That is what I said to myself as I drove back to the Miracle Center for the fourth time in twenty-four hours, as I slammed the car door and walked across the parking lot, as I eased back into L&D in the silent hospital: “Steady, Abe, steady.”
IN THE EARLY MORNING, Rajani gave birth to a baby boy. He was perfectly healthy. We called him Jacob George Verghese: his first name after Rajani’s father and the middle name after my father.
I was ecstatic, jubilant. I held Rajani’s hand and searched for the right words for the occasion. I said how this was a new beginning for us, how I would work hard to make things better for us as a family. She was exhausted, distracted by the baby being bundled away to the nursery. She turned to look at me; she did not respond but instead fell into a deep sleep. After a while, I left the room.
I drove back to the VA. I reached the card-key barrier that separated Mountain Home and the Miracle Center. My wife and newborn baby were on one medical campus, Steven on the other. The sun was coming up and I stopped at the threshold for a minute. I cut the engine to look at perhaps the most glorious sunrise of my thirty-two years. Thank God, everyone was safe.
10
THE WEEK FOLLOWING Jacob’s birth was strangely calm. Steven and I spent our evenings together. Suddenly he was elder brother, no longer the baby. I was trying to wean him from his mother, help him deal with the arrival of a baby who had consumed the attention of his grandparents, a baby who had stolen my heart. It took all my will and concentration to walk into the house and not let my eyes drift from Steven. I trained myself to give him my undivided attention for five minutes. Only then would I sidle over to the baby, letting the infant’s unfocused gaze play over me. When I reached out to put my finger in his palm, Jacob would squeeze it.
Steven, at two years, was a quiet child, startled by sudden noises, quick to clamp his hands over his ears, hesitant whenever he ventured beyond the boundaries of the familiar world around him. If he felt rejected now, betrayed, he did not express it in tantrums or by uttering a word of protest. Instead, there was only a puzzled look. Later, a sadness set in on his face.
Tuesday, a week after Jacob’s birth, Steven, his grandfather and I took a walk. We headed down from our house and cut across the lawn to reach the old jail and guard house which now served as the Mountain Home VA personnel office. There we left the manicured bluegrass and the flower beds of flame azaleas and reached the perimeter of the campus.
To enter this forest of maple, ash and pine was to go from light to shade, to enter the silence of a grotto, a silence broken only by the call of birds, each of which caused Steven to pause and look at me inquiringly, his hands raised, ready to clamp them over his ears should the sound get louder. I told him what I knew: the raucous thief-thief-thief cry was a blue jay. The whistled ree-ree, ree-ra could be a chickadee or a pewee.
We halted on the thick mat of leaves and twigs, looked up, tried to keep our feet silent as we searched out the singer. The summer foliage was so dense we saw nothing.
On we went, behind the interns’ quarters, behind the psychiatry building. At the horseshoe pit, in a little clearing in the forest, three males in their thirties, all smoking, were playing a desultory game. The horseshoes seemed inordinately heavy in their hands, hanging in the air like giant transport planes, landing with a thud and kicking up a spray of dust. The men waved. Steven, with encouragement, waved back. One of them made the grimacing and smacking movement of his lips and face that is a side effect of Thorazine, an antipsychotic medication.
We emerged from this enchanted forest behind the main hospital building. Here, in a giant clearing, the “bed towers” was under construction next to the old hospital. I resented this project for a new hospital, resented the trees it had cost, resented the glass, concrete and steel scale model that stood in the director’s office—try as it might, it could not help but betray the symmetry and grace of our old brick buildings. I could not picture myself working in a building like that.
We came here many an evening because of Steven’s fascination with the cranes. There were two of them, their cabs empty, their hooks raised. They stood unnaturally still, like monuments; they towered over the deep crater where the foundation was being laid; they presided over the assembled backhoes, bulldozers, ditch-witches, portable toilets, storage trailers and flatbeds that cluttered the ground below.
