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Cheery pictures of rainbows, stick people, and animals with five legs -- drawn by other pediatric patients -- hang from the walls of 6 East at UCSF Medical Center. Medical equipment and stuffed animals are scattered around the room. Metko raises his eyebrows with boredom, his headphones hanging around his neck. He estimates that he has spent 15 percent of his life at the hospital. Now he comes once every eight weeks.
The nurse prods his arms and wrists with mild frustration. She had to take the first needle out because she missed a vein. "This is what four years of heroin will do to your veins," he says. "Mine are all scarred, or they've collapsed. There's hardly any good veins left."
Manio and the other nurses bustle around Metko in a complicated dance of needles, blood, hands, and color-coded vials for lab tests and a T-cell count. After they finish he waits calmly, expressionless, drumming his fingers on the blue armrests.
A doctor brings him a grocery bag overflowing with medicine. At the end of the visit Manio hands him $20. She pays all the patients to encourage them to come in for their checkups.
Unlike many of Manio's patients, Metko is not poor, but he is remarkably aware of other people's suffering.
"The world is going to hell," he says. He happily calls himself a misanthrope. "I just can't imagine bringing a child into the world right now. Either people are making insane amounts of money, or they have seven kids and three jobs and they're making just enough to have a one-room apartment, and they can't even buy the good cereal, they have to buy the generic cereal. Nobody should have to buy the generic cereal."
Now, eight months after that hospital visit, Manio has retired from practice at UCSF, and Metko says he has fought most of his demons.
"I'm as healthy as I've ever been," he says. "My life is stable -- I've got a steady job and I'm getting along with my grandparents. I went to Holland with my band, got hooked on heroin, but I kicked again. That was really tough -- harder than it was the first time around. But this is a really creative time for me, mostly because I'm constantly encountering things from my past and resolving them."
He catches the light rail to meet his dealer and buy more weed. Two stops later, a girl with dyed red hair and a lip ring gets on; they recognize each other. He gives her a hug and then sits back down. She stares out the window for a while.
"Hey, Metko, remember Laurie? She died. Of a heroin overdose." The girl stares out the window again, then yawns.
"Really?" Metko seems interested, but not surprised.
"They found her in St. Mary's hospital on the sixth floor, passed out in the bathroom. We're having a memorial for her tomorrow, if you want to come."
"Well, may she rest in peace," he says, standing up. It's his stop.
Metko is one of 479 children in California known to be born with HIV and then diagnosed with AIDS. He's one of more than 8,000 children in the United States who were infected with HIV at birth. He eats breakfast every morning, brushes his teeth every night, and doesn't dwell on his probable early death.
But some gray mornings when he wakes up, he wishes his life weren't such a game of chance. Wishes his grandmother didn't nag him to take his pills on the hour. Wishes he didn't have to worry that the woman of his dreams will be too afraid of AIDS to marry him. Wishes he didn't have to worry that every little cold might be his last. Wishes he weren't born with HIV.