Part 1

He hadn't heard the receptionist the first two times she called him; his thoughts were someplace other than the doctor's waiting room. When she finally got his attention, she was mispronouncing his name.

"Mr. San Ray-feel."

Marc hesitated before standing up. He was fighting the feeling that when she had called him earlier—when he hadn't been paying attention—maybe she had said or done something to hint at the reason for his visit. From his seat in the far corner of the room, he had to walk toward the doctor's office in front of about twenty pairs of eyes. Dr. Gabriel was a specialist in infectious diseases who handled many kinds of conditions, but he was famous for treating AIDS patients. The others in the room will know about me, Marc thought nervously; then he forced himself to cross the floor calmly.

The idea that the waiting area might be filled with people facing the same trouble that he was did not occur to him until he was sitting alone in the examination room. He leaned his head against the wall and waited for the doctor. Maybe the first test was wrong, he told himself, a cruel joke or mistake somehow. I could sue. God, please let it be a mistake. Come on, God. I haven't been a bad person. Let me off this one time….

Dr. Gabriel looked over the file the nurse had left for him—Marcus San Rafael, initial positive for HIV, overall health good.

"Married," the doctor said softly to himself. This diagnosis was never easy to deliver. People still heard a diagnosis of HIV-positive as a death sentence, even with treatment available. Some got angry. Some became so distraught they thought of killing themselves, rather than face the suffering they believed was inevitable.

When you told people they were HIV-positive, of course, you also had to instruct them to inform any of their sexual partners, or to give the authorities as much information as possible so that people could be contacted and informed within a few weeks. The doctor was usually able to keep the initial consultation cut-and-dried and let the patient process his or her personal issues over the course of a few weeks. Even those with live-in partners usually took a little mental and emotional time for themselves, to assess their own condition before confronting the suffering it might bring to the lives of others.

For all infected individuals, a meteor shower of fears assembled instantly and came hurtling at them all at once—the fear of their own suffering and death, the fear that people they loved would leave or be taken from them, the fear that they had already made someone else sick, the fear that their financial situation would become impossible. Many of their fears they couldn't name, but often they still tried to deal with all of them at once.

Dr. Gabriel took a deep breath as he entered the room. "Hello, Mr. San Rafael," he said, positive and businesslike, keeping his eyes on the chart that he had already memorized. "How are you today?"

"I guess you'll tell me," Marc said, trying to be light and casual.

"Well, let's see. You've tested positive for human immunodeficiency virus, and your follow-up test confirms these results. So, we're here today to talk about care for you."

Marc was only half-listening to the doctor. His thoughts careened and bounced off one another like bumper cars at the amusement park. Oh, no. Hold on, dude—no crying, no screaming. But I want to do both. What am I going to do? I feel like I am going to throw up. The doctor is there looking at his damn chart, waiting for me to say something. Say something to the doctor, Marcus, say something.

"Wait, hold up. You mean I have AIDS?" he blurted out.

"No, Mr. San Rafael, you have had two positive tests for the human immunodeficiency virus—HIV. The second test is fairly detailed and very reliable. It just shows that the virus is present in your body, and in enough quantity to be of concern.

"It is true that HIV can become AIDS," the doctor added. "If your immune system is disabled by the virus to the point where you contract two or more illnesses that your body can't fight—what we call opportunistic infections—you will be considered to have AIDS. But it is also true that there is treatment available that can prevent that from happening."

"But, Doctor, I don't understand. If I have this, why don't I feel sick?"

"A virus is a living organism, but HIV is a retrovirus. It can't live on its own. It must connect to the genetic material in white blood cells in order to live and multiply. Once it is inside, it starts destroying your white blood cells. The more your white blood cell count is reduced, the harder it is for your body to fight other viruses, bacteria, or fungi that produce disease. Unless or until your immune system is severely weakened, you may not have symptoms. You may not even feel sick."

"When will I feel it?" Marc asked, still clearly in shock.

"When we evaluate a patient's progress with the virus, we look at the count of a certain type of white blood cell that we call CD4. The average healthy person has a CD4 count of 700 to 1,200. We become concerned when the level drops to half the normal immune level, but even at 350, people can still be doing well. It's possible that at some point you may develop flulike symptoms. We usually don't begin treatment with antiretