AIDS and the Common Man

Johnny was my first patient on the day after New Year's. He had made a marginal living scalping tickets and driving a tow truck for an auto repossession company. In his younger days he had been addicted to alcohol and downers, but when he tried speed once he developed severe chest pain. The resulting hospital evaluation revealed severe hypertension, which brought him to me 2 years ago. About 6 months after his initial visit, Johnny asked me to help him find a dentist for his friend Lindaa dentist who would accept HIV-infected patients.

Linda was an IV heroin user. While imprisoned on a prostitution conviction she had been subjected to mandatory HIV testing and had tested positive. Johnny found a lawyer who would take Linda's case, and they sued the city to provide AZT for her in prison. When she finished her sentence, Johnny finagled a scarce place for her in a methadone treatment clinic with the help of a social worker. He moved Linda to a new apartment to remove her from the group she shared needles and drugs with.

Linda did well for 6 months. Johnny told me her CD4 counts were low, but she had not had any infections, she was taking her AZT and methadone, and she had kept up the journal she started in the treatment program. Johnny was now the storage lot manager for the repo company, and it also seemed that his ticket scalping sideline was evolving into a small-scale booking agency.

Linda's first serious complication came in the spring, when a cold evolved into bronchitis, and then into full-scale pneumonia. She bounced back quickly on antibiotics and was home from the hospital in less than a week, but now tired more readily. Johnny began doing the shopping, cooking, and housework and took her to increasingly frequent doctor's appointments. He learned about AZT-induced anemia and synthetic erythropoietin. He asked me about unconventional therapies and drugs available overseas. Linda was hospitalized for 3 weeks in August and received transfusions of both red and white cells. Her CD4 counts were now less than 50. Back home again, Johnny learned about bedbaths and bedpans.

When Linda was hospitalized again in September, Johnny called her parents, who lived on an estate out in the horse country. Their contacts with Linda had been brief and painful since she ran away from home 20 years earlier. Johnny told me the bedside reunion was painfulbut it was not brief, and thereafter her parents began to visit regularly.

Johnny seemed depressed when he came to see me during Linda's hospitalization in October, recognizing that the end he had known was coming was now close at hand. I praised him for all he had done for her and pointed out that few people would have done so much. Doc, he said, I never expected to have a close man-woman relationship, a real friend. None of my friends or family do. Linda pulled me out of the gutter, got me sober, made me get a real job, made a home for us. Now she needs me. I couldn't do anything else.

In early November, Johnny asked me to test him for HIV. He had not been willing to be tested previously, but now Linda was pushing him to have it done. He told me how relieved she was when he tested negative.

She was in and out of the hospital in November and December. They hoped to celebrate one more Christmas together. On that day after New Year's he told me of her seizure 3 days before Christmas, the lapse into coma, and her death on December 26, at age 38. Linda's gone, doc. But she beat the rest of it. She got off the street. She got off the drugs and booze. She got her family back. She was even beating her depression. I believe she'd be here today if we could have gotten her into treatment a few months earlier, before she got AIDS, but that can't be helped now. I have to get on with my life and my business, and I will. I know I'll have bad days. And I know I'll never have anyone like Linda again, but at least we had each other.

• Copyright 2004 by the American College of Physicians