Sensing Light (22 page)

XXI

G
WEN HAD A HANGOVER
the next morning. The headache lingered into her mid-afternoon meeting in a hospital conference room. Thirty nurses, medical assistants, and laboratory technicians sat around the perimeter. They looked tired after finishing their eight hour shift and uneasy about the subject to be discussed. Gwen introduced herself and explained the specifics of what had been advertised in flyers posted throughout the City Hospital corridors. They could sign up here to get a blood test that would determine if they had been infected with the AIDS virus. In addition, they could opt to have the test repeated every six months.

“It's
voluntary
screening,” Gwen said. “I want you to be clear about three things. First, all results will be kept strictly confidential. Second, screening is being implemented for our protection, to learn how to make our jobs safer. Third—this hopefully is just hypothetical—if someone were to be infected from a needle stick or scalpel wound, the antibody results could be used to document it was due to the occupational exposure rather than…some other behavior.”

Lilly, a Filipina nursing supervisor, exactly Gwen's age, raised her hand.

“Yes?” said Gwen, recalling a framed photograph of three children she had seen on Lilly's desk.

“How long before we know the result?”

“We only have enough lab tech support to run the assay once a week, and we have to schedule a counseling session to give you the result. So right now it's taking about two weeks from the time your blood is drawn until you can get the result.”

“That's a long wait,” objected a middle-aged black ICU nurse.

“I couldn't agree more, but regulations require a counselor to be present when you get the result, whether it's negative or positive. Most employees
at City Hospital want to participate, and there aren't enough counselors to schedule it any sooner. Once we've completed this round of screening, we can spread out the follow-up testing. Then the waiting time will get shorter.”

A young, blond woman with a Swedish accent said, “I have a friend who was tested in a research study. He says it's very frightening, waiting to find out.”

“Honey,” said an older gay man, “The folks I know who've been through it say the waiting is ice-cold terror.”

There was a collective, introspective lull. Gwen looked around the room to see if anyone had an question. She saw doubt and vacillation, though no one appeared ready to articulate it. She invited comments and was met with silence.

A few people walked out. The rest got in line to sign a consent form and choose a date for their blood draw. As the last staff somberly exited, a public health nurse hurried in. The woman was assisting Gwen in this project and held one of the manila folders they were using to keep each participant's records.

“Can we talk?” she whispered urgently to Gwen.

“Sure, what's up?”

She didn't speak until the room was empty and she had shut the door.

“One of the stored samples is positive. It's a woman. Her only risk factor is a needle-stick three years ago.”

Gwen felt her chest pound. The pace of her breathing involuntarily sped up. She couldn't remember the drill for dealing with an infected health care worker. After her own close call, she had never really believed it could happen to anyone else here. What was she supposed to do now?

“Who is it?” Gwen asked.

“You sure you want to know? Her post-test counseling visit is next week. We can't tell her before then, can we?”

“No!”

Gwen considered the implications. If she knew who it was, that could help her prepare to handle the woman's reaction. But what if it was someone she worked with in clinic? What if they interacted before the disclosure meeting?
How could she not be tense and artificial? And afterwards, wouldn't that be seen as a betrayal?

“When's the appointment?”

“Monday, three o'clock. Can you be there?”

“Of course I'll be there.”

Gwen deliberated, eyes fixed on the manila folder. She held out her hand.

As soon as Gwen was alone in her office, she opened the folder. It slipped from her moist, shaking fingers onto the floor. She wiped her palms on her skirt, clenched and unclenched her fists, and tried again.

It was a name she didn't recognize—one small mercy—Laurie Hampton, an ICU nurse. Another was her age, forty-seven. Future pregnancies wouldn't be an issue. Gwen read the account of a needle-stick exposure. The source patient had later been diagnosed with Pneumocystis pneumonia. The file was small, just the incident report, a behavioral questionnaire that had every box checked ‘No,' a signed consent form, a phone number and address in Daly City, and a woman named Tanya listed as an emergency contact.

Gwen noticed a page stapled behind the report. It was a photocopy of a letter dated a month after the incident. Herb Wu had written to City Hospital's head administrator demanding the hospital refer Ms. Hampton to a psychotherapist and pay all costs.

She closed the folder and chewed on her ballpoint pen. Suddenly, the pen snapped. She watched in horror as a drop of black ink fell from her lip onto the file's cover, obliterating Laurie Hampton's identification number.

XXII

K
EVIN'S HANGOVER, MILDER THAN
Gwen's, was gone by end of his morning clinic. He had a pleasant break in the early afternoon. A ward team presented their most interesting cases to him, and he did a little teaching. When he returned to clinic, he passed the waiting room where three of his suramin trial subjects sat fidgeting. Their study folders were in his exam room. He found a note on top from his research assistant alerting him to new lab test results inside. Kevin picked up one labeled HW.

