Eventually the text page from Chanel arrived. I walked across the street to the pharmacy and handed an Indian man the handwritten prescriptions. After I gave him my full name and date of birth, I wanted to say something else, something like “I don’t actually have HIV. This is all precautionary. You agree, right?” But I said nothing and waited.
—
Twenty minutes later I was on the southbound 1 train headed home with a large plastic bag containing all of my new medications. There were eleven pill bottles in all, including medications to prevent nausea and vomiting. Head in hands, I wondered what to say to Heather. I had to tell her, but how? And how would I respond if the shoe were on the other foot? I’d received frantic calls from college friends after “the condom broke,” but this was something altogether different. Heather and I had made a point of not talking about work at home, but that was about to end.
“Excuse me, ladies and gentlemen!” someone yelled. It was Ali, wearing suspenders and a top hat. My spiritual healer had returned. He headed in my direction and attempted to hand me another business card, but I waved him away. I didn’t want to see him or anyone. I didn’t want to touch anyone. And I didn’t want to tell anyone. I wanted to be completely alone and I wanted an answer. Did I have HIV or not? Banderas said I wouldn’t know for weeks. If the virus didn’t destroy me, the uncertainty might.
Emerging from the dank subway at Seventy-Ninth Street and walking toward my soot-stained building, I started examining the bottles of various pills Dr. Chanel had prescribed—ritonavir, lopinavir, tenofovir, darunavir, raltegravir. More comic book characters, all with extensive side effects profiles. Darunavir looked a bit like a football, burnt orange and oval-shaped, while ritonavir was an enormous pale capsule, a meal in a pill that an astronaut might carry. As I twisted the various pill bottles between my thumb and forefinger, I wondered if the medication causing diarrhea would be balanced out by the one inducing constipation.
When I passed a stationery store, I thought of Peter Lundquist and the heart he had drawn on his legal pad, the broken one without any names in it. The one that had brought me to tears. If I couldn’t keep it together that afternoon sitting with Denise and Peter, how was I going to deal with this? It was easily the most wrenching thing that had ever happened to me, the kind of thing you heard about happening to other people that made you thankful it wasn’t you. This wasn’t like waiting for some STD result after a drunken night out; this was a high-risk, life-threatening screwup that could potentially affect everyone I cared about and even those I didn’t. For the last month I had watched people in the hospital on the brink of death, but the stakes were always theirs, not mine. I wasn’t sure I was up to even waiting to find out my results. And if it turned out I had contracted HIV…well, I certainly wasn’t ready to think about that version of my future.
“Mr. Matt,” the doorman bellowed as I entered the lobby. “How goes it?”
I quickly stuffed the pills back in the bag and gave him a salute. “Terrific.”
As I waited for the elevator, my thoughts moved elsewhere. Could I have kids with HIV? Or would the act of conception put Heather at too great a risk? Fuck, I should know this. My mind wasn’t working properly. Suddenly I wasn’t so sure I knew how Heather was going to respond.
I started running through opening lines to say to her.
So, funny thing happened today at work…
Guess who gets to start using condoms again!
I might have AIDS and I would understand if you want to leave me.
I quietly unlocked the door and entered the bedroom. I gave her a light shake, but she was fast asleep. Maybe this could wait. I was terrified of telling her and was looking for an excuse to buy more time. I backed out of the room, but as I was closing the door Heather opened her eyes.
“What?” she asked, wiping sleep from her eyes. “What are you doing home?”
I smiled uncomfortably; words jumped out:
careful understand needle nightmare awful explain Carleton viral sorry
“Holy shit,” she said, throwing the blankets onto the floor. “Are you okay?” She bolted out of bed and stood just a few inches from me. “Are you okay?”
She hadn’t yet touched me. I wondered if she would. “I had an HIV-positive needle stick this afternoon. I was drawing blood and it just happened.”
“Oh my god.” She threw her arms around me and said, “Whatever happens, I want you to know that I’m here.”
“I don’t know exactly how it happened but I just jabbed the fucking thing. I don’t know if I blacked out or what.”
“Whatever happens,” she said, grabbing me more tightly, “I’m here. I’m not going anywhere.” I pulled back to look at her face. “I love you,” she said, giving me another hug. “I love you. Period.”
I stood dumbfounded. It was the most wonderful thing anyone had ever said to me. I reached for the bag of meds, about to show her my new reality, but thought better of it. She gave me another hug, and moments later we crawled into bed and I fell asleep with my hand locked in hers, like Denise and Peter.
I was unceremoniously awoken hours later by an urgent need to move my bowels. Stool vanity cast aside, I was curious to see if my excrement could give me an early indication of my viral status. Could I detect a subtle difference or was I being ridiculous? I wasn’t sure.
I thought of my friends and what they would say. But before I contacted them I needed to speak to my mother and father. I’d counseled patients on how to disclose an HIV diagnosis to partners but not parents. A few minutes later I had them both on the phone. A childhood spent watching TBS and Lifetime had taught me what to say next.