The silence of this scene was powerful. I think this is what Steven liked: the sense of machines that at any other time would be making an infernal racket, now stilled. The only time he wanted to see them was in the quiet of the evening. To Steven, they were like dinosaurs. His hand clutched mine tight, in case the cranes should move. My father and I followed Steven’s example and gazed at this scene with reverence, our heads tilted back, silent, until Steven indicated his readiness to leave.
We returned via the paved walkway. Some days we ventured down to the pond where, at this hour, solitary veterans, couples from town, whole families came to feed the ducks. But on this day we wanted a last look at the “roof birds”: pigeons and mourning doves that roosted in great numbers under the eaves of the hospital as they had done on every old building on the VA campus. The pavement beneath the overhang was painted with a salt-and-pepper fringe of droppings. As you approached the hospital doors, the collective, low-pitched coos made it seem as if the building was grieving aloud.
The VA maintenance crew, the ubiquitous men in green, had tried all sorts of tricks to drive the birds away: noisemakers, repellents, grease. Nothing had worked. The previous week they had installed chicken wire under the eaves of the watchtower building and the domiciliary buildings. The doves had promptly moved from the domiciliaries to the hospital building. In the week to come, the hospital was slated for the chicken-wire treatment.
I wondered what would happen after that? Where would the doves go? Would they fly west to Murfreesboro where another quaint old VA of similar construction awaited them? Or would they go down to the Bay Pines VA in Florida, mimicking the migratory pattern of our domiciliary residents? Had an eccentric old domiciliary veteran brought them here to begin with, only to have their population explode, much in the manner in which the aggressive European starling had first arrived in America?
After our walk, Steven and I went to the mall to roam in the air-conditioned coolness and to pick up diapers, milk and other sundries. On the way back, we stopped at Allen’s gas station where Allen raised and lowered a Camaro on the hydraulic lift, just for Steven’s pleasure. Then Allen opened the soda machine and extracted a Coke from its innards for Steven. Steven was awestruck by this trick; all his Daddy had been able to do was put coins in and punch a button. What Allen did must have seemed like a cesarean.
Back at home, we checked on our “garden”—a narrow strip of earth outside the front porch that Steven and I had reclaimed from the lawn and that the groundskeepers had not as yet taken back. The tomato seeds we had planted months before were now full-grown plants. We had put stakes up to support them. Until two weeks ago, they had looked scraggly and their fruit was jaundiced and anemic. I broke down and added store-bought fertilizer to the soil. It had worked miraculously, just as the proprietary name had suggested it would. Steven plucked one ripe tomato and ran in to show the voluptuous ruby-red orb to his mother and to the new baby.
After his bath, Steven and I stepped out to the porch to look for fireflies. They were not abundant that night for some reason.
We stood on the driveway and looked at the stars. The night was so clear, the stars seemed to be within our reach. Steven said, “Oh!” as if understanding completely when I pointed out to him Orion the Hunter, then Orion’s head, Orion’s belt. The reverse-question-mark shape of the body of Orion had always seemed as if it was my talisman, watching over me in Boston, and now in Tennessee. Steven repeated after me, “Bellatrix” and “Betelgeuse.” I had such ambitions for my son: astronomer, astrophysicist, astronaut.
THE NEXT EVENING, before Steven and I could take our walk, my beeper went o
ff. Scotty Daws had stopped breathing. A few days before, Scotty had been taking enough breaths on his own to wean him off the ventilator. I had quickly shipped him out of the ICU and back up to the fifth floor. His sister, uncle and I agreed that we would not put him on a respirator again if his lungs failed. But now the nurse had found him without a pulse, and with gasping respirations. She had called a Code Blue, even though Scotty had been made a “No Code,” a “DNR”—Do Not Resuscitate. The message on the phone was from the telephone operator at the Miracle Center informing me that “your patient is coding.”
I rushed over, ran through the parking lot and took the stairs three at a time.
