Comfort Zone

Chapter 48

"Your T cells are getting lower every time we check. You're healthy now but you can't count on that forever." Katy Byron, like her friend Ms. Phillips, had advanced AIDS by the numbers but had refused medicines every visit; she was the only holdout in the practice, and Miriam tried to cajole her one more time.

"Not yet, Dr. G. I'm saving up some money. There's this guy up in Ft. Lauderdale who has a natural treatment for HIV. He cured someone I know. I'm going to him as soon as I get enough money together."

"Katy, you're always looking for a miracle." Miriam realized she'd lapsed into first names, which sometimes happened when she was particularly exasperated. "Don't you realize you found it here? Why don't you stop looking and try my miraculous drugs?" You don't want to end up like your friend Lisa, do you? she felt like saying. Why couldn't Katy be like Francis Mayer and all the others who popped a pill every day and had undetectable viral loads? Thinking about Mayer and an upcoming lawsuit gave Miriam a twinge of dread. She focused on the patient in front of her.

While it was frustrating when anyone refused treatment, it was especially the case with HIV medicines. Miriam didn't remember the bad old days of HIV, but she'd heard enough about them, and saw healthy people with HIV every week—healthy because they took their medicines.

"Remember when I told you how it works? The virus invades your white blood cell and takes it over, forcing it to manufacture more HIV. But the medicines block the virus in different parts of the cell. They help you fight back, take control. Sounds like a miracle to me!"

She surprised herself with the passion in her voice. I haven't heard that for a while, she thought. For a moment she thought she saw Katy's face change, like she was paying attention and might be convinced, but then her face closed again...

"They're not a cure, Dr. G, they just keep the virus in check, like you always tell me. I want a cure."

"There is no cure, Katy, not yet, but the pills can keep you healthy until there is one."

"Oh there's a cure," the patient said. "Everyone in the community knows it, but the drug companies are keeping it under wrap. Think of the money they'd lose if no one had to take their medicines. Remember the plane in Malaysia that went down carrying all those AIDS researchers? What do you think that was about?"

"Oh, Katy, do you really believe that? How could such a big secret be hidden for long? It's too farfetched—"

"Yeah, like a heartless hospital CEO in cahoots with a gangster."

It's not at all the same thing, Miriam wanted to shout. Why are you so distrusting?

True, as a transgender woman, routinely subjected to discrimination and disrespect, Ms. Byron had ample reason to distrust the medical community—and everyone else, for that matter. Miriam had no idea how to convince her otherwise, and had to let her patient have the last word.

Why didn't people want to take medicine? Of course it was different with pills like Xanax or antibiotics that gave instant gratification or promised a quick cure. But the others, long term treatments for high blood pressure or cholesterol for example, were a harder sell.

I'm not a pill person, some said. But Miriam wondered if behind all their words was the fact that all medicine is just a reminder of sickness, a sign of weakness. Their bodies had let them down. Even cloaked in the uplifting words of prevention, it still had a whiff of death and disease.

"This will prevent a heart attack like your father had," she'd said to Rory Scott, intending to motivate him. But didn't that imply that only a small pill stood between him and the Grim Reaper? While many would embrace the chance to cheat death, for him it had likely been a nocebo, something to be repressed at all costs.

Maybe next time she would explain things differently. Even the strongest heart sometimes needs a boost, she thought about saying, thinking of Lilly Fielding's pacemaker. Or even better, wasn't he a plumber?: this pill will keep your blood flowing, keep your pipes open.

She knew what was important to her. She wanted her patients to take their pills, wanted their numbers to improve so she could feel she'd done her job correctly and other stakeholders like insurance companies would know. But as she opened the door to the next room, she asked herself: what was important to them? What was their payoff?

"I have good news for you," Miriam said to the patient as she entered the room. "Your tests are all normal!" The patient frowned. Oops, bad way to start.

"So there's nothing wrong with me?'

"Likely nothing serious." Another frown. "I mean, nothing that shows up in the tests we did."

"So you're going to order more tests?" Uh-oh.

"Well...I understand your symptoms are significant validate patient, always good but further testing probably won't help, and would just expose you to complications."

"I'd like to hear about the additional tests anyway."

Spout statistics, or just redirect?

"You know, other people with your symptoms generally benefit from a change in diet. Regular exercise helps, too. Sometimes we prescribe a low dose antidepressant."

"An antidepressant? You think I'm depressed? That it's all in my head?"

Miriam looked at her patient. If your blood pressure goes any higher, I'll have to call 911. Maybe my bedside manner needs CPR.

"Antidepressants have other helpful effects, and no, I'm certainly not saying your symptoms are imaginary. They're real, and you're feeling them. But medicine doesn't have an answer for everything. There are many things we feel in our bodies and minds, and medicine hasn't yet figured out why."

The patient paused, considered her words, then nodded. "OK, I'll given the medicine a try."

Whew! Resuscitation appears to be successful.

Ted Grayson was back in the office after his hospitalization for his infected toe. He'd lost the toe but gained the motivation to deal with his other medical problems. He claimed he was now ready to hear her lifestyle suggestions, maybe even follow one or two.

Caroline Foster also stopped in for more help with the paperwork for housing. Belle ran interference so Miriam was off the hook, and only had to see the Betty Boop earrings swinging and hear the unfortunate young woman crying about her roach-infested house when walking from exam room to exam room from a safe distance. She saw Belle accept a small package from the young woman, likely another gift for Miriam or the office.

To whom it may concern,

Caroline Foster is under my care and I'm writing on her behalf. She has several serious medical conditions and stable housing is vital to her heath. Ms. Foster's husband is living with her, helping her with medicines and providing other help that allows her to live independently. His help is essential to her care.

I've spoken to Ms. Foster's housing social worker, and we are requesting an exception that would allow her husband to live in the apartment with her. As we discussed, an exception would be compassionate...

Nice touch. Maybe I can manage to get some more of that stuff back. After all, I almost lost my life defending it.

If you have any questions, please contact me. Thank you for your time and consideration in this important matter.

Sincerely,

Miriam Gotlin