My Life After Now

30

A Fact Can Be a Beautiful Thing




My dads had let the Thursday and Friday group meetings slide because of the snowstorm, but they ardently refused to let me bail on Saturday’s doctor appointment.

We took the train into the city because the roads were still a mess, and cabbed it across town from Grand Central to the medical center. The closer we got to the building, the more the butterflies in my stomach seemed to multiply.

“It’s going to be okay, Lucy,” Dad said, noticing my white knuckles clenched nervously around the shoulder strap of my bag. “Remember, you’re going to a different doctor this time.”

“I’m sure she’ll be better,” Papa said. “And if not, we’ll keep searching until we find the doctor that’s right for you, I promise.” Papa still felt bad about the Dr. Jackson debacle.

Even though it was the same practice, the lady at the front desk made us refill out the paperwork. Apparently Dr. Vandoren had a different record-keeping system than Dr. Jackson. It was like some cruel déjà vu.

As I waited for my name to be called, my mind kept wandering back to Ty. He hadn’t called or texted me since he left the house yesterday. I checked my phone about once every twenty seconds, but it remained silent. Where was he? Wasn’t he thinking about me as much as I was thinking about him?

“Expecting a call?” Papa eyed me curiously.

I shoved the phone back in my bag. “No.”

Not expecting, just hoping, I thought.

Just then, I heard my name. A different nurse from last time escorted me through a different door. She led me down a short hallway and gestured to an open door.

“Have a seat. The doctor will be with you shortly,” she said.

It wasn’t an exam room—it was Dr. Vandoren’s office. There was a big wooden desk with papers and files stacked all over it, bookshelves with numerous medical books, and framed photos of her family everywhere. There was also a shelf with several thank-you notes propped up on it. I couldn’t see inside any of them, but I was curious. Could they have been from patients? I was debating sneaking a peek at one when the doctor breezed through the door.

“Hello, Lucy,” she said, and sat down behind the desk. “I’m Dr. Vandoren.”

She was in her early fifties, with shoulder-length dark hair peppered with eccentric streaks of gray. She wore blue-framed glasses and had a red ribbon pinned to her white coat. Most importantly, though, she was looking at me, wearing an inviting smile. I already liked her heaps better than Dr. Jackson.

“Hi,” I said shyly.

“I understand you saw Dr. Jackson last week?”

“Yeah.”

“What made you request an appointment with me then, may I ask?”

How was I supposed to explain? I couldn’t very well tell her how revolted I was by the man. They were probably friends. “I…wasn’t exactly…comfortable with him,” I said.

Dr. Vandoren smiled and nodded understandingly. “Yes, he’s not known for his bedside manner.”

“That’s an understatement,” I muttered.

To my surprise, Dr. Vandoren laughed. “Well, I’m glad to have you. Let’s get started, shall we?”

I nodded.

“Can you tell me the circumstances surrounding your contraction of HIV, Lucy? It helps me to know your background. And please know that anything you tell me will be kept confidential.”

The appointment continued on pretty much like that; it was more of a conversation than an interview, and Dr. Vandoren would respond to certain things I said with questions of her own, occasionally writing things down for her notes. She spent a long time talking with me—I didn’t feel like she was in a rush at all.

Then she got to the results of my tests from last week. “You are currently in what we call Stage I of HIV infection, Lucy. If you have to have the virus at all, that’s where you want to be. You are asymptomatic, and your CD4 count is just over five hundred. Are you familiar with the term CD4?”

I shook my head.

“You may have heard of T-cells?”

“Yeah, I have.” I didn’t add that the only thing I really knew about T-cells came from listening to the Rent cast album a million times.

“Well, the CD4 is a kind of protein on the surface of the T-cell, which is a white blood cell. In people without HIV or AIDS, the normal CD4 range is usually between six hundred and twelve hundred. The lower the CD4 count, the less capable your immune system is of fighting off infections. When the count drops to below two hundred, that means the patient’s condition has progressed to AIDS. We aim to keep the CD4 count above three-fifty in our HIV-positive patients. So the fact that yours is above five hundred is very good news.”

