Best Friends (46 page)

Soon after, another new patient arrived in my clinic, Larry Cotton, a school psychologist with a chiseled face and soulful eyes who wore plaid flannel shirts and was referred by a Dr. Nicholaides. He'd just been released from the hospital after a bout with pneumocystis. His HIV serology was positive; the Western blot, the confirmatory test, was positive too.

“A friend of mine told me about you,” Mr. Cotton said. “He'd read about you somewhere.”

Probably gay, I thought. A male friend.

But Larry Cotton denied any risk factors for HIV. According to him, he was a monogamous heterosexual who lived with a girlfriend. He'd never even smoked marijuana.

I don't really care how people get AIDS. Other than to learn what behaviors I should warn people about, the mode of transmission doesn't interest me at all. There is a weird tendency for gays, and not drug abusers, to get Kaposi's sarcoma. Some people blame this on a concern with appearance, since Kaposi's can be disfiguring, and gays care a thousand times more than drug addicts what they look like. HIV has this amazing propensity to hit people where it hurts. The weight lifters get muscle wasting, the brainy people get dementia, the fastidious get diarrhea.

“No surgery lately? No dental procedures?”

He'd gotten it somehow, but I wasn't going to press him. “Your girlfriend should get tested,” I pointed out. “She should go to the health department for that. And I have a set of guidelines for safe sex.” I handed Mr. Cotton a booklet I'd written up, an explicit and (I thought) rather humorous guide to safe sex in the nineties. One of my first and longest-gone patients had done illustrations for the manual (the “Kannot Sutra,” he called it), and the text had been vetted by the University Internal Review Board, who approved it with the caveat that only I could hand it out, as personal advice not sanctioned by the University, and that I must keep all unused copies locked up in my office. Mr. Cotton glanced at it with little interest, then rolled it up and stuck it in his pocket.

“What's his story?” LaTonya, the clinic's brightest nurse, asked me as he walked down the hall.

“Beats me,” I said. “From what he tells me, he's the Virgin Larry.”

 

 

 

ONE NIGHT SALLY NEEDED some Q-tips to clean out her dad's ears, another night Mylanta, another night an antifungal cream. One time she asked for Vaseline and rubber gloves.

“I'll run out,” Peter would announce eagerly, standing up. All four kids would be in bed, after their protracted bedtime ritual, with Peter and me sitting around with the TV on, talking about the amazing durability of Saddam Hussein.

“Oh no,” I'd say. “You sit. I'll run out.” I often used Sally's car. “Have some time with Sally.”

Yes, Peter and I parried over who'd get to leave: it was that bad. Weekends, when Sally slept late, Peter spent hours with the kids. Late in the day, after going to his time-share office in Malibu, he played squash. Every time I saw him now, he was just arriving or just getting ready to go. He was in a transition time, he said. What do you mean? I asked. His father-in-law wouldn't be living with them forever, Peter said. After he was gone, they'd have a normal life. Crazy optimist, I remember thinking.

“Rubber gloves and Vaseline? What's the problem tonight, Sally?” Peter asked.

“Fecal impaction,” I said, recognizing the supplies. “Can't the night nurse do it?”

Sally looked at Peter, her red cheeks flaring. “He's my father,” she said tonelessly. “He won't live forever, and I have to think I've done everything I could.” And she bounded away from me and Peter and up the stairs to her father's room.

 

 

 

I LEFT L.A. on a Sunday in March 1992, and the very next night, Sid, being fed his supper, choked and aspirated on a piece of Sally's excellent chicken cacciatore, a leftover from my visit. Troy the companion and Peter struggled with the Heimlich maneuver while Sally phoned 911.

Sally called me at eleven her time, forgetting in her grief that it was two A.M. for me.

It took me a moment to grasp the situation. “He's on a respirator?” I said, that fact alone jolting me into awareness. Usually I dozed through late calls, even when I was talking.

“He has pneumonia. I can't just let him die.”

