FEBRUARY 18. THIS AFTERNOON the downstairs corridors of the hospital are crowded with people—people loitering, people staggering, people searching, people passing through, people laughing, people eating, people drinking, people smoking, people staring, people dozing, people trying to squeeze by. There are people on crutches, people in wheelchairs, guards, nurses, cops, patients and their families. The corridors are crawling with a surging mass of people.
Perpetually, people are waiting. A long line runs around the corner and down the hall from the cashiers’ windows. A long line snakes around roped stanchions in front of the pharmacy windows. In the outpatient waiting rooms people sit in rows of chairs. (“Patients aren’t called patients for nothing,” puns Mr. Carter.) In the halls and the waiting rooms, there are puddles of cola and coffee on the floor. Everywhere, there is an air of resignation and imminent alarm.
The corridors are full of noise. Everyone is talking. Lite F.M., piped in through ceiling speakers, is playing. Somewhere an elevator alarm bell rings unceasingly—its message goes unheeded as the elevator moves from floor to floor. Someone is shouting into the receiver of a pay phone. Vending machine levers rebound with a clatter. The doors to the emergency room bang open.
Every year, over half a million outpatient visits are made to the hospital. This Wednesday afternoon, 28 outpatient clinics are being held here. These include gynecology, occupational therapy, dental services, neurology, urology, plastic surgery, and the weekly so-called parasitology clinic. Mr. Carter manages to commandeer an examining room for his outpatient group, which is composed of people who have already been in the hospital at least once with complications from AIDS or ARC.
This isn’t how they told Mr. Carter to run a group in school. There aren’t enough chairs, so someone perches on the lid of the trash can, someone else on the edge of the examining table. Others lean against the wall. Patients drift in. They’re called out to see the doctor. The group is always liable to get evicted. Conversation is desultory. Mr. Carter doesn’t lead the group. Nor does he contradict misguided or misinformed statements. He sits and listens. Now and then he encourages someone to talk. If people talk he can say he’s had a good group.
Today before clinic he runs into Diego Ruiz and Alberto Flores in the hall, talking to Luis Alegria. As he promised he would last week, Mr. Ruiz—instantly Dino to everyone he meets—has brought a newsletter published by an organization called ADAPT. ADAPT stands for the Association for Drug Abuse Prevention and Treatment. The group is right now for drug abusers what the Gay Men’s Health Crisis was for gay men at the beginning of the epidemic, six years ago. Dino and Mr. Flores follow Mr. Carter back to the examining room—Mr. Alegria, who says he’s depressed and wants to be quiet, stays behind in the waiting room.
The health department estimates that over half of the addicts in New York City are infected with the HIV virus. Most of them are heterosexual. The Centers for Disease Control says that fully 5 percent of heterosexual men ages 30 to 39 in New York are now infected. According to the ADAPT newsletter Dino brought with him, most of the 36,000 people in city treatment programs have been IV drug abusers in the past five to seven years and two thirds of them shared needles. ADAPT estimates that 80 percent of male IV drug abusers are dating females who are not drug users. These are just a few random indications of the extent of the ever-expanding reservoir of infection that is spilling over into the hospital.
Dino heard about ADAPT from his younger brother, who also has AIDS. People from ADAPT visited Dino’s brother in jail on Rikers Island, where he’s still being held in spite of his illness. Recently another of Dino’s brothers, a drug dealer, was shot in his apartment, in his bed, in his sleep. The funeral was last week. “My other brother was killed the same way, man,” Dino says. Dino shakes his head. “So my brother with AIDS came to the funeral. He was there. He was in handcuffs. He had to go right back.”
This afternoon there are 26 inmates in the “AIDS cellblock” on Rikers. The connection between drugs and incarceration has long been taken for granted—last year four in ten indictments right here in the Bronx involved drug use—but the connection between prison and AIDS is new. Of the 50,000 inmates who passed through Rikers Island last year, as many as 12,000 were thought to be infected with the HIV virus. AIDS is now the leading cause of death among prisoners in New York State.
Dino and Mr. Flores have both been in prison, too, and when Mr. Carter leaves to photocopy the newsletter, they sit quietly swapping stories about what it was like. Mr. Flores, a nervous, powerfully built man, maintains that prison was a good experience. Partly because there’s a reporter in the room, partly because he wants to believe it, Mr. Flores delivers a jeremiad on the benefits of incarceration. Speaking in a hard, flat voice, he tells how good prison was for him, how he spent five years in prison just thinking, how he pulled himself together in prison, and how he is going to pull himself together now.