On his way to get the patient, he opened the folder. His assistant had highlighted three abnormal results with a fluorescent yellow marker—creatinine 3.5, blood urea nitrogen 40, urine protein 4+. Dazed by the bright halos encircling numbers that indicated imminent kidney failure, Kevin leaned against a wall. To fend off mounting dread, he concentrated on what he had learned about suramin toxicity. Individuals who had received the drug for sleeping sickness often suffered kidney injury as a side effect. It began with innocuous amounts of serum proteins leaking into urine. If suramin continued to be administered, it could lead to irreversible kidney failure.

“That's why we check a weekly urinalysis,” he complained aloud. “Kidney toxicity isn't supposed to happen this fast.”

This patient's urine had shown a trace amount of protein last week, though not enough to meet the protocol criteria for stopping treatment.

Kevin went to the waiting room.

“Hubert?” he called softly.

Mr. Wilson had requested Kevin use his first name. It wasn't Kevin's style, but he adapted to what his patients wanted. A slender, blond, twenty-eight year old man stood up. Hubert was a graphic artist for a downtown advertising firm and quite a success at the job from the rumors Kevin's assistant had
heard. Other than a birthmark on his neck, Hubert had remarkably smooth, unblemished skin.

In the exam room, Kevin asked how he was feeling.

“Not great,” he replied, quickly adding, “But no worse than when I started the trial.”

“More fatigue?”

“Not really.”

“All right if I examine you?”

“Sure.”

Kevin shone a light in Hubert's mouth, palpated his neck and under his arms for lymph nodes, listened to his heart and lungs, and pressed a hand on his belly. Everything looked, sounded, felt normal.

Despite three years of working with people who had a fatal disease, Kevin still hated giving bad news. He calmly told Hubert about the lab results while suppressing a deluge of guilt. Hubert must have been receiving real suramin, he said, not placebo, because there was no other plausible reason for the kidney damage. It was severe enough that the medication had to be discontinued at once.

“No!” Hubert protested. “I don't want to stop. This is my last chance.”

Kevin had been at international meetings, cultivating connections with NIH scientists and pharmaceutical companies, learning all he could about drugs developed for other chronic viral infections. He knew Hubert was right. There was little on the horizon more promising than suramin. Given that Hubert's helper T cell count was less than two hundred, it was hard for Kevin to spin this as anything other than the final door closing.

“Hubert, more suramin infusions would permanently destroy your kidneys. You'd need dialysis forever.”

“So the choice is between living with kidney failure or dying from AIDS? That's a no brainer.”

“Sorry, I'm not being clear. There is no choice. According to the protocol rules, if toxicity this serious occurs, the drug has to be stopped. Permanently.”

Hubert sat still, his lips pressed tightly together.

“If I gave you another dose of suramin, I'd be violating the most fundamental rule of human research—do no harm. And if the FDA or the
university found out, they wouldn't let me, wouldn't let anyone at City Hospital conduct another treatment trial for AIDS.”

Hubert's head drooped.

“Let your kidneys recover. Then you could be eligible for the next study that comes along.”

Hubert gave a short snort of disgust. Kevin wheedled him into making an appointment in two weeks to check how his kidneys were doing off the drug. Hubert's mechanical consent intimated he might never be back. He left without acknowledging Kevin's good bye. From the exam room doorway, Kevin watched him shuffle toward the elevator.

“Fuck,” Kevin swore. “I can't do this anymore.”

He stared at Hubert's folder, blinking, his vision blurred.

“I don't have time for this bullshit,” he hissed, wiping his eyes with a sleeve.

He grabbed the next folder and marched out to get the patient.

XXIII

I
T MUST BE A
dream. How could she not have felt the earthquake? Still, the ER staff were saying it had been the big one. She heard sirens approaching the emergency room.

“Ambulance alert!” screamed a ward clerk. “Six hundred AIDS patients on their way, all critically injured. ETA five minutes.”

In moments, they would be awash in infected blood. Men in white plastic jumpsuits walked through the hallways fumigating doctors and nurses in preparation for the onslaught. Covered with oily disinfectant, damp hair stuck to her neck, she waited. The sirens kept howling but didn't come closer.

Waking in the dark, Gwen realized the telephone was ringing. Her digital clock showed five a.m.

She picked up the receiver and mumbled, “Hello.”

“Dr. Howard, it's the answering service. I have a Terrell Hunt on the line. He says your patient, Ed Greames, is dying. I told him he should call an ambulance, but he insists Mr. Greames told him not to.”

Gwen remembered the two prescriptions she had written and sat upright, wide awake.

“Connect me please.”

Gwen had met Ed Greames' boy lover once in clinic. She thought his name was Timmy, perhaps because he looked like the child actor who shared top billing with Lassie in her favorite girlhood television show. Allegedly nineteen years old, Terrell acted the part of a devoted son or nephew.

She heard the operator say, “Dr. Howard is on the line.”

A pleading voice, punctuated by static from the tenuous phone connection, said, “I don't…to do. How…know when he's dead?”

“Slow down, Terrell. Tell me what happened.”

“Ed took the death cocktail.”

