Showing posts with label HIV. Show all posts
Showing posts with label HIV. Show all posts

Monday, December 21, 2015

Turn on the light: A parable.



parable: n.  a usually short fictitious story that illustrates a moral or spiritual lesson


The house was beautiful. I mean, just looking at it from the outside you could tell that these people weren't hurting financially. At all. The lawn was professionally manicured and the garden had this intentional spray of blooms welcoming every visitor. And, if that wasn't enough, there was the solid concrete lion that sat at his regal perch right next to the brick walkway leading to an enormous pair of doors. It looked like something out of a fancy home magazine.

We rang the doorbell and the chime totally fit. I imagined some person striking a xylophone to announce our arrival. All of it elegant and flawless. I looked over at my husband and smiled. He smiled in return and added, "Daaaaag. This joint is nice." I nodded in agreement.

"Heeeeey!!!!" That's what we all said in unison when the door opened and we saw our friends standing in the vestibule. Technically, these weren't our super close-close friends and admittedly, this was our first time in their new home. But we were certainly friendly with them since they were friends-of-our-super-close-close-friends. And you know? It was all good from the jump. We felt comfortable right away.

I mean, how could we not in a house like this one?



Of course, we got a brief tour of the home and oohed and aaaahed at every detail. They'd worked hard and, like a lot of people we know, had come a long way. (Although they appeared to have come further than most.) This home was unbelievable. It was thoughtful of them to welcome us for the evening when they heard from our mutual pals that we'd be passing through town.

Yep.

That evening we had a delicious dinner and then sat around talking and laughing in their exquisite family room. The ceiling was two stories high and the walls were decorated with art from their travels all over the world. That said, we were super comfortable. Everything was so easy and laid back. The libations began flowing and the laughs got louder. We had a wonderful time.

Fortunately, no one had to drive anywhere. Our only destination was up the stairs to the bedrooms. Harry and I quickly buried ourselves in the heaping down comforters and fell fast asleep.



I'm not sure how long I was out before my unforgiving mother-of-two-babies bladder woke me. My head was still a little swimmy when I sat up on the edge of the bed and I had to remind myself of where I was. The heavy cloak of custom drapes was pulled tight. Even if there was daylight outside, it wouldn't have gotten into that room. I waved my hand in front of me but could barely see it. That room was pitch black.

There was a little nightlight on the stand next to me. I started to turn it on but knew that it might disturb Harry. That said, I couldn't see a damn thing in that room. I squinted my eye in the dark and tried to get my bearings on the direction of the bathroom. They'd pointed it out during the tour we'd had earlier but I still wasn't fully sure. I should turn on the light, I said to myself. But, again, I hated the idea of bothering my very light-sensitive husband from his slumber.

When I stood, the plush rug felt good on my bare toes. Even though I still felt a few of those champagne bubbles from earlier, I was mostly okay. I took a few steps toward the bathroom and felt like I was in a cave lined with high end carpet. The smell of lavender and jasmine wafted into my nose and though I had no idea from where it came, I imagined some elaborate candle collection on a nearby occasional table. Somewhere between the big inhalation I was taking and the door threshold, something sharp poked deeply into the ball of my foot.

"Ooooh aaah aaahh owie!" I whispered through clenched teeth. Whatever it was hurt bad enough to cause me to hop in place for a bit and then force me to walk on my heel only. I'm pretty sure I'd broken the skin but wasn't completely sure. By now, I had to pee so bad that I focused on that only.

I'm still not sure why I hadn't pulled out the slippers I'd packed. I guess it just seemed unnecessary in such a swanky house, you know?

Anyways.

Eventually, I got to what felt like a marble floor and heel-walked my way to the toilet. I tried to turn what I think was some sort of fancy dimmer light on in there but couldn't get it to work. I shrugged, flushed the commode and set back out into the darkness once more--still with my antalgic hobble and still with some slight giddiness from those generous glasses of Veuve-Clicquot. My eyes were now a little more adjusted so I could now at least see in front of me.

Suddenly, something flew across the floor in front of me. It ran straight over the top of my foot and disappeared into a dark corner. A massive cockroach? A small mouse? I wasn't sure. Either way, it startled the hell out of me--big time. To make matters worse, when I jumped, I stepped down on something slick and oily. Since my footing was already unsure, up went my legs straight into the air and WHAM! I landed on my back with a big thud. Not only did I knock the wind out of my chest, I also ended up knocking over some candles and lamps and causing a 3AM cacophony.

Whoops.

Lights came on and feet could be heard quickly thumping the floor in my direction. By the time I caught my breath and sat up, Harry and both of our friends were standing over me panting.

"Whoa! Are you okay, babe?" Harry said while reaching for my hand.

"I'm fine. I just slipped."

"Oh my God, girl!" My girlfriend looked at the bottom of my foot and then looked at the floor. She gasped and then looked at her husband. "Did you trip on something? What happened?"

"Uhhh. . .I'm not . . .uh. . . . I'm not sure. I think I slipped or was just. . .uhh. . .clumsy."

Right after I said that, out came that mammoth sized roach thing. It shot across the floor right next to my foot. Both of us ladies jumped behind the door while the guys ran after it with their shoes in hand.  Harry's foot slid a little and he nearly fell, too.

We all winced when we heard a crackling sound under the smack of that shoe. I looked over at them and spoke. "Okay, maybe I'm kind of scary and just maybe that little guy is partially responsible for that spill I took."

"Little guy?" my girlfriend said. "Good heavens."

"Oh damn! It looks like this scented oil lamp thing leaked," her husband replied. He looked over at her and sighed. "Since no one had been in this bathroom, I admit I didn't even check again." Then he looked at me. "Damn, I'm sorry, KD. This is super embarrassing."

"Girl, you just missed the edge of that tub!" She clutched her chest and shook her head. "Kim, I had no idea there was oil in here or a leak in this thing. Good Lord. If I had known, I totally would have moved that thing or gotten rid of it altogether. And as for that bug? I don't even know what to say. You could've gotten really seriously injured. I'm so sorry."

"I'm fine. Bugs are stealthy and this is the south. And I also should have turned on the light."

"Your foot is bleeding. Looks like a cut on the side of it." Harry pointed at my right foot. I pulled it closer to inspect it.

"Oh man. Forgot about that. I actually stepped on something sticking from the carpet when I was walking to the bathroom. Felt like something hard plastic. But I thought it didn't break my skin."

"Girl, you are kidding me!" She reached down and picked up a piece of a broken Lego. "I'm going to fuss at those kids as soon as they get back from their grandparents' house."

"It's no big deal. I was kind of heel walking with this foot which is the one I stuck in the oil when our little friend showed up. Pretty much a Murphy's Law kind of thing. It's actually kind of funny."

"Not to me, Kim. I'm sorry, girl." Her usually olive skin was beet red. I felt terrible for her.

After that we were all awake.  Our friends looked mortified no matter what we said. Over and over again they kept saying that they were sorry and had no idea that something was on the floor. Then they'd imagine that roach thing and fall silent. They handed me bandaids and towels and kept asking me if I was sure my foot didn't need stitches.  I kept saying that it was no big deal and that sutures weren't necessary. I also said repeatedly that I wasn't upset.

Because I wasn't. 

"Why didn't you just turn on the light?" Harry said to me later.

"I didn't want you to get upset since you were knocked out asleep," I replied. "I didn't want to wake you up." He rolled his eyes and shook his head.

"Babe. I love you. I wouldn't have cared if you turned on a light, crazy woman. Besides, you didn't even know this house."

"Gotcha. Seems silly now. I should've had on my house shoes, too. Then I probably wouldn't have freaked out so much or slipped."

"Kind of a shock to see a bug in that house, huh?"

"It just affirms what we always say--anybody who hasn't seen one of those things in their home in the south is either lying or they just moved in."

We both laughed.

"Next time, turn on the damn light and put on some house shoes, okay?"

"Duly noted."

The following morning we were standing in front of our friends' home as we prepared to go to our next destination. For whatever reason, they still seemed embarrassed. Just before getting into the car, I paused and spoke. "You know everyone has those bugs in their home, don't you?"

"You don't have to say that. I'm so embarrassed, girl. We try hard to keep our home clean."

"Ha. Seeing one in your clean, new crib made me feel better about the ones I've killed in my house. They should pay rent, those big ones. It's a bible belt thing. If you figure out a way to never, ever see one, though, let me know." I looked around at their home again. "This is still the swankiest house I've seen this decade."

She chuckled and reached out to hug me. "You guys are always welcomed."

"Great. We'll be back for sure. And y'all can come stay with us, too, although we aren't as neat."

"Deal."

****



December 1 was World AIDS Day. In honor of that day, I was asked to talk to a group of people in a pretty traditional church that following Sunday about the importance of getting tested for HIV. And then, whatever that test reveals, making responsible decisions with the results. And, yeah, I've done that before in churches and other large gatherings, too. Almost always it comes out preachy and uncomfortable. I can always see peoples' eyes glazing over and body language getting squirmy. Kind of like a teenager who's getting admonished by a parent about something or other that they'd rather not hear about.

