Joey's physician's assistant, Laura Strauss, speaks more freely. Unlike Christen, she doesn't have a political constituency to tend to. Her more than 100 clients on Ward 86 at San Francisco General Hospital are the underclass, the homeless, the mentally ill, the drug-addicted. No one can call her a fat cat or complain about her salary.
"You want to know what I think about that point of view [the one advocated by ACT UP]?" she asks, her eyes narrowing and taking on a hard glare. "It's elitist, selfish, and narrow-minded," she blurts as if the words were all one.
It's late on a Wednesday afternoon on Ward 86. The sun pours in through the window, casting shadows on Joey's face as he sits on the exam table.
Strauss shuffles through his papers, reminding herself of the particulars of Joey's case. "You're not very good at taking care of yourself are you?" she scolds.
Joey stammers, "I'm good."
"Your last visit was in October and before that July. You like to skip a few months," Strauss says, riffling the sheaf of pages again.
Joey is disappointed today. He started Crixivan two days ago and has had nothing but trouble: nausea, diarrhea, and headaches. So he stopped taking the drug.
"I was doing it wrong," he says. "I didn't know you had to drink a lot of liquids with it."
Strauss peppers Joey with questions. How much are you smoking? How are you emotionally? Have you lost or gained weight? How bad is your nausea and diarrhea? Do you want to take another protease inhibitor?
"No, I will give this one a shot and I promise to adhere to all the policies," Joey says.
Joey's daily regimen looks like this: 11 to 13 pills a day. Two Crixivan pills three times a day on an empty stomach. One 3TC pill and one d4T pill a day. And a few anti-ulcer pills a day depending on need. Not bad, some AIDS patients have to take up to 40 pills a day.
In June 1995, the last time he had blood work done, Joey's viral load was at 42,000 (a middling amount of HIV), and his T-cell count was a troublingly low 299. "But that was up from nowhere," he says. As AIDS patients go he is doing OK. Not great. But not bad. He has no opportunistic infections.
But he has blood in his stool, he tells Strauss, and he has had abdominal pains for years.
She performs a rectal exam.
The next day, Joey calls an acquaintance.
"It's been a real bad night," he says in a shaky voice. "Laura thinks I have colon cancer."
The line goes silent. Then:
"I'm beginning to think," he says, steadying himself with a chuckle, "what's next?"
What's next is that Joey is going to be needing a lot more help than can be found inside a pill bottle. Joey's going to be keeping a small corner of the AIDS social service structure very busy. With any hope, for a long time.
Joey Richardson is a pseudonym for a San Francisco man living with
