The STD Clinic and the New Year
Traditionally, the New Year is a time of renewed hope and heightened expectations for the next twelve months – sort of a new beginning – readdressing old resolutions with a revitalized desire – at least looking for the New Year to be better than the past one.
January 6, 1993 was a first for me. According to my physician-assistant friend, Bob, it was also a precursor for things to come – the beginning of something that is not filled with hope and wonderful expectations or any of that other “new year” hype. Bob says that it is a glimpse of the future, when it will be the norm for STD patients to be co-infected with HIV.
January 6, 1993 was the first time I conducted an HIV pretest counseling session with a patient I felt was positive. Without knowing much about him, I had a suspicion that John was positive and already suffering the effects of AIDS. He was a contact to syphilis in March of 1992. His lover was treated for the first stage of the disease, primary syphilis, in Tucson. The contact paperwork was sent here because John left Tucson, supposedly to move back up here with his parents.
I talked to John’s mom, Shirley, two or three times, trying to locate him. The only information she had was that he was in Tucson. As it turned out, nobody really knew where John went until May 1992 when he showed up at his folk’s house. He was only there for a couple weeks when he disappeared again, this time for six months.
The day of John’s birthday, November 17th, he called his mom from Houston, Texas and asked if he could come home. Shirley said he didn’t remember how he got to Texas, but he came home on a bus. John was welcomed home with open arms again.
Shirley told me that John’s biological mother was an alcoholic and he was born with fetal alcohol syndrome. His thought processes and reasoning abilities might be equal to those of a small child. Sometimes he appeared to grasp certain ideas and was able to repeat what has just been said to him – but the context or meaning of the words seemed to be lost somewhere in the mist of his confused mind.
John appeared to live his life in complete reaction to everything around him. If he got hurt or scared, he just left – sometimes returning in a few days or a couple weeks – sometimes returning in several weeks to several months. The last time he left home, in May 1992, he said he was going to the store to get some cigarettes – he didn’t call or write or anything until November 1992. John got his courage from alcohol. Usually he was a timid person, not challenging anything – allowing himself to be trod upon or abused by whoever was around and willing. His father, Jim, was particularly adept at unsettling him. Evidently, Jim had a hard accepting his son and his problems. Nothing was ever good enough – John never met his dad’s expectations. So, John takes it for a while, goes out and gets drunk and then leaves. One time he left school at lunch time, got drunk, and then passed out in the middle of Camelback Road on the way back to school.
When John came home in November, he was very thin. His mom said he had always been on the skinny side, but this time he looked unhealthy. Shirley all but forgot about me until she took John shopping for clothes at Christmastime. She had told him about the health department looking for him when he was home in May – he told her he’d take care of it – so she put it out of her mind. Now, in the changing room at the department store, she remembered me. John’s torso was covered with bright red, crusty spots. Some were fresh and others had started healing already. Suddenly, things began to fall together. Now maybe there was a reason for his weight loss, for his thinning hair, and for that “look” that said something just wasn’t right.
John called me around 9:30 on the morning of January 6, 1993 – he said he had my card now – he’d just gotten back into town. I vaguely remembered his name – it had only been nine months since I had been looking for him. When I asked him what date was on the card I left for him, he said it was April 1, 1992. Now I remembered him. I told him why I was looking for him and stressed the importance of him getting to the clinic ASAP. He said he’d probably be able to get to the clinic the next day, but couldn’t do it today. Again, I told him what was going on – still not fully understanding me, he put Shirley on the phone. She mentioned the rash and I told her that John needed treatment now – today – not later. They were to ask for me when they got to the clinic.
An hour or two later, I was paged to the front desk. As I entered the waiting room, I looked around at the faces of whoever might be waiting to see me. I spotted John and hoped like hell that it wasn’t him. In that two-second glance, I saw the image of what my mind might conjure-up if I asked myself what a person with AIDS would look like. The shell of what was once a body – thin, almost ghost-like with sunken eyes and hollow cheeks.
That scene above is done, yet unfinished. Until some tidbit of news is uncovered or until I become brave enough to call Shirley and ask her about John, that story has ended. It is alive only within the confines of my memory – and separately, in a very detached way, it goes on still in John, Shirley, and Jim’s lives, but to me the story travels unawares. One of the disadvantages, or maybe true benefits, of working in the clinic as an investigator and not as a caseworker, is that we don’t see the end of the stories in people’s lives. We don’t often know how they come to an end, as we don’t know how they come to be delivered from the circumstances that could so easily swallow them into nonexistence.