares recurred. Fanged maggots invaded her blood stream. They were breeding inside her spleen and preparing attacks on other vital organs. She awoke gasping, her chest pounding.
Herb was alone at the sink, washing his hands. Guessing this would be her best chance, Laurie approached him.
“Can I speak with you—privately?”
“Sure.”
Taking note of her dilated pupils and the droplets of sweat at her temples, Herb led her to an empty room.
“What’s up, Laurie?”
She stammered. Her tongue felt too thick. Averting her eyes, she described the needle-stick incident.
“And all Employee Health told you was to come back if you get sick?” Herb asked, attempting to suppress his outrage. “They gave you no information about the patient, didn’t offer you any counseling?”
“They said I should have my blood checked for hepatitis in a month. That’s all. I’d really appreciate your advice.”
Herb heard no complaint, only apprehension and the desire to preserve her dignity. She clearly didn’t want to be a victim.
“Let me see what I can find out. I’ll talk to our GRID expert, Kevin Bartholomew, and get back to you tomorrow. OK?”
“That would be great, Herb.”
He wanted to give her a sympathetic touch. But concerned she might think it inappropriate, he didn’t act on the impulse. She left to start an intravenous medication.
Herb pretended to skim through a chart. With Laurie’s presence no longer threatening to arouse untamable feelings, he reconsidered that decision. Inappropriate? What a pathetic excuse.
Herb first conceded there was a problem during his residency. He tried psychotherapy but found the mandatory self-revelation humiliating. After seeing how senior physicians at NIH maintained a balanced distance in dealing with young leukemic patients and their distraught families, an era of rationalization began. Despite his incapacity for expressing strong emotions, Herb felt them deeply and was well attuned to how others showed them. He determined by trial and error the minimum amount of emotional juice needed to appear credibly caring to people facing devastating loss. He gave only the minimum, just enough so he wouldn’t be drained and depressed for days afterwards. Damage control, he told himself. When in a charitable mood, he was reassured that he hadn’t completely succumbed to the impediment. At moments like this, however, he couldn’t avoid the truth. He was bottled up inside and making no substantive effort to change.
Once rounds were over, Herb drove to the airport. He reached the gate of an inbound flight from New York City as his mother was walking out the jet way. He hadn’t seen Chen for a year and was delighted to discover her lush white hair and vigorous gait hadn’t changed. In a few days she would turn seventy, he marveled.
“You didn’t need to come, Herb. I could have taken the shuttle. Don’t you have to be at work?”
“I’ve got time to drive you to the house. You can surprise the kids when they get home from school.”
Chen was elated, but only briefly.
“Oh,” she said mournfully, “The happiness those darlings give me makes me sad your father never got to know them.”
He had heard this plaint before and was confident his father, if he were still alive, would pay little, if any, attention to his grandchildren. He didn’t doubt his mother’s unconditional love for Allison and Martin. He felt guilty about how long it had been since Chen last saw them and had to remind himself this was her issue with Cecilia’s family that kept her from visiting more often.
“Any plans for while I’m here?”
He understood her real question.
“Cecilia’s parents are out of town, so it’ll just be Will and Andrea coming for dinner on Saturday night.”
Chen was pleased. She liked these old friends of Herb and Cecilia. Though he was quite sure she had chosen to like them before she ever met them, based solely on his telling her they both had parents who belonged to the elite, educated class in China prior
to immigrating. Socializing with Cecilia’s family, on the other hand, had always made her uncomfortable. His wife’s great-great-grandparents had been peasants in China, lucky enough to escape to California when workers were imported to build the transcontinental railroad.
As Herb drove from the airport parking lot to the freeway, he brooded over an incident that happened during his mother’s first trip to San Francisco. Cecilia and he had brought her along to a red egg and ginger banquet in honor of a cousin’s newborn baby. The sheer number of Chang relatives and their raucous chatter made Chen ill at ease. She spoke little until the conversation shifted to the People’s Republic of China. Chen said it was tragic how Mao was destroying the world’s oldest civilization. Another cousin, a radical college student, retorted that Mao’s rule had ended the world’s longest history of state-sanctioned slavery. This interchange quieted all cross-table talk. The young man took the attention as a cue to pull out Mao’s Little Red Book and quote aloud from the Chairman’s sayings. The older Changs quickly tired of his rant and ordered him to shut up. As soon as they moved on to other topics, Chen asked Herb if they could leave. Now he wondered if her discomfort with the Changs was less about class and political differences than about seeing a close-knit, argumentative family in action.