The assembled crew looked at me wide-eyed as I walked into Scotty’s room in my street clothes and instructed everyone to stop at once. I found an army of persons dressed in yellow gowns, green caps, gloves and goggles, administering CPR. There was little room to maneuver, what with the crash cart, the ECG machine, the pharmacy cart, all assembled in his room. Half the people in the room I did not know—they had rushed up from the operating room and elsewhere in response to the Code Blue. I was incredulous: I thought I had made it clear on the chart and to the nurses that none of this was called for with Scotty.
The respiratory therapist who had been bagging him, now lifted the rubber mask away from Scotty’s nose and lips. The person who had been kneeling, administering chest compressions, now stepped off the bed. While they looked on in astonishment, I felt for a pulse, my bare fingers pressed to one side of Scotty’s neck. On the other side of his neck, blood had trickled from where an overzealous intern had tried for a central venous line. There was no pulse. I pulled back his eyelids and saw that his pupils were fixed and dilated.
I saw looks exchanged by the persons in the room: Is he crazy? No gloves? This only goaded me on. I was irritated at this production at Scotty’s bedside, the moon-suits and yet the paradoxical and absurd effort at resuscitation.
I laid my hand over Scotty’s left nipple, feeling for the apex beat of his heart. I put the diaphragm of my stethoscope over his heart, my fingers cupping the head of the instrument and resting comfortably on Scotty’s sweaty chest. Silence. Only the rush of blood in my own ears.
I lifted myself up, thanked everyone and stood there till they filed out. When everyone left, I asked the nurse (a face I did not recognize, perhaps that explained the Code Blue) to get me a biopsy needle and small bottles of formalin and gloves. She seemed confused, lost. She would be gone a long time.
In death, Scotty already looked long dead. I was conscious of a peculiar, sweet, mousy odor in the room; I had noted it on previous visits to Scotty, but now it was particularly strong. It evoked a sense of nostalgia, an olfactory déjà vu. Was it an odor I had detected at an AIDS deathbed before this?
As I looked at Scotty’s face, the way the skin was stretched taut over his bones, the fat of his cheeks long gone so that what could have been a smile was instead a grimace, I felt sorry that he had suffered so long in the hospital, sorry that even in his last minutes our mindless technology had so rudely interrupted his transition, leaving him with oozing puncture wounds over his neck and a red splotch over his chest and cracked ribs from the cardiac compression.
I wished I had seen him earlier in the course of his illness, gotten to know him in the clinic, instead of first encountering him already in extremis in the hospital. How many other men did we have in our town with time bombs ticking in them? How many others had returned home from elsewhere and were too scared to come to me or were still in denial? How many others did not even know they were infected?
When the nurse returned, I took biopsies of Scotty’s lungs, his liver and his spleen, leaving tiny, almost invisible punctate marks on his skin where the biopsy needle had gone in. The previous day, when I had talked to Scotty’s sister about his inevitable death, something she was resigned to, I had asked whether she knew what Scotty’s wishes were: cremation? burial? . . . autopsy? She had flatly vetoed an autopsy; she had been agreeable to the postmortem biopsies I was now performing. I labeled the little formalin bottles and sent them off to pathology. I washed my hands in Scotty’s bathroom. I was curious to know what had gone on in Scotty’s body other than the pathogens we already knew about: Cryptococcus and Pneumocystis carinii.
By the time I got home, Steven was already asleep. The baby was awake. When I reached for little Jacob, Rajani asked me, “Did you wash your hands?”
I washed once more.