He'd been losing his memory for at least two years; his mental status was marginal at best. The odds of his getting off the respirator and returning to a coherent existence were slim to none. “Didn't he have a living will? Did you ever decide on resuscitation?”

“I can't just let him die,” Sally repeated. “Even if he's a vegetable, he's alive. He's a person. There's a value to life itself, you know. Only God can know the place and time. I can still take him home. We'll have to hire someone extra, but I can be there all day.”

“But you'll have to run your office too, you'll—” I hesitated, thinking this wasn't the time for practicalities. Sally reminded me of some of the partners or parents of my patients, rushing in, at the moment of diagnosis, with all sorts of exalted plans. We'll build a new wing on the house, sell our business, quit work, and stay at home. Sooner or later, daily life sifts in. The plans are less a framework for the future than a flimsy wall tossed up to block it out.

“Listen, Daddy's doctor just got here, is it okay if I have him call you? You'll understand everything and then you can tell me.”

I wasn't really hearing her, I was thinking of Sid on the respirator, the tube taped into his mouth, the catheter in his penis, the nurse drawing up syringes of Valium for sedation, restraints around his ankles and wrists. Whatever happened to “pneumonia, the old man's friend”?

 

 

 

MR. COTTON, the Virgin Larry, went into the hospital. I spoke to his mother in the hall. “He's better, but he's not out of the woods yet. He still needs the oxygen, and his CD4 count is low.”

“That's from the chemotherapy,” Mr. Cotton's mother said.

A strange way to put it, but I supposed AZT was a form of chemo. Sometimes nonmedical people try to sound knowledgeable and end up not making sense. I was trying to be kind to Mrs. Cotton.

“But he's looking better,” his mother said eagerly. “His color is better.” She closed her eyes. “It's a terrible disease, isn't it? Every day I pray for a cure.”

I agreed and hurried off.

I had at that time, apart from Mr. Cotton, a bunch of particularly unloved patients, including a man with Elvis hair who gripped my hand and twisted it whenever I left him, and what I thought over and over as Sid sickened and rallied, rallied and sickened, was how lucky he was to have Sally, who loved him, who sat beside his bed and challenged the nurses, who held cups of water to his lips and rubbed lotion on his arms and hands. Why did Sid get this, how did he deserve this?

The next time Mr. Cotton was in the hospital, he agreed to have a feeding tube inserted into his stomach, a procedure that would entail some help at home. I left several messages on the answering machine for the girlfriend, but she didn't call back.

“Sometimes the cure is worse than the disease,” his mother said cryptically. No one seemed to visit but his mother.

“His accountant's in there with him again,” the head nurse muttered one day as I headed for Mr. Cotton's room.

The accountant was a slight, pleasant-looking black man in a suit, wearing shoes so perfect I wondered if they were scuffed even on their bottoms. Papers that looked like tax forms were spread out on the bedside table. “Hello,” he said politely.

It wasn't one of Mr. Cotton's better days. He drifted off in the middle of my questions. “He agreed to a feeding tube yesterday,” I told the accountant, “but maybe you could help me. I really should speak with his girlfriend.”

“Girlfriend!” the accountant said sharply. “I've been invisible, but I've never had my sex changed.”

Mr. Cotton roused, gave a weak, apologetic smile.

“It's a secret to his family,” the accountant went on, “but you're his doctor, I thought you'd—”

Mr. Cotton was shaking his head weakly, admonishing his friend not to say more. The accountant picked up Mr. Cotton's hand and stroked it. “I only come here under cover of business,” the accountant said. “I'm the helpful neighbor next door.” He stroked Mr. Cotton's bearded cheek. “Don't you worry, Larry. I'll take care of you.”

 

 

 

THROUGH IT ALL, I talked once a week or so with Dr. Farouk, the Rose family internist. Sally told me he looked like Cesar Romero. At first he spoke to me in an avuncular manner that teed me off—the doctors in Akron are afraid of me—but as time went by, he loosened up and became, in a strange stiff way, flirtatious.