“Mom…Dad…are you sitting down?” I asked solemnly. “Because I’m afraid I have some bad news.”
I imagined them on separate phones, just a few feet away from each other in their living room, raising their eyebrows.
“I was drawing blood today and I stuck myself.” Silence. “I injected myself with HIV. Several hundred thousand—”
I paused. It occurred to me that my calculation was off—it was impossible to know just how many copies of HIV had been thrust into my finger. I didn’t remember David’s most recent lab results, and the number might be much higher than that. My parents started speaking, but I only caught fragments.
oh my love you safe when will why would job come home love walk away
My thoughts were somewhere else, trying to remember David’s exact HIV viral load. Wasn’t it closer to a million? Did it really matter? I returned to my parents.
“It’s been a nightmare, obviously,” I said.
“You know, Matty,” my dad said, his voice rising slightly, “I hate to say it, but this never would’ve happened if you were a dermatologist!”
It was one of the long-running gags between us and it always made me laugh; insulation from the vagaries of life was only a skin biopsy away. After some obligatory, mutual reassurance, I hung up the phone and crawled back into bed.
21
The next morning I caught my reflection in the bedroom window—my face was droopy and distorted like a Dalí painting—as dozens of numbers whizzed through my head. I had spent the predawn hours devouring research about HIV transmission, hoping that by precisely calculating my risk, I could establish statistical boundaries and somehow contain the nightmare. But the numbers only reinforced the reality of my situation; some unlucky souls were going to contract the virus after a needle stick and I might be one of them. I just had to take my pills, cross my fingers, and wait.
I auditioned various brave faces as I shaved. What if I cut myself? Would HIV-infected blood drip into the sink? I closed my eyes and put down the razor. Now that abject fear had begun to recede, a new, equally terrible feeling was emerging to join it: embarrassment. The idea of walking back into the hospital seemed excruciating. How was I going to face David? Or Ashley? I was a liability, a danger to myself and those around me. How could Ariel and Lalitha and Meghan trust me to do my job? How was I
ever going to face all of those AIDS patients—the ones who were disintegrating before my eyes? What were the odds they’d trust a doctor careless enough to accidentally join their fate?
And that was just today. More worrying was what it might do to my reputation and career progress in the long term. Everyone in my intern group felt a pressure, spoken or not, to improve every day—to make diagnoses more quickly, to write notes more adeptly, and to know more about our patients and their illnesses than anyone else in the hospital. We did this by toiling behind the scenes, staying late to talk with a patient’s family or coming in early to read up on an obscure disease, and in many cases, we did this by quietly violating strict work hour regulations. No one knew about these violations because we didn’t formally punch in and out; we just stayed until the work was done. And the work was never done. Anonymity ultimately meant better care for our patients because we could bend the rules, and I feared that my needle stick would shatter my anonymity; I would become that guy, someone people knew about, someone to keep tabs on, and I would not be the only victim of my mistake.
I considered how far word of my needle stick might have traveled in our insular hospital world. Although we didn’t have much time to socialize, we had time to gossip. I knew who was screwing, who was pregnant, and who was trying to become pregnant. It was quite easy to attain vast sums of secondhand knowledge of questionable veracity about colleagues I’d never actually spoken to. I could only imagine what would be said about me. How would Ashley relay it? How would Carleton describe it?
What had he said after I was whisked away to meet Banderas? Did the calm, collected medical student describe the incident in detail to his classmates? Did he say I handled the situation well or did he acknowledge the truth—that I was scared and increasingly unable to function as the implications of my mistake set in? And why did I care? The incident was over, there was nothing to do but move forward and tackle the matrix of assignments that was about to unfold. Of course I cared.
—
I carefully laid out all of the HIV medications on the kitchen table, popping six in quick succession, followed by a glass of water and a handful of cornflakes. The remaining pills I packed in a Ziploc bag and stuffed in the front pocket of my white coat for later. I wasn’t technically required to go back to work—supervisors made it clear that I could come back to work when I was ready—but I didn’t want to let down my peers. Interns were spread so thin to begin with; sulking at home would only make things worse and perhaps create the perception that I was not a team player. Plus, the fact was that in spite of the psychological blow, there was nothing actually wrong with me. I had to get back to work.
I spent the subway ride to the hospital flipping through Heart Disease for Dummies as a mariachi band bounced from one car to the next, but I couldn’t focus. I closed the pages and shut my eyes until I arrived at 168th Street.
Entering the hospital, I slipped on my white coat and put my hand in my pocket, rolling the pills through my fingers. The first recognizable face I encountered was that of Benny, who was standing next to a vending machine with a large grin.
“How you doing, big man?” he asked. “You good?”
“Hi, uh, Benny.” He was undoubtedly the only patient in the CCU capable of taking a stroll to the vending machines.
He held up a Snickers and giggled. “Don’t tell.”
He shouldn’t be eating that, I thought. “I won’t.”