Dino pretends to listen but his eyes are blank. He twiddles his thumbs. His hair and beard are streaked with gray. He is 41. He has been a drug addict for 30 years.
Mr. Flores is hopeful about his prognosis. He is “building up my antibiotics” through diet. He is taking the new drug called AZT. He has developed a rash from it, but aside from that—so far, so good. They said AZT might make him anemic but he feels good. Mr. Flores hopes AZT is a wonder drug that will save his life.
Dino is not on AZT. He had to stop taking it “on account it killed my blood cells.” He has a lot of complaints to voice today. “I’m beat, man. I get exhausted. I get exhausted just walking the five flights up to my apartment. I get attitude, too. Sometimes I just shut myself up in the bedroom and sleep, you know? I don’t go out. I’m jumpy. I get attitude from nothing. My son, he comes in from school and he throws down his books, I blow up. I never used to do that. It’s this thing man”—he does not say AIDS.
(Last week, when Mr. Lares, eyes bulging in a sallow face, complained that the clinic gave him attitude because he never saw the same doctor twice, Dino told him he had “a hostility problem.”)
It isn’t good, Dino says. If the weather were warm, he’d be outside selling name bracelets. He sets up a table on the street in the spring and pretty soon word gets around that the name-bracelet man is back. Dino says it’s the only time he’s happy, when he has a pair of plyers and some wire in his hands. “I’m good at it. I make good money at it. I once had my own flea market. Everyone knows me. Howya-doin?”
Harold Campbell comes into the room, mutters a word of greeting, and gravitates toward the corner.
Mr. Flores has taken off his leather cap and is twirling it in his hands.
“I just hang around the house,” Dino continues, speaking to no one in particular. “My wife, she’s a diabetic. She’s sleeping with the baby now.”
“I’m doing good,” insists Mr. Flores.
“I’m running up twelve flights of stairs every day in the projects where I live,” says Mr. Campbell from his corner. Mr. Campbell has ARC—though no one here is exactly clear on why that makes him different. Mr. Campbell’s legs and wrists are covered with a rash that makes his brown skin black as charred marshmallow. His hands look as if he’s been working in a garage. Because his wife and two girlfriends have died of AIDS, Mr. Campbell says, the children in the projects call him “girl killer.” Because of this rash, he says, people on the street fall back when he passes “like I’m a walking plague.”
Mr. Carter returns with copies for everyone of the ADAPT newsletter. “These are good people,” Dino says, tapping the sheets of paper in his hand. The cover of the newsletter bears a crude illustration of a big hypodermic needle and a pile of skulls. “Before these people got on the case, the brothers with this at Rikers was all in a room where everybody coughed all over everybody else. Now they change the sheets every day, not once a week, and they got screens between the beds.”
“I’m going to the dermatology clinic tomorrow,” Mr. Campbell says from his station in the corner.
“That’s great, man,” Dino replies absentmindedly. Dino can barely drag himself up the stairs to his apartment. This guy says he’s taking them two at a time.
The door opens and Milagros Fuentes slips in with Richie Suarez on her heels. Neat, trim, her face carefully painted, Milagros is almost 40 but looks years younger. Milagros has AIDS but she looks great. She is also taking the new wonder drug, AZT. Richie, 32, is her lover. Richie has ARC and has been in the hospital once because of it. Now, he says, he feels fine—he makes it clear today, he’s just along for the ride, to keep Milagros company.
Most of the time, Richie lives at Milagros’s apartment. When they argue, which is frequently, Milagros accuses Richie of giving her AIDS, and Richie screams back that she gave it to him. Since Richie found out he had ARC, he’s overdosed on pills twice—both times, he’s downed them ostentatiously in front of Milagros.
Richie is tall, handsome, dark skinned, well dressed, well spoken. He has a black mustache. Black moles are scattered over his throat and face. You immediately think, he is the kind of man who as a boy lived in a house with a lot of sisters darting back and forth, waiting on him.
The men stumble over themselves to offer a chair to Milagros. Since Connie Rivera stopped coming to clinic—maybe she’s better, maybe too sick—Milagros is the only woman in the group and she receives due deference. There is no discussion about sex and/or condoms in front of Milagros.
(When guilt over her supposed frigidity goads Milagros into approaching Richie again, in a few weeks, she will be surprised to learn that he won’t have sex with her without using a condom—this, she will tell him, is proof that he doesn’t really love her.)