“Is he breathing?”

“Sort of…stops and starts.”

“Terrell, find the pill bottles and see if they're empty.”

“What difference…” he shouted. “Are the police…arrest me? Do I need to get out of here?”

“Don't go anywhere, Terrell! Give me your address. I'll be there in half an hour.”

Her mind raced as she sped across the Bay Bridge. This was the first time she had intentionally given a patient the means to end his life. She hadn't thought through how it might play out. What if Greames didn't swallow all the pills or couldn't keep them down, and then Terrell called an ambulance? Would Terrell, or Ed, if he woke up, tell the ER doc that Gwen had written the fatal prescriptions? Would that trigger a criminal investigation? Or if Ed did die at home, would people from the coroner's office come and find empty morphine and phenobarbital bottles that had her name printed on them as the prescribing physician? Would they call the police? How could she honor Ed Greames' wishes without losing her medical license and facing manslaughter charges?

A band of orange light rose above the East Bay hills as she descended into Eureka Valley. It was spreading across the sky when she found the address, a second floor Victorian flat off Castro Street. She rang the bell. The door promptly buzzed open.

Gwen climbed a dark stairway and entered a high-ceiling living room decorated with splendid millwork. Ed Greames lay on a couch. He didn't respond to her shouting his name or rubbing his collarbone. He was breathing, intermittently, and had faint heart sounds. She couldn't feel a pulse.

From behind her, Terrell asked, “Is he dead yet?”

“No,” she answered, thinking minutes, an hour at most.

Then she reconsidered. What if his phenobarbital levels had already peaked? God, what is the half-life of that drug? It's long, isn't it?

She turned to the boy and said, “Timmy, I mean Terrell, what did he take? Which medications?”

“I don't know”

“Think hard. It's important.”

“He told me he was going to take the death cocktail, but I didn't see him do it.”

“
When
did he take it?”

“Probably when he went to sleep, maybe two in the morning.”

Gwen demanded he show her all of Ed's pill bottles. Terrell led her into the kitchen where medication containers littered the breakfast table. She inspected each bottle, several times. None were labeled morphine or phenobarbital.

“Are you sure this is everything?”

“I don't know,” he answered defensively. “I just fed him and cleaned him. I didn't deal with his pills.”

Gwen couldn't remember the precise words of their conversation, but she had seen Ed write down the names of the drugs and the number of pills. She studied the boy. Nineteen might be pushing it a year or two. Gwen chose to believe him. Ed must have taken the pills four hours ago. In his terminal state, he would absorb the medication slowly. That meant his blood morphine levels should be peaking now, possibly the phenobarbital as well.

Terrell twitched. His eyebrows knitted. Gwen saw a frightened kid, only a few years older than Eva. She was appalled by the questions she had just asked him, the tone she had used. This had to stop being about what she was risking and start being about what he had already lost.

“Terrell, you did the right thing. No one is going to accuse you of a crime. OK?”

He looked doubtfully at her.

“We have to wait until he goes. It won't be long. Are you OK with that?”

“Like I have some other choice? If I leave now, you can tell the police I killed him.”

“As soon as he dies, I'll call the coroner. They'll send people to take the body away. I'll do the talking. There won't be any police.”

Terrell crouched on a stool with the posture of a dog about to be struck.

“Look, they'll see evidence that someone else has been living here. They just need to see you here, so it won't look like we're hiding anything. OK?”

He reluctantly acceded then slipped away to the bedroom.

Gwen sat next to Ed Greames. She watched him breathe in crescendo-decrescendo cycles, each ending in a protracted period of no movement. Then his airflow would fitfully recover and his respirations mount again in depth and frequency.

It had been over a year since Gwen's last death vigil. She'd done it many times during her training and again in the first months after City Hospital opened a special AIDS ward. Gwen believed being present at a death was a great privilege. As an intern, she had hoped witnessing the transition from warm, pulsatile life into cold, motionless death might give her insight into the mystery of her own being, of all life. She would hold patients' wrists, feel their pulse stop, their skin temperature drop, their bodies transform from a volitional creatures into inanimate objects. There was a disconnect, like the reversal between figure and ground in an optical illusion, but there was never an epiphany. The only revelation was how unfathomable the mystery remained.

Ed's gasping was more forlorn than desperate. He was tired out, ready to quit. Gwen concentrated on the rise and fall of his chest, which calmed her. After another half an hour, Ed paused at the end of a cycle. Five minutes later, he still hadn't taken a breath. Gwen placed her stethoscope over his heart. There was no sound. His skin was distinctly cooler. She covered him with a blanket.

Gwen dialed information and asked the operator to connect her to the coroner. While listening to the rings, she again worried the coroner's staff would search the apartment. What if they found the two pill bottles she had missed—the ones with her name on the label? Would Terrell say something indiscreet?

On the twelfth ring, there was a click.

“Coroner's office,” a gruff voice said.

“This is Dr. Gwen Howard from City Hospital. I'm on a home visit. I have a death to report.”