Yeah. Like that.

So. I decided to try something new. Instead of lambasting them with scary statistics, I shifted gears to do something that I didn't think church folk would mind so much. This time, I kicked it bible-style with a parable. This parable.

I had their full attention, too. It was awesome.

Then I closed with this. (Or something close to it.)

It's funny how similar HIV is to visiting that house. Just as that house looked spotless, people can look that way, too. We drop our guard when an outward appearance seems to scream immaculate and impossible of tarnish. Slack also gets cut to people that we don't know well when they're connected to people we do know well. You assume nothing could possibly be wrong.

Right? Right.

But the truth is that you can never just look at anyone or anything and know anything for sure, can you? So the best thing any of us can do is get to know what you're dealing with first. That said, we're all imperfect. So even though we know better, we don't always make the right choices do we?

Given all of that, there are still some ways to prevent accidents even when we're too impatient to know all the details. First, avoiding anything that affects your judgment is a start. Like maybe not having alcohol might have given me the sense to turn on a light or put on some slippers. And, just maybe, I wouldn't have felt the urge to pee so badly. Or even at all.

If I'd just turned on a light and worn slippers, I could have seen where I was going. And avoided stepping on something that hurt me. With something on my feet, though the bug would have still alarmed me, I wouldn't have been limping and I probably wouldn't have slipped. Especially since I would have seen that puddle of oil from the get go.

Knowing your HIV status and the status of your partner is like turning on the light. No need to guess where you're stepping. Or depend upon somebody else to protect where you've stepped. Because even the shiniest, prettiest, newest, richest and cleanest things have surprises. And sometimes even they don't know about those surprises, do they?

I guess the other thing that stops us from turning on lights is fear of what someone else will say. Like, when I was scared of waking up my husband so bumbled about in darkness. But, of course, we all know that anyone who loves you wants you to turn on the light. As a matter of fact, if they really, really love you, they'll turn the light on for you. Yeah, they will.

Then there's our friends who wanted to disappear after that whole incident. We'd discovered some blemish in their world. But little did they know that everyone has something lurking in a floorboard, a crawl space or crevice that jumps out sometimes. The kind of things that you pay people to come and spray but that still somehow exist in spite of that. That is if you realize there's something that might require pest control maintenance.

Hmmmm.

I wanted our friends to know that seeing that bug and slipping on that floor and cutting my foot on that Lego made us admire them no less. We were still just as impressed with their accomplishments, glad about our growing friendship and eager to return. And eventually they believed us.

We need to do that with HIV.

Our friends got a good exterminator. And he told them that because they live in the south and amongst a lot of trees, that there'd always be some tiny amount of pests hiding in there. But nothing that would likely bother them or anyone else.

Nope.

So I guess HIV testing is like turning on a metaphorical light. And seeing a bug when you do isn't the end of the world. It isn't. You just need to know so that you can get into care. Then yes, you'll live with a tiny amount of virus, but it will be so undetectable that it won't bother you or anyone else.

You feel me?

The most elegant homes can have debris in them and an unwanted pest or two. Just like the most amazing people can have HIV. But a lot can be avoided by just turning on the light. Or putting on some house shoes. Or avoiding anything that clouds your judgement. Or makes you greatly feel the urge to go.

What's up in your house? What's up with the houses you sleep in? Do you know your way around? Would you be surprised by a sneaky wood roach or not shocked at all? Are you scared to turn on the lights? And if so, why is that? Is it that you're with someone who doesn't care whether or not you crash into something? Or someone who doesn't even know that there is something to crash into? Or even worse--both at the same time?

How well do you know your own house? What are you doing to protect it? Do you inspect it regularly? Do you allow someone else to make sure everything is okay? If not, why is that? What are you afraid of?

Remember: Knowing isn't the worst thing that could happen to you. Even if you find something. Not knowing always, always is. So turn on the light. Look around. And if you still aren't sure? Or if you're still too scared to turn the lights on?

For Christ's sake--put something on your damn feet.

Now. Let the church say, "Amen."

***
Happy Monday.


Sunday, December 4, 2011

Where is the love?

Ryan White (December 6, 1971 – April 8, 1990)
 "Where is the love 
you said was mine o' mine
'til the end of time?
Was it just a lie?
Where is the love?"

Roberta Flack and Donny Hathaway singing "Where is the Love?"

_____________________________________________
This world is crazy. For real. Like real, real crazy.

I was trying to decide yesterday. Go there? Or not even go there? Meh. I decide to go there.

Here is the there.