“You good?” he asked again, extending a fist. Doctors, nurses, and patients buzzed around us. Some peered into cell phones, others at scut lists. I didn’t recognize a single face.
“Well…”
“You look a little ashy,” Benny said.
Benny, by contrast, looked as well as I’d ever seen him. He was wearing a blue Giants sweatshirt and gray sweatpants and had just finished another session on the stationary bicycle. His enthusiasm for the new NFL season, I soon discovered, was mitigated by his frustration that one of his daughters had been misbehaving at home. I tried to imagine what it must be like for that girl, to miss her father, to tell friends that the old man’s not around because he’s waiting in the hospital for a heart transplant that might not ever come.
I noticed a small gauze pad near Benny’s neck where a large IV had been removed. It reminded me that the man wasn’t simply idly waiting, he was constantly undergoing blood tests, MRIs, CAT scans, and X-rays while receiving all sorts of powerful, potentially toxic medications. But to what end? In many ways, Benny reminded me of an intern: smiling on the outside, tortured on the inside.
“Matisyahu!” a passing intern shouted. I gave a small nod and looked into the vending machine for Doritos. My appetite momentarily appeared stronger than my resolve. Thoughts of the needle caused my index finger to throb; I wondered if I should cover the finger with a Band-Aid or if that would only draw attention to the site.
“I’m still waiting,” Benny said.
“I figured,” I said, referring to his impending heart transplant. “How much longer do they expect?”
He shook his head. “Still waiting for you to tell me you’re good.” He pointed the Snickers at me like it was a pistol. “Gonna make me ask again?”
I pounded his fist and smiled. “I’m good.”
He looked at me askance. “Yeah?”
“Yeah. Took your advice…slowed things down, not in such a hurry.” I hadn’t rushed that blood draw, had I? My mind jumped back to the needle stick, as it had every hour or so since it happened, and again I tried to figure out what went wrong. My mind leapt ahead a few years, to a time when I was just another patient in the HIV clinic. One who couldn’t drink alcohol because of the hepatotoxic side effects of ritonavir, one who might need weekly dialysis because of the dangerous side effects of tenofovir, which I learned could tear up the kidneys. I imagined myself on a waiting list, just like Benny, hoping for a new organ after my own had been eaten away by HIV.
“Whatever it is, Matt, you’ll get through it.”
“I’m good!” I insisted, giving him another fist pound. “What’s new in the CCU?”
“Reading a good book,” he said. “Sick Girl, about a heart transplant.”
“Haven’t read it.”
“And”—he winked—“it’s Bad Girls Week on Judge Joe Brown.”
A moment later my pager went off: PATIENT WITH ILLICIT ITEMS IN HER BUST. PLEASE EVALUATE.
“Popular,” he said, looking beyond me to a small boy holding a balloon. “Stay positive, friend.”
“I will,” I said. “Gotta run.”
“Gotta walk,” he said, taking one last bite of the candy bar.
I looked at the pager again, shaking my head at the impending search and seizure, and softly said, “Amazing things…”
“They’re happening,” Benny said, pointing at the slick, off-white floor, “right here.”
—
Exiting the elevator a few minutes later, I bumped into Ashley. “Question,” she said, pointing at my belly.
My knees buckled. What was she going to say about the incident? I was in no mood to relive the moment with her or be admonished for my sloppiness. “What’s up?” I asked nervously.
“Need your opinion.”
“Of course.”
“Would you rather marry someone who cheats on you one time or marry an alcoholic?”
She smiled, and a wave of relief washed over me. “Love this question.”
“So do I.”
We had occasionally batted this around in medical school. The consensus was to marry the person who cheats, but Heather and I had both initially said alcoholic.
“I’d go with the alcoholic,” I said to Ashley. “No question.”
She shook her head. “No way!”
I shrugged. “Maybe I have trust issues.”
“Have you ever lived with an alcoholic?”
“No.”
“Then you can’t answer the question.”
I smiled. “Let me amend my answer. I canno
t answer your question because I have never lived with an alcoholic.”
Her pager buzzed and she shook her head. “See you in rounds, pal. You’re good.”
That stupid interaction with her glorious cheekbones was just what I’d needed. She’d treated me like nothing had happened. I didn’t have to feel embarrassed; I didn’t have to defend actions or offer some lame excuse. Perhaps things would unfold differently in the next few days, but for now, Ashley had tacitly let me know that I’d be able to focus on being a good doctor and not worry about what everyone around me might think.
“P.S.,” Ashley said, skipping away, “I think you broke Carleton. Holy shit balls!”
22
I glanced at my scut and tried to prioritize. My instinct told me that the only way I’d make it through the next six weeks without tearing my hair out from worry would be to throw myself even deeper into the job, to focus on the patients. Even this, however, presented a major problem: I was about to spend a month immersed in the world of HIV/AIDS patients while waiting to find out if I was going to become one of them. Each interaction offered a possible mirror into a future I was hoping desperately to avoid.
The Real Doctor Will See You Shortly Page 13