THE NEXT DAY, Wednesday, and my clinic had only two patients, both with non-AIDS-related conditions. The first was a pretty, waiflike young lady with infection around her left breast prosthesis. Multiple courses of antibiotics prescribed by the surgeon had failed; she continued to ooze pus from the operative scar and to have pain—it had been a year since the surgery. The right prosthesis was fine. I was convinced that the left prosthesis would have to come out to cure the infection in the chest pocket in which it resided. Once the infection was totally cleared—a matter of four to eight weeks, during which she would receive intravenous antibiotics at home through a special venous catheter—she could have a new prosthesis inserted. I explained to her that the silicone prosthesis was now acting much like a splinter in the pulp of a finger, it was a foreign body: no amount of ointments or antibiotics would help until the splinter came out. She left, disappointed, having hoped for a magic drug to cure her, but promising to think about my recommendation. I dictated a diplomatic letter to the plastic surgeon who had sent her to me. I know he also wished the problem could be solved without undoing his handiwork.
The second patient was a farmer with a chronic bone infection that had followed a motor vehicle accident when he was a teen. The broken tibia had mended, but for years he had drained small amounts of pus through a sinus track that came out onto the skin just below his knee. He was in the habit of tying a bandanna over the pouting mouth of the sinus track; the bandanna concealed this proud flesh and picked up the two or three drops of pus that trickled out every day. He replaced the bandanna with a fresh one each morning—he had a large collection of bandannas.
Multiple courses of antibiotics over the years had not helped: at best, the sinus opening would close over temporarily. Then, after a few weeks or months, he would get fever and chills and bony pain, which was relieved only when a red spot blossomed again on his skin and burst, allowing the pus to come out. His incentive for coming to me now was his upcoming second marriage. When he and his future wife had reached a critical state of undress, she had been startled by the bandanna and slightly repulsed by what was underneath when she insisted on looking.
His x-rays showed fragments of dead and infected bone in a pocket deep within his tibia; the infection was surrounded by very dense but healthy bone; the little tunnel to the surface served to drain the infected cavity whenever pus built up in it. For him to have any chance at cure, it would be necessary for a surgeon to aggressively cut out all the dead bone and unroof or “saucerize” the cavity and thus drain the infection. He would be bedridden for weeks. It would be painful. And the problem was that such surgery, if it was to cure infection, might cut out so much bone that it would compromise the ability of the tibia to bear weight. Worse still, there was a good chance that infection would recur despite surgery. And as a tobacco farmer, he could ill-afford the downtime the surgery and recuperation would entail. My recommendation was to leave well enough alone; nature was providing him with good drainage of a well-localized infection, even if the means it chose was not aesthetically pleasing. I suggested we work on his fiancé, encourage her to visit me, help her come to terms with his chronic osteomyelitis and the bandannas.
In between my two patients, I saw Fred Goodson walk in and hug my nurse, Carol. I saw a nurse who worked on the other wing of the clinic make a long face at this demonstration. Fred gave this nurse a stately bow, which made her turn away, flustered. Fred had come by to pick up forms that I had signed for Otis and to visit with Carol. She had now become an integral part of
AIDS care in our town. Patients came as much to see her, and be cheered by that visit, as they came to see me. When I finished with my second patient, Fred was still there, chatting with Carol. Now he came to the dictation room to visit with me for a while.
When I had first met Fred and Otis, I had been struck by their Tweedledee and Tweedledum sameness, by the Castro-clone look they seemed to be affecting. I still saw Otis this way.
But not Fred. Now, whenever I saw Fred Goodson, I thought bear. His thick, gray-speckled beard stretched up in a skullcap and then swept down the back of his neck to disappear into his T-shirt, showing every possibility of reaching the soles of his feet. The tangle of hairs in his nostrils, the way his neck ran into his arms without intervening shoulders, and the serenity with which his hands stayed folded over his belly were all bear. His close-set blue eyes peered out through Gandhi glasses and took sight of you down his nose, and he often cocked his head to one side or the other. It was the exact demeanor I had seen a few months before when we drove through Cades Cove in the Smoky Mountains and were scrutinized by a hulking specimen of Ursus americanus, standing by the side of the road.
Fred was telling me about the Tri-City AIDS Project, TAP, a community-based group in Johnson City that he had been instrumental in forming.
I was incredulous! I had been unaware of the group which was already having regular meetings.