You may or may not have heard this in the news, but I'm a nerdy doctor at a public hospital so this grabbed my attention. Alright, so check it.  In Pennsylvania, there's this not-for-profit school in Hershey that the chocolate bar mogul started back in the day. Anyways, they have a state of the art facility and bring kids who are academically able yet financially unable into their building for a chance at movin' on up Jefferson's style.

You with me so far? Cool.

Alright. So this school does good things and I am not disputing that. In addition to having all these bells and whistles for these pre-K through twelfth grade kids to partake in, they house them, too. Yep. It's a boarding school. And although I have never considered boarding school for my kids, on one day when I was super bored, I looked up how much they cost--and trust me, they cost a GRIP.  So, yeah. The folks behind this school waive that GRIP and bring deserving children there for a first-rate education.

That's cool, right?

Well. Here's what went down recently that got this boarding school in Hershey, Pennsylvania on my radar. This thirteen year-old boy who happens to be a scholar athlete and all around great kid (from what I read) applied to this school.  His mama, like a lot of mamas, is a little light in her pockets and surely appreciated the possibility of seeing her hard-working boy have the great fortune of going to this elite boarding school. On paper? He was a good fit.  Great student. Even an athlete. And yes, there was need.

But.

One small issue.  He is HIV positive.  And because of that little inconvenient truth, this chance-giving school ix-nayed his acceptance. They didn't even lie about it either. They flat out kept it real--which you must give them props for--and said that they could not allow him in their school because he posed a "direct threat" to the other 1,800 students in their student population.

Wait, huh?

Yeah. He got denied entry into a school in 2011 because he is HIV positive.

Well. Turns out that's not really a cool (or legal) thing to do. So this kid and his mama decided that they'd sue this school. And they filed their law suit this past Wednesday--just in time for World AIDS Day.

But the school? Oh they stood their ground. Pretty much saying that because they are a boarding school and a "unique learning environment" they can't take the chance, albeit a remote one, of putting others at risk. Yep.  The superintendent even got on CNN and stood the school's ground even more. Hell no. He won't go.

Did I mention? This kid takes antiretroviral drugs, too. In other words, he's under a doctor's care and does what he's supposed to do.  He's in great health and is just trying to do his thing to get ahead in this world.

But that's just too bad. Because if it's up to them, he ain't gonna be doing his thing there. Not on their watch. Around their kids. God forbid he accidentally bumps one of them in the hallway or the bathroom. Oh helllls naw.

So the potential concern is as follows--at least this is what the superintendent said on CNN.  She said that the issue is that there is some chance that at some point this boy might have sex with one of those one thousand eight hundred and something other kids and just maybe when he does, he will not use a condom and in turn infect them with his poisonous bodily fluids. Oh, and I almost forgot. He'd need to say to hell with his HIV medications to make this already remote possibility even worth discussing (and even then it would still sound crazy.)

Can I just state that the chances of one of the eighteen hundred kids in that school getting hurt, disabled or killed in an automobile accident are FAR greater than the individual risk they have of this (hello? responsible!) child exposing them to HIV? And surely--SURELY--they transport those students in cars or buses don't they? Uhhhh, okay. I guess the risk has to be socially acceptable.

Okay.

I at least give them credit for publicly recognizing that sexual intercourse is the most common way people get HIV in the world. Hell, at least they didn't publicly go running from the cafeteria screaming that he might give their forks and knives the cooties.

Sigh.

Now. Let me get on my nerdy soapbox and say just a couple of nerdy academic things that some folks reading this may or may not know:

1.  People who take antiretrovirals are less likely to transmit the virus. Yep. A big ol' study proved it. Gave people treatment and turned them loose with their HIV negative partners. The ones who were on meds were NINETY-SIX plus percent less likely to give it to their partners. Yep. The HPTN 052 study, in case you just needed to Google it.

2.  People who know they are HIV positive modify their behaviors. Yep. Turns out that if you KNOW you have HIV, you are more likely to protect others. Imagine that.

3.  (In case they didn't know.) You can't get HIV from kissing, hugging, sharing forks or any other casual contact. Oh and what about a nosebleed? Well, I guess if he stood over someone with blood pouring from his nose into their openly exposed bleeding wound, then yeah. Perhaps there could be risk.

4.  Saliva has no significant amount of HIV in it. This means that when this kid is ready he (and any other HIV positive person) can get their full French-kiss on with no concerns. Yep. Sure can.

5. Oh, and there are, like, 250, 000 plus people in the U.S. who are HIV positive but don't even know it. Which means even if you think you don't know anyone with HIV, chances are you're wrong in that assumption.