Herb was back in clinic by four to meet Sister Anna. He hid his clenched fists under the desk as he calmly told her about the source of the donated blood she had received. Her equanimity was unshaken by his explanation of GRID, which delicately alluded to its primary mode of transmission and acknowledged the disease might be transmitted by blood as well.
When he was done, she asked, “How likely is this to do me in before the lungs go?”
Herb opened his hands helplessly.
“You’re more worried than me,” Sister Anna scolded. “Are you afraid the bishop will sue you for poisoning a daughter of the church who’s still in her prime?”
He couldn’t smile.
“I’m afraid of losing you,” he confessed.
“That’s most flattering.”
Mired in despair, he couldn’t stop frowning.
“Herb, I know what’s coming. The modus operandi doesn’t matter to me.”
He knew that Sister Anna had worked for years as a pastoral counselor, that she probably had more experience talking with people about dying than he did. She might also be right about the ineluctable obliteration of her airways trumping any complications of GRID. None of this helped him.
“I feel responsible. Hell, I am responsible. I made the decision to give you that transfusion.”
“And it would be a terrible thing for you to bear if I was a young person, not already stricken by an incurable disease. But really, Herb, what difference does this make? I certainly don’t blame you.”
Her eyes sparkled as she added, “If you feel so guilty, perhaps you should talk to someone, a professional, about it.”
Herb managed a weak smile.
XXII
KEVIN WALKED TO THE clinic waiting room doorway and called the first name on his afternoon schedule, a new patient, Tommy Paulson. A short, slender man with thinning brown hair stood up. Kevin introduced himself and ushered the man into an exam room.
Once they were seated, he affably asked, “What brings you here?”
Speaking to the floor, Mr. Paulson said, “I read about you in the Advocate. You’re the gay cancer specialist, right?”
“I am,” said Kevin, deferentially subduing his usual upbeat approach. “Why don’t you tell me about yourself, where you’re from, what you do, whether you’ve ever been hospitalized or take any regular medications. Then we’ll get into the concerns that brought you here.”
Tommy Paulson was shy. He gave an abbreviated account of growing up in rural Pennsylvania and obtaining an engineering degree in college. He was thirty, lived alone, and worked for a construction firm. He had never been in a long-term relationship. There had been no health problems, other than an episode of gonorrhea, until a flu-like illness began six months ago. The fatigue had persisted. Then he started having diarrhea. He had already been to one doctor who ordered blood and stool tests which failed to reveal a cause for his symptoms. Two weeks ago, he noticed a white substance coating the roof of his mouth and made the appointment to see Kevin.
A physical exam confirmed Tommy had thrush. The lab results he showed Kevin included a lymphocyte count well below the lower limit of normal. There was going to be bad news to give, but this was not the time. Kevin needed to go through the motions of ordering and interpreting more tests. He needed more contact to establish credibility and rapport before Tommy would believe his prognosis and trust Kevin to help make the rest of his life as bearable as possible.
Though pressed by his new patient to make a diagnosis on the spot, Kevin stood his ground.
“There are viral and parasitic infections, some autoimmune diseases too, that can cause a prolonged illness like this. Let’s find out for sure what we’re dealing with, OK?”
Tommy was mollified, which Kevin used as an opportunity to ask what drew him to engineering. Tommy described the blueprints he created, the pride that came from seeing his drawings transformed into office buildings and industrial plants.
Kevin imagined a ten-year-old Tommy spending rainy days assembling an Erector Set. He envisioned a boy so adept with his fingers he wouldn’t be frustrated by working hex nuts onto bolts in a tight space. Kevin had done it as a child. He hadn’t minded the repetitious fabrication—constructing girders, tying and cross-bracing them into a bridge, even adding a second or third tier. Anticipating the completion was half the fun.