“Hi, it's me,” I'd say when he got on the phone, “sorry.”

“I am always happy to hear from my eminent colleague,” Dr. Farouk would answer, or some such drivel, and then he'd tell me, elegantly and concisely, what was going on.

The family was difficult and full of tragedies. Sally was the strong child; Ben had had “too-much disease.” At first I thought Dr. Farouk was referring to multiple illnesses, then I realized he meant something more philosophical. “It is a common disease in my practice,” Dr. Farouk said, “too-much disease. The American disease.” He pronounced the word dis-ease. “The parents were too lenient.” The mother was off in a world of her own. Dr. Farouk did not believe it was the happiest marriage. The father had perhaps sought “comfort outside.”

Dr. Farouk would make an awed, despairing sound, half rattle in the throat, half sigh, a sound I came to recognize and even anticipate, as Sid kept going week after week: “Now your friend, he is off the respirator, but his kidneys have shut down”—the awed sound—“and Sally tells me yes, she wants a nephrologist.”

“Finally,” I said.

“Yes, finally.” He made the sound again. “But, Dr. Mann, your friend, she wanted the respirator, and he is still alive.”

“He's alive?”

“He is stabilizing. He is not at all alert, but he is peeing.”

Peeing. A doctor knows that if a patient is putting out urine, he or she may survive.

 

 

 

“SALLY?” I said into the phone. “Sally?”

Her voice sounded faraway and hollow, as if she were standing in a cavern. “He doesn't respond at all, Clare. Dr. Farouk persuaded me to let them take out the breathing tube, and when they did, I thought that would be it, but now he's breathing on his own. He doesn't open his eyes at all now, he doesn't squeeze my hand, he's just . . . breathing.”

“Sally,” I said. “I'm sorry. I'm very, very sorry.” He was her father; she was my best friend. And my memories of him were not all bad.

“Dr. Farouk says he could last like this a long time. He thinks I should look for a nursing home.”

“Oh, Sally.”

She had his power of attorney. It was all legal. When Sid had choked, Sally hadn't missed a menstrual period; when he was moved by ambulance from the hospital to a fancy nursing home, she was three months pregnant with her fifth child. She was also the guardian of his business, of the magazines, the mailing lists, the contracts, the licensing agreements, of everything, even his studio.

 

 

 

FOUR CHILDREN THREE AND UNDER.

Pregnant.

Lead partner in a law office with twenty-three employees.

An unwanted inheritance.

A husband without steady interests or income.

A dead brother.

A dead mother.

A breathing father.

No faith.

“I thought you hated faith,” I said.

“I hate psychology,” Sally said. “How could someone hate faith? I'd love to have faith. Come on, Clare, do you think I'm a barbarian?”

 

 

 

HIS ROOM LOOKED OUT on a butterfly garden, and he rested on a technological marvel of a bed: a plastic top stretched over a metal box frame, and underneath the plastic a layer of sand puffed and blown by electric jets. All this to prevent bedsores. The aides in this facility were unusually attractive, and all the female staff wore white dresses and white nylons.

He looked the same but blanker, his mouth and eyes open, his tongue fissured and dry as leather. “Hi, Daddy!” Sally said, kissing him on his cheek. She held his hand and told him about our day.

 

 

 

VIRGINIA LUBY, SID'S LONGTIME assistant, was a woman of close to sixty wearing a yellow button-down shirt, a plaid skirt, stockings, and beige sandals with soft soles. She appeared to wear no makeup, but her hair was carefully curled. She reminded me of the church ladies who had done the reception for my wedding to Ted. She sat on a swivel chair in Sally's extra upstairs bedroom—Sid's former room—which had been transformed into a sort of porn command center, complete with computers, modems, phone lines, and a tabletop movie projection device that accommodated editing. Sally kept the door to this room closed; she had had the lock restored. On the computer screen in front of Virginia Luby was a close-up of a lipsticked mouth and an erect penis. “Nice to meet you, Ms. Luby,” I said.