KATHERINE CAME TO SAN Francisco on Labor Day, and for the rest of the week, Kevin quit working at noon. They went out to lunch, then spent the afternoons wandering through the city’s more affluent neighborhoods—Pacific Heights, the Upper Haight, North Beach, and the Marina—enjoying the bay views and Victorian architecture. Katherine was fascinated by the houses, especially once Kevin told her what they cost. He had been in a few of these places and helped her imagine the furniture, people, and dramas inside. It was so relaxing they put off talk of Douglas until the weekend.
They were having a late brunch on Saturday when Katherine brought up her son’s conflict over coming out. He had only told his mother he was gay.
“How’s Ben dealing with it?” Kevin asked.
“Denial, to the extent he can. He’s unhappy, but at least he’s not angry at Douglas. I’ll give him that.”
“Should I write to him?”
“Ben?”
“No, Douglas,” Kevin giggled. “My consoling Ben because his son is queer would be pretty hilarious.”
“It would be lovely if you wrote Douglas. Just be sure to address the envelope to me.”
She shook her head and laughed. Seeing his sister free of worry unleashed an impulse to run his fingers through her long, thick hair. He couldn’t find a trace of gray. He looked at her muscular arms and the faint creases around her eyes. He was proud of her vitality at forty-two. He wanted to say how much their shared history meant to him. He was searching for the right words when the doorbell rang. It was Gwen, stopping by on her way home from the airport after a thirty-six hour trip to the East Coast.
Gwen had never met Kevin’s sister. More than their obvious resemblance, she was struck by Katherine’s apparent equanimity. If she was anxious about her brother, she wasn’t going to let it show.
“I would have flown back last night,” Gwen said, “But I had the chance to go out to dinner with some HHS folks.”
“Any money headed our direction?”
“We’ll see.”
As Kevin and Gwen discussed the likelihood their ideas for new clinic services would get federal funding, Katherine listened with interest.
“Is the government taking responsibility for finding a treatment?” she asked.
“There’s a ton of grant money,” said Kevin. “NIH, even the FDA, is giving it away to anyone with a reasonable hypothesis to test. The fuel is there. What’s missing is the right tool.”
“Tool?”
“We’re not going to be able to cure this infection any time soon. The best we can hope for are medications that can control it, which means the effectiveness of a new drug has to be judged by how much it reduces the amount of virus in people’s bodies.”
“That makes sense.”
“Unfortunately, we don’t have an accurate method for measuring that. There’s no gold standard. Labs all over the world are working on ways to quantify the virus. But so far their assays are too complicated and expensive to use in trials, and their results aren’t anywhere close to reproducible.”
“Hey, wasn’t that what your paper in the British journal was about?”
Kevin’s forehead furrowed.
“Your brother made waves by exploring whether some other markers in people’s blood could be a substitute for measuring the virus,” Gwen explained tactfully, “but the FDA shot down his idea. They issued a statement that any surrogate marker like the ones he reported on would have to be validated by a lot more studies before they would even consider allowing it to be the basis for new drug approval. Which basically means until we have a reliable method to measure HIV viral load in a patient’s blood, we’re going to have to wait for more trials to show differences between treatment arms in the number of deaths and complications of AIDS that occur.”
“Which will take years,” Kevin said, “With AZT on the market, it’s unethical to conduct trials where people get nothing but placebo, which means new trials have to have an AZT control arm, which mean the trials have to be much larger and longer to show statistically significant differences in those kinds of outcomes. So the longer it takes for viral load assays to become reliable, the longer it will take to develop effective treatment, and the more people with AIDS will die.”
Gwen wondered if Katherine shared her brother’s belief the infection would eventually be mastered. Gwen was hopeful but not convinced. She glanced at Kevin, who was lost in thought, then to Katherine who turned her eyes to him then back to Gwen, smiling confidently.
Gwen was puzzled. Was Katherine naïvely optimistic or did she have a deeper source of certainty? She decided she needed to get to know Kevin’s sister better.
He changed the topic by asking Katherine about the Massachusetts governor running for president. Having just returned from Washington, Gwen didn’t want to talk politics. She noticed a coffee cake in a glass baking dish. She knew cooking wasn’t in Kevin’s repertoire of skills.
“Did you make that?” she asked.
“I did,” Katherine answered. “Have some. Kevin’s trying to maintain his boyish figure.”
They all laughed.
That evening, Kevin and Katherine went to a restaurant in the Castro. He had no appetite and became queasy with his first bite of food. Soon a dull ache was throbbing under his left rib cage. The intensity increased rapidly. Over the past year, Kevin had cultivated a stoic approach to physical discomfort. He could ignore nausea, diarrhea, fatigue, the constant sensation of pins stuck in the soles of his feet. But pain like this was outside his range of experience.
The anguish on his face terrified Katherine.
“What should I do?” she implored him.
“Get the car. I don’t know how far I can walk.”
He handed her the keys. By the time she returned, the pain had subsided enough that he could stand up and avoid the humiliation of being carried out of the restaurant on a stretcher.
Katherine drove to a nearby private hospital where Kevin’s doctor had admitting privileges. Art Krimsky was one of several dozen physicians in the city, unaffiliated with the university, who devoted their practice exclusively to HIV patients.
In the emergency room, Kevin had blood drawn and an intravenous catheter placed. He was transported to radiology for a sonogram of his abdomen, then to a private room where Art was waiting. After pressing gently on his belly and listening with his stethoscope, Art spoke.
“You have pancreatitis, Kevin. You’re amylase is 800.”
Kevin was unnerved by Art’s grim demeanor. Acute pancreatitis eventually resolves, he thought. It’s just pain that has to be gotten through. There’s probably a gall stone blocking my pancreatic duct. Sooner or later, it’ll pass through.
“I know the drill,” he said. “Nothing to eat or drink. IV fluids and morphine. Surgery if it gets worse. I’ll stay put here.”
Art looked away.
“Why are you laying so much crepe?” Kevin demanded.
“Sorry,” Art apologized.
The next morning, Art arrived more somber.
“I called NIH, Kevin. They’ve seen four cases of pancreatitis in patients on DDI. You’re the fifth.”
“OK, I’ll lay off it for a while.”
Now Art looked positively glum. He nodded in agreement and patted Kevin on the shoulder. Kevin turned to Katherine whose face was ashen.
“It’s not the end of the world,” Kevin declared.
Katherine’s eyes welled with tears.
Kevin knew he was missing something. If it’s so obvious to them, why don’t I get it? And then he did.
“NIH won’t give me any more DDI.”
“I’m so sorry,” said Art.