Yep. Those are the facts. Straight from a reputable source--a medicine nerd who has worked at a public hospital for over a decade with all sorts of "communicable diseases" -- including HIV. Which also happens to be in the same city as the Center for doggone DISEASE CONTROL and PREVENTION. Yep.

But so much for all of that. This is factual information and obviously this was not a decision made based upon that. Instead, it was based upon fear. I think we have learned over many, many years that facts and logic don't readily overcome fear. At all. And that fear is a powerful driver for some of the stupidest decisions of all time.

Alright (imagine me rolling neck and shadow boxing) I'm getting loose here, y'all.

And since I'm all the way loose (insert knuckle cracking and more shadow boxing here) why don't I just "unpack" another part of this story.

First let me digress and give my friend and fellow Grady doctor David M. credit for me using that term "unpack." He's a qualitative researcher that happens to be an HIV doctor, too--and he tells me that when researchers have a variable that is probably affecting a clinical outcome, that that variable needs to get investigated. . .or "unpacked" . . . .at some point.

Oh, and did I mention? He's young, gifted and black.


Well. Let me just unpack the fact that this 13 year-old HIV infected boy just happens to be African-American.

Gasp!

Yep. I said it. And consider it officially "unpacked."

Now. Let's just all close our eyes and imagine this deserving student as an angelic little doe-eyed thirteen year-old girl with a porcelain complexion and eyes like pools of cerulean water. Do you think this might change how this situation was viewed at all? Might it alter the level of threat from bright red down to a cool shade of yellow?

Or.

Would there have even been a case to be had at all?

Hmmm. Don't answer that. Let's just agree that it sucks that we live in a world where the answer to this is questionable. But since I'm loose, I'll just call it just like I see it. And here's how I see it. I sure do think that the amount of empathy felt for this child is somehow affected by his race. And the belief that he will run all over this campus spewing forth blood and semen everywhere he goes is, I think, somehow shaped by somebody's perception of people--especially male people--who look like him.

Perhaps maybe even unknowingly this is the deal. I don't even want to imagine that it is totally egregious and tied into some warped view of all black males as irresponsible hypersexual animals. Because that is exactly what he'd have to be to cause even a remote amount of plausible risk by having him in that school. Even if he's an honor student.

It's an ugly variable to imagine, isn't it? But a variable that must be unpacked all the same.

Alright, I know that part was getting uncomfortable so I'll pack it up and move on.

Ryan White was this really brave kid who got HIV from a factor 8 blood product transfusion needed for treatment of his hereditary hemophilia. When he was diagnosed in 1984, he was given 6 months to live. He was expelled from his Indiana middle school because he was HIV positive. Ryan was pretty much a courageous bad ass and he fought this decision in a very public legal battle. He even got some high profile people in his corner like Michael Jackson and Elton John. All that press changed him overnight from an unknown Joe Schmoe (literally) from Kokomo to the poster child for HIV and AIDS. Oh and Ryan and his six months? He lived another five years. Mmm hmm. He showed them.

But that was in 1984. And HIV was poorly understood then.  

Then, right?

Um, yeah.

See, here's the thing. There are some times when someone having HIV poses a risk. Like, say. . . .you are sexual partners with someone who has HIV and you don't know. Then hells yeah, you need to know and be able to protect yourself because there's a sho' nuff direct threat. But this? This?  Come on, man.

What bothers me the most about this is that it almost doesn't seem true. I liken this to those instances when I, a black person, think that most people are cool with black folks and how far they've come--and then something really crazy happens like Kramer from Seinfeld saying the n-word repetitively or someone hanging a noose from a tree in a Louisiana high school that says. . . uhh. . . hello? Or even when Mel Gibson had that cringe-worthy anti-Semitic rant. See? Things like that make me say:

"Damn. And here I was thinking things was cool."

Sorry, kids. Some times you just got to unpack the facts.


Now. I know for certain that there are many, many, many people who don't feel that way. That have no issues or qualms about black folks or Jewish folks or Muslim folks or gay folks or any kind of folks for that matter. And I know for certain that a lot of y'all reading this love all folks. (Unless, of course, you're Ms. Moon and we're referring to that Herman Cain--wink, wink.) Otherwise. . . . I know, I know. Not you.

But.