Demure, dignified, self-contained, Milagros doesn’t say much, so everyone was surprised last week when, with a little prodding, she told a long story about a fight she had with her daughter. She’d sat mute for an hour and when Mr. Carter asked her if she wanted to say anything, Milagros said, “No, but listening makes me feel sadder. I get a lump in my chest like I want to cry.”
“Why do you want to cry?”
Then Milagros burst forth with her story:
Milagros has two daughters, 12 and 15. The older one has always been a problem. This daughter lives in Washington, D.C., with her boyfriend, who is no good. This daughter came to New York to see her mother and told Milagros she was pregnant.
“You’re not pregnant,” Milagros insisted. “I know you just had your period.”
Her daughter screamed, “You don’t believe me, I’ll kill myself!”
Milagros’s daughter said she was going to get a knife from the kitchen and stab herself. There was a struggle. Milagros wrestled her daughter to the floor. She pulled her down by the hair—somehow she found the strength. They wrestled on the floor. Slowly Milagros’s daughter dragged herself and her mother across the floor into the kitchen. In the kitchen Milagros’s daughter seized a butcher knife and held it to her belly.
“I’ll kill myself!”
Milagros reached for the knife. It slashed her hand. There was a lot of blood. Then, talking in a quiet voice, Milagros managed to get her daughter to drop the knife.
The two women fell into each other’s arms, hugging and weeping. Sitting on the floor, Milagros spoke to her daughter about God and the Bible. But when her daughter tried to kiss her, Milagros froze and turned her face away, afraid she would give her AIDS.
Later when Milagros found the 12-year-old trying to mop up the blood on the kitchen floor, she yelled at her and chased her out of the room. Then she cleaned up the blood herself.
Today when she’s asked about her daughter, Milagros says she went back to Washington. Milagros doesn’t like to see her daughter living with this boyfriend, who has been in trouble with the police and who her daughter says seduced her when she was 11. But today Milagros says, “I don’t care. She can stay there. We’re fighting so much.”
Everyone feels for this poor lady who never shot drugs but now has AIDS.
Milagros has not told the group that when her husband left her alone with two children and she lost her job and faced eviction, she turned to prostitution. For only one year, Milagros says, early in the morning, five days a week, she transformed herself from a whore back into a housewife on the subway home to her sleeping children. Milagros is able to admit now that she probably was first exposed to the HIV virus by a john, not by Richie. She is convinced that AIDS is a punishment from God for the things she did.
Dr. Lieberman comes to fetch Milagros. When they’ve left the room, Richie tells everyone what a bitch Milagros has been lately.
“She’s a ball-buster,” he says quietly. “She gets bitchy then she gets down on herself like she’s nothin. I don’t know.”
“You don’t look so good, man,” Dino says. “What’s wrong which-you?”
Beads of perspiration dot Richie’s forehead.
Richie is in a methadone program in Harlem but his dosage is a low one. Some days he goes in and just pretends to drink the drug—he throws it away with the cup. He’s still shooting heroin.
“You carry your own spike?” Dino asks.
Richie nods.
“You carry your own works, too? Without you carry your own cooker, you may as well be passing the needle.”
Dino is fatherly, protective. He speaks as if Richie weren’t already infected.
“I’m going off meth’ anyway,” Richie says. “I’m going back to P.R.”
“You better cut down gradual and then you tell them you wanna detox, they’ll send you to downtown. They’ll give you the number of the doctor. You’ll check in for 21 days and they’ll detox you. But then you have to be willing not to get high.”
At that, Richie smiles—his first real smile—and rolls his eyes. You see the child he was once. You see he will never go to detox.
Everyone laughs.
“I know,” Dino says. “I done it. All that pain and sacrifice, then you’re back on the street and you think, Just a little methadone would take the edge off of this. And you’re right back where you started. The methadone, it’s worse than horse.” Dino is relentless. “Once I got these abscesses, you know? I got one on my neck out to here. I thought I was growing another head!” He laughs, a short bark, and passes a hand over his eyes. “I got one here, on my forehead. When the doctor cut it open, man, he said I had a garbage disposer in there. It was full of worms and shit. That didn’t stop me. I was still shootin then.”
During Dino’s story, a tiny brown man, emaciated, is brought to the door by the receptionist. It’s cold out today but the little man is wearing nothing heavier than a short-sleeved polo shirt over a T-shirt. His fly is undone. He is complaining of a headache. Mr. Carter takes him aside and does an intake interview on the spot. His name is Francisco Santos. He has trouble remembering how to say his social security number in English.