Authors: Mark A. Jacobson
G
WEN GOT HOME AT
eleven. Rick and Eva were already asleep. She sat at the kitchen table, arms wrapped around her chest, trembling.
I need a plan, she thought. No, two plans. One for dealing with the fear. Another for what I'm going to say to Eva and Rick. She started on the latter, thinking of words that wouldn't suck the three of them into a self-perpetuating cycle of anxiety. An hour later, she had made no progress.
Eva's backpack lay on the table. Gwen noticed a folded piece of paper spilling out the top. She opened it. The first line was in someone else's handwriting, the second in Eva's.
“Why him?”
“Because there isn't any other boy I like.”
“You're wasting your time.”
“Why?”
“Because of the way he looks at Carla. Sorry, he doesn't look at you that way.”
Gwen was afraid to put the note back. Refolding it would be handling a razor blade by the cutting edge. She was ashamed and instantly realized shame was a convenient way to erase the glimpse she just had of Eva's vulnerability. Gwen stared at the stove, ignoring the note on the table, denying it would pop into her mind whenever she was unguarded, a reminder she might not be there when Eva finally did need her mother's comfort.
Gwen climbed into bed and rustled the sheets. Rick didn't wake up. What could she tell him anyway, besides the essential facts. She had been stuck, deep in the hand, with a bloody needle from an immune deficiency patient. Of course, he would understand the implications. She might die as a result. They would have to take precautions for his protection. More than ever, she was glad they weren't married. She couldn't tolerate the thought of being a burden, seeing him bear the responsibility for taking care of her.
Gwen ruminated over what to say, if anything, then lost the will to continue, approached sleep, became alert again, looked at the clock, felt dread
twisting her intestines, and weighed her options once more. By two in the morning, she knew this wasn't going to work. She had to deal directly, definitively, with her own fear before considering what to tell Eva and Rick.
She could think of only one solution. She shut her eyes tightly and forced herself to imagine Eva distraught, using drugs, casual sex, anything to fill the emptiness after her mother's death. A great moan passed through her, loud enough to stir Rick. She cast out this vision of a desolate Eva. She was absolutely certain she had the resolve never to let it back in.
Suddenly, she could think rationally. Gwen understood that in the worst case scenario she would survive until Eva graduated from high school, which was enough. It was futile and dangerous to think of the future beyond Eva turning eighteen. And there was no sense in telling Eva about the needle-stick. That could only do her damage.
Rick was sitting up, looking at her with concern.
“What's going on?” he asked.
“I stuck myself⦔
She had begun calmly but now lost control.
“With a bloody needle,” she sobbed, “from a GRID patient.”
This is the last time I cry, she swore silently.
Rick breathed in and in. His diaphragm was in spasm. He couldn't exhale. He couldn't even speak. He touched her tentatively, afraid she might become hysterical.
Gwen knew he hadn't a clue about what she needed him to say or do. This had to make him feel inadequate, if not somehow at fault. She took his hand and squeezed.
“Jesus!” he expelled.
He reached for her and said. “I'm here for you, baby.”
Gwen curled into him and whispered, “Please say that again.”
K
EVIN AWOKE IN THE
middle of the night and couldn't go back to sleep. He sat at his desk calculating and typing, trying not to think about Gwen or Boston. Four hours later, he had a headache. His protocol, he decided, was at the point where “better is the enemy of good.” He had learned this shibboleth from the mechanics in his father's garage and still believed in its wisdom.
Marco, who had arisen at six to run at a nearby high school track, returned soaked in sweat.
“Nice run?” Kevin asked, rubbing his scalp to ease the pain.
“
AsÃ, asÃ
. I didn't push myself today.”
“No? What was your time?”
“Thirty-five minutes,
más o menos
.”
“Christ, Marco! That's under a six-minute-mile pace. You don't call that pushing yourself?”
“Sweetheart, I'd be happy to jog ten-minute miles with you. Just two miles, three times a week, would be so, so good for your body.”
“Marco, you knew when you met me I'd never be buff.”
“I love your body. You know I don't want muscles. I want health. You've got a family history of coronary disease, and you're already in your thirties.”
“I have a headache, too. Let's change the subjectâ¦Oh, my God! I forgot to tell you about Gwen.”
After Kevin finished recounting the details of her accident, Marco asked, “Is there anything we can we do?”
“I wish, but it's not the sort of thing you can bring over a casserole for.”
“What?”
“It's an American custom. Sorry, that was a stupid thing say. The truth is I don't know what to do. Wait until she's ready to talk about it, I guess.”
“You think they might want to know how we deal with the uncertainty?”
“That's not a good idea. We can ignore it. She can't. She's got a kid.”
Marco turned sarcastic.
“I could tell her about your
macho
attitude.
Que será, será
, eh?”
“Marco, come on. If anyone's anxious here, it's me.”
“Ignoring the sword over our heads was my idea?”
“Jesus, Marco! I worry enough already. I don't need to add that to the list. Anyway, there's nothing we can do now, besides staying monogamous, and that still works for me.”
Marco leaned against Kevin and massaged his neck.
“Don't get upset, sweetheart. We're on the same page.”
At noon, Kevin was leaving clinic when his pager beeped and displayed the ICU phone number. He had heard “Code Blue” announced on the intercom earlier and hoped it wasn't Miller.
Kevin reached the ICU breathless from running up four flights of stairs. He found Gwen standing over Miller, her arms extended, her palms on his sternum. She rocked downward at one second intervals, counting the compressions aloud. As soon as she saw Kevin, she let her medical student have a turn.
“Miller arrested twenty minutes ago. I was just waiting for you or Herb to OK pronouncing him dead.”
He glanced at the flat line on the monitor and agreed they should give up. With no heart activity after this long, there was zero chance of survival. Gwen signaled her student to stop. She stated the time of death for the nurse keeping the resuscitation log.
As they walked back to the unit's central work station, Gwen looked straight ahead.
“You OK?” he said.
“I'm fine, Kevin.” she said with enough force to make it clear he shouldn't ask again.
He watched her write a final order in Miller's chart and depart. As the door was closing behind her, Tom Redding appeared. Kevin saw him talk to
the first nurse he encountered. His posture sagged with the news of Miller's death.
Kevin offered his condolences and escorted him to the bedside.
“I'm so sorry.” Kevin said. “We did everything we could⦔
“I have no doubt of that. What you people are doing here is tremendous. But I have some questions. I've been looking into GRID. What the CDC is reporting makes it sound like an epidemic. If the number of patients is doubling every couple of months, isn't that an epidemic?”
“We think so.”
“And the federal government, what are they doing? I've heard there's no research going on, other than the CDC tracking cases.”
“Not yet.”
“That's not right. It wasn't how the feds responded to the Legionnaires' outbreak. We'll be talking to some congressmen, pressuring them to lean on NIH. And by the way, the mayor is going to beef up funding for your clinic.”
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 dressingâ¦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.”
L
AURIE
H
AMPTON, 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 youâprivately?”
“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.