Everybody isn't you. I made the mistake of reading the ABC and CNN message boards on this topic. Looking to see what other American people had to say about this whole "sitch-i-ay-shun" (as my dad says). And OH, they had PUH-LENTY to say on it. Well. It turns out that a whooooole lot of people were one hundred percent KOOL and the GANG with that school's decision to say no way. So KOOL, in fact, that one of them even sent me a scathing email telling me how wrong I was to "put peoples' children at risk" after I spoke about it on television. (At least I didn't unpack the race variable!) Okay, okay. . . . I'll be the first to admit that it wasn't too hard to see where I stood on the subject. But I really, really wanted to believe that most people think this is as preposterous as I do. (I, at least, know for sure that there is a fully educated lawyer-dude somewhere in Mississippi that officially does not.)

Arrrgggh!

Where's the empathy, man? Where is the love? To hell with the fact that the boy got HIV in utero and not even because of something he accidentally or irresponsibly did. And to hell with the fact that his life expectancy is EXCELLENT.  Matter of fact, a lot points to the fact that many with HIV who are under care like he is, live long enough to die from causes other than HIV. It's fine if that's the facts. So long as he ain't in the same boarding school as THEIR kids.

Uhhh, yeah.  

Now I bet Ryan White is rolling over in his 1990 grave saying:

"Damn. And here I was thinking things was cool."


Sigh.

Tuesday, December 6, 2011 would have been Ryan White's 40th birthday.  Had he been diagnosed in 2011 instead of 1984, he would have lived to celebrate it. Hmmph. Some celebration.

I'm interested to hear your thoughts. Please. Weigh in.

***
Shout out to my friends and fellow Grady peeps who have dedicated their careers to making sure that the Ryan Whites-- and the Ryan Blacks -- of the world live to see as many birthdays as possible. Thank you, thank you, thank you for all that you do.

Grady doctor, friend, and all around wonderful person--Wendy A.
and of course my other fellow Grady doctor, friend, and rock-star, David M.


***
 And now playing on my mental iPod. . . .The Last Song. . .written by Bennie Taupin and sung by Elton John in memory of one of the bravest souls that ever lived--Ryan White. . . .

. . .and of course, Donny and Roberta asking the question that I'm still wondering, too.

Tuesday, June 29, 2010

Reflections on a Tuesday: Jeremiah's Eyes

*names, details, etc. changed. . . . .

Butterflies begin from having been another
As a child is born from being in a mother's womb
But how many times have you wished you were some other?
Someone than who you are?
Yet who's to say if all were uncovered

You would like what you see
?
You can only be you

As I can only be me.

from Stevie Wonder's "I can only be me."
____________________________________________________________
"Jeremiah"

I had just heard him presented to me by one of the interns on our team. A young man. . .not even legal yet. . . admitted with community-acquired pneumonia. "Double pneumonia" as some patients refer to it--the kind of aggressive lung infection that doesn't limit itself to only one lung or even one lobe. I stood tall, with my arms folded as the story unfolded before me.

"His white count is low," spoke the resident as the team stood in a semi-circle around the chart box, "like only two thousand." I nodded and continued to listen.

"If you calculate how many of those are lymphocytes, it's like not even fifty," added the intern.

"Do we know his HIV status?" I queried, considering one of the most likely causes of such a reduced white blood cell count. The team cast glances at one another, as if saying, I knew she was going to ask us this.

"He refused to be tested. . . and also denied every possible risk factor," the resident responded with an exaggerated sigh. "No matter what I asked, it was, 'Nope. Nope. Nope.' That's pretty much how the entire history went."

We wrapped up our discussion and entered his room to get more insight. I made confident, deliberate strides as the leader of my team; always believing that self-assured doctors make reassured patients. After passing by the first bed and pulling back the curtain, I froze. There sat a slender, young African-American man who could have easily passed for a pre-teen. I scanned his patient information. 20 years old. But it wasn't his youthful appearance that struck me the most. . .it was his troubled and lonely eyes.

He was, literally, shaking when we approached the bedside. . .vibrating beneath the she sheets. I did my best to relax him."Good morning, Mr. Foster. . . ." I smiled wide and cupped his hand in both of mine, "I'm Dr. Manning, the senior doctor on this team."

"Hi, Dr. Manning," he replied in a delicate and undeniably effeminate voice, "I'm Jeremiah. Call me, Jeremiah, okay?"

"Jeremiah," I repeated with a nod for emphasis. "What a strong name--Jeremiah. Okay. . .then Jeremiah, it is." He seemed to relax just a little bit which nudged me to continue. "Jeremiah, I heard a lot about you from my team. If you don't mind, I'm just going to recap what brought you into the hospital to be sure I have the story right. Is that okay?" He nodded quickly.

And so I narrated back to Jeremiah exactly what I'd been told. That he had been fine until two days ago when he started having shaking chills and coughing up something that looked like rust or blood maybe? That he'd never been sick before this. And that he'd never been hospitalized. Ever. Other than this pneumonia, he had never had any medical problems. He filled in the blanks with more information. Like the fact that he lived with his mother, and attended community college where he was studying to maybe be a nurse one day. That he sang solo in his church, and played a mean piano. Never smoked anything in his life, once tried alcohol and hated it, oh--and hadn't yet had his sexual debut. Ever. "Not even close," he said emphatically. His body was shaking again.

I listened as the intern explained to Jeremiah that he was being treated for a fairly extensive pneumonia. He was improving with our treatment, but his low white blood cell count was concerning. That sometimes people who have HIV can get really bad pneumonia. Had he ever been tested for HIV? Would he reconsider getting tested? Is he sure there are no risk factors we may have overlooked?

Nope. Nope. Nope.

We asked Jeremiah if he had any questions, and eventually left his room without much more insight or information on this man with the childlike face and the lonely eyes.



Later on that evening, I was standing at the nurses station writing a note just before heading out to pick up my kids. "Dr. Manning?" I looked over my shoulder and found Jeremiah timidly standing in the doorway. His narrow shoulders were wrapped in a hospital sheet, and his eyes were still sad and troubled. I took in his searching expression. The clock directly above my head had just creeped beyond the 5 o' clock mark.

"Hi, Jeremiah." I wanted him to hear me say his name, to know that he was worth remembering.

"Can I. . .do you have a minute to talk to me?" His voice was shrinking and now his body was trembling again. But I needed to go. Being late to daycare sets you back $1 per minute. But his eyes said, I need you. Those troubled, lonely, tired eyes. They needed me. I couldn't leave.

"Of course," I said while walking over to him. Crossing the threshold into his room, I dragged a chair over to his bedside and we both winced as it screeched across the floor. I mouthed the word 'sorry' and leaned onto my crossed legs with my elbows. Jeremiah settled back into the bed.

"Did you see I'm off oxygen, Dr. Manning?" He sounded nervous. Like this wasn't what he wanted to talk to me about. It wasn't what I wanted to talk about either. I took a deep breath and willed myself to be patient.

"That's really good. It's a huge step towards you getting out of the hospital."

"Oh okay. . ." His voice trailed off. I could feel myself getting anxious. $1 per minute for every minute after 6 p.m. The clock now read 5:14 p.m. . . . But his eyes. They are willing me to stay put. To wait. To listen. I swallowed hard and waited. He remained silent. But those eyes. . . .for some reason they seemed to be waiting just for me.

"Jeremiah, can you excuse me for one moment?"

Something told me that if he felt my thinly veiled attempt to rush him, that I might never have this opportunity with him again. I slipped out of the door to call Harry. "I have a situation here in the hospital. Can you pick up?" Harry groaned into my ear so loudly that I pulled pack the phone. "Babe, it's important."

"Babe! It's five-damn-thirty. I can't do it." ('Five-damn-thirty.' Oh, how my husband has such a lovely way with words.)

"Look, babe, it's important, okay?" Somewhere between another groan and the words, 'okay, but' he launched into his predictable Harry-style rhetorical questions. "So, when you need to work late, you can just call me at the 11th hour? When I need you to drop off without warning, can I just spring it on you? Can I just. . . . . " -- All that mattered is that somewhere in there, eventually, he said 'okay.' That was all I needed to hear.

I returned to Jeremiah's bedside visibly more relaxed and palpably more patient. "Okay, I'm sorry about that," I said gently as I settled back into the chair. His eyes still needed me. . . .

Then out of nowhere, Jeremiah looked at me and said, "Dr. Manning, do you like yourself?"

I turned the corners of my mouth downward, and grasped his question before answering. Then carefully, I replied, "Do I like myself? Yes, Jeremiah. I do. I really do." I pressed my lips together and paused for a second. "What about you? Do you like yourself?"

He looked out of the window wistfully. His dainty fingers were laced together over his abdomen. I could still see that he was shaking a little bit.

"Jeremiah?"

"Sometimes I wish I wasn't me. Sometimes." I waited to see if he would say more, but he just kept those lonely eyes fixated on some distant fixture in the Atlanta skyline. "Like. . . .somebody with different insides and feelings."

I could feel my every breath as I searched for the right thing to say or not say. I decided to keep waiting. I caught him looking at the ring sparkling on my left ring finger.

"You married, Dr. Manning?" I wasn't sure where this was going but I kept with him.

"I am."

"That's good. . . . " he murmured. His voice faded once again and came back. "If it was wrong to have feelings for your husband, Dr. Manning, what would you do?"

"Honestly, Jeremiah, I'm not in that situation, so it's kind of hard to say. . . . .are. . . you? In that situation, I mean?"

Without warning he buried his face into his slender fingers and began to weep. Hard. I reached out for his forearm, the closest thing I could touch. My first instinct was to start talking, but I resisted the urge.

"Dr. Manning?" he finally said with the trouble in his eyes reaching a painful climax. I opened my eyes wider fearing what would come next. I continued to hold his forearm in an attempt to brace myself just as much as him. "When I was in middle school, I used to. . . ." He started crying again and then slowly wiped his eyes with his palms. "I used to see a girl, and . . .and think. . .friend. . . or sister. . . ..but I would see a boy and. . ." Jeremiah's voice began breaking up with emotion.

"You're doing fine, Jeremiah. Doing fine, okay?"

". . I would have feelings for a boy like how you are supposed to like a girl. And I knew it was not right but I couldn't help it." He then let out this terrible, ashamed moaning cry that broke my heart. I was speechless. He sighed hard. "So when I grew older, I kept saying, I would stop feeling this way, you know? Like I kept asking to be changed into someone else with regular feelings, but I kept feeling like this. I would sing with all my might in church. Singing out to say sorry for feeling like this."

"Regular feelings? They're your feelings, Jeremiah." But this was more complicated than that.

"Why do I have to be like this? I didn't ask to be like this." He wiped his eyes with his forearm and stopped fighting the urge to cry. I waited patiently until the room fell to a hush.

"Does anybody know?" I finally asked.

"It would kill my mother. No. I haven't told nobody. . . .I never told nobody until now. . .I mean, my family is against that. Like they always suggested stuff, but they don't know. . . .nobody knows. . . ."

"So, there is no one. . .like, in your life?" I stammered.

"No . . . except there were some times that I did stuff. . .like. . .with . . .you know. " It was like he couldn't bring himself to say it, so I didn't make him.

"Somebody you knew well, or not so much?"

"Not. . .really at all. Like, more than once."

"You had sex?" He covered his face again and nodded.

"Okay," I said gently, "listen, it's not so much about if it was with . . .someone of the same sex as you. . .it is more about if you protected yourself and what you did."

"I didn't use nothing with none of them. I let them do everything. . . .but I wanted it . . that's bad I know. I just couldn't help it." Fat tears rolled down his cheeks again, his tiny neck being strangled with shame. He covered his face and shook his head again.

"It's okay, Jeremiah. It's going to be okay, alright?" I smiled and reached for his hand. "You are so brave."

"I don't feel brave," he whispered. I offered him an affirming squeeze. He took a deep breath and locked eyes with me. In his bravest voice yet, he said, "Do you think I could have HIV?"

I'm not sure why but I didn't hesitate. "Honestly? I think it's a real possibility. But I think you are in a safe place and knowing one way or the other would free you from worrying if you are."

"Okay. . ." he uttered in the tiniest voice possible. "Okay. . . ." Just then, I realized that he wasn't shaking any more.

"Flowers cannot bloom until it is their season. . . . .
as we would not be here unless it was our destiny. . . ."

Today, I am reflecting on how complicated the thin line between self acceptance and happiness can be. I am thinking of the loving interactions with my husband, the one I get to love without any one questioning or picking apart, that led to that single moment in time where my patient trusted me enough to be his authentic self. Every time I think of Jeremiah's quiet eyes and how they pleaded of me to stop and listen to him, I want to wrap my arms tight around myself. . .feeling thankful that I was dealt a hand that made it easy to be okay with me. Why? Because the older I get, the more I think that people who are the most okay with themselves are the most okay with others. That's my goal for myself, my children, and of course, my patients.

Thanks to several factors, most of which were completely out of my control, on most days, I'm alright with me. Because of that, a tiny part of me likes to think that there was something Jeremiah saw in my eyes that day, too. . . .something that made it okay to be honest with his doctor and with himself.

As it turns out, Jeremiah was indeed HIV positive and unfortunately also had advanced AIDS. But he got the help and treatment he needed, and even better, when he told his mother about his feelings, she hugged him and said, "It's okay, I love you, son." As simple as that. I still wonder if all along he'd known that his mother would be alright with the real Jeremiah, would he have eventually been alright with him too. . . .?

"Love the you that you see--you can only be you. . .as I can only be me."


Please take a moment to watch the amazing Stevie Wonder singing this haunting ballad. . . .
Today, I'm dedicating this to all of the Jeremiahs and to the Jeremiah in us all.