Kevin gave Tommy a return appointment slip and was about to say goodbye when he sensed his patient wasn’t finished.
“Any other questions?”
Tommy declined. He started to leave but paused at the doorway.
“I don’t get it. I mean, yeah, I tried the bathhouse scene a few times. It wasn’t for me. I’d only had sex with a couple of people before that, and there’s been nobody since. And I never, ever used poppers. I just don’t get it. There are all these men who’ve been at the glory holes forever. They’re fine. Why me?”
Kevin had no answer.
XXIII
ON SATURDAY, ONE OF the chief residents rounded with Gwen’s interns so she could have a day off. Rick was already out running when she awoke. Eva wouldn’t be up for hours. Gwen got of bed and made coffee. She sat at the kitchen table, mulling over the strategy she had settled on. The more she considered it, the sounder it seemed. She was going to be living for her daughter and lover now. Their inner peace mattered more than hers. She could be oblivious to the uncertainty of her own fate as long as she was sure they were all right. It was a relief to have clarity at last. Gwen was ready to put her plan into action.
She went to a neighborhood pharmacy. Avoiding all eye contact, she purchased a packet of condoms. When she came home, Rick was at the kitchen table, grading history quizzes. She sat next to him, resting her head on his shoulder. He gave her a long inquiring look and returned to work. She sat still, trying to be mindless, unable to sustain it. She stroked his calf. He stretched languidly. Her hand drifted to his back. He kept marking papers. She kissed him on the neck.
Rick let go of his red pen. They rose as a unit, moved to the bedroom, undressed, and lay down wrapped around each other. She wanted sex but was too scared to take pleasure in it. Rick felt the tension in her thighs, the absence of her familiar abandon. He stopped moving. Gwen nestled under his arm. She began to cry softly.
“It’s going to be OK,” he said. “We’ll get through this. We will.”
Looking up, she saw his wet eyes and believed him.
XXIV
KEVIN AND MARCO ALSO slept in on Saturday morning. They awoke to bright sunlight and after breakfast drove north to a trailhead in Point Reyes. The fog here hadn’t burned off yet. Fortunately, the path they chose stayed close to the floor of a winding, forested canyon, protecting them from cold s
ea breezes. By the time the trail climbed to an exposed, grassy plateau, they were warm from their brisk pace and invigorated by the sudden drop in temperature.
Two hours after leaving the car, they arrived at a bluff overlooking the ocean. The hike had flown by for Kevin. Not a muscle or joint was protesting. He was energized. Maybe Marco is right about exercise, he thought.
Marco ran the last hundred yards to the cliff’s edge. He searched the water below and waved excitedly. His thick eyebrows were bouncing in delight. Kevin caught up with him and faced an expanse of gray, wind-battered sea. Marco pointed to a band of clear water where dark shapes, diamonds and crosses, floated beneath the surface.
“Bat rays and leopard sharks,” Marco exulted.
Staring in awe, Kevin said, “Holy Mother …”
“Holy what?”
Kevin laughed and spread his arms wide.
“This is what the church wants,” he proclaimed.
Marco looked puzzled.
“For us to be dazzled and spellbound before God’s great creation.”
“Querido, I think their first priority is having us be passive and guilty so we’re easy to manipulate.”
“That’s only because they decided to raise fortunes and build cathedrals instead of celebrating mass in places like this that would have cost nothing.”
“Dios mio. He’s a visionary now. Move over Joan of Arc, make room for Saint Kevin of Distressed Automobiles.”
On their way home, they stopped at the road’s high point to view a rolling carpet of round hills, lush early this year from a series of October storms. The late afternoon sun was behind them as they silently watched swells of grass slowly change hue from deep emerald to a soft pine shade.
This was how Kevin had always imagined serenity would feel.
“What are you thinking?” he asked Marco.
“That winter is my favorite season here. These green hills, they go on forever, full of possibility.”
Kevin kissed him on the lips.
Sensing Light Page 14