My mind was frantically trying to keep track of all of this. It was a lot to try to understand, but I would take this any day over the way Dr. Jackson spoke to me last week. At least Dr. Vandoren was treating me like an individual capable of actual thought.

“We also ran the RNA viral load test. When you have HIV, the virus actually makes copies of itself while inside your body. The lower the virus levels in your system, the better. The higher your viral load, the quicker the HIV progresses. This is why it’s important to always have protected intercourse, even if your partner is also HIV positive. You can pass it back and forth to each other, which causes the virus to replicate exponentially.”

Whoa, I didn’t know that. I’d figured having HIV was kind of like getting pregnant—once you had it, that was it. I didn’t know you could keep getting infected over and over again. The thought was…upsetting.

“Your RNA viral load count came in at over one hundred thousand, which is fairly high, but don’t get too concerned.”

Fairly high? Too late, I was already getting concerned.

“The count is always higher in the initial months after infection, because the HIV is just taking hold in your body and it’s reproducing at a rapid rate. Within the next couple of months, it will decline and level off.” She paused. “Do you understand all of this?”

“I think so,” I said.

“Don’t hesitate to ask questions if you think of any, okay?”

“Okay.”

We moved into an exam room, and she did a physical on me. The entire exam process was a lot more comfortable than last week. Dr. Vandoren told me what she was doing and what she was looking for and asked me about myself. She seemed genuinely interested in knowing who I was as a person, not just a patient. Then she asked the nurse to get my parents, and told me to get dressed and meet back in her office. Five minutes later, I was sitting across from Dr. Vandoren’s desk again, my dads at my side.

“So, the next step is to determine treatment,” Dr. Vandoren said after introducing herself to my dads and explaining the test results to them. “I would like to see you once a month initially, to monitor the decrease in your RNA viral load. Does that sound reasonable?”

I nodded, although the thought of getting eight vials of blood taken every single month wasn’t exactly appealing.

“And after the first few months, if everything is going well, we can reduce our meetings to once every three months.”

“That sounds good,” I said, and meant it. I liked Dr. Vandoren, and I trusted her. I would do whatever she said.

“The last thing I want to discuss with you today, Lucy, is medication. There is a lot of debate throughout the medical community on the best time to begin drug therapy. Some physicians believe it is best to wait until the CD4 count dips below three-fifty, because the side effects of the drugs can be tricky and they want to give their patients as much time as possible without having to deal with them. I, on the other hand, am of the ‘hit hard, hit early’ school of thought.”

“What does that mean?” Dad asked.

“It means that even though Lucy’s CD4 count is high, I think it’s beneficial to begin medication immediately. We’re only thirty or so years into researching this virus, but studies thus far have shown that the death rate is almost twice as high when medication is deferred. If we start Lucy on a therapeutic regimen now, she could live a very long life,” Dr. Vandoren said firmly. “However, I can only recommend what I think is best. The decision ultimately lies with you.”

“What kind of side effects are we talking about, exactly?” Papa asked.

“As with any drug, they vary from person to person and are difficult to predict, but the more common side effects include rash, headache, fatigue, drowsiness, dizziness, strange dreams, trouble sleeping, diarrhea, and vomiting. But these usually go away after a few weeks. Other more serious possibilities can include loss of fat in your arms, legs, or face, shortness of breath, pancreatic inflammation, and skin discolorations,” Dr. Vandoren stated matter-of-factly, without even consulting a cheat sheet.

Dad sucked in his breath. “That doesn’t seem very pleasant.”

“Which is why many patients decide to defer treatment. However, think of it this way: as unappealing as these possible side effects may seem, for individuals with HIV and AIDS, the ultimate side effect of no medication is death.” Her last word echoed around the room.

Oddly, even though she was throwing around words like “death,” I felt safe in her hands. I looked to my dads. “What do you think?”

“I think we should start the meds,” Dad said, nodding with conviction. “Seth?”

“I agree,” Papa said. “But what do you think, Lucy?”

I thought about Roxie—nineteen years and still no sign of AIDS. I nodded. “Hit hard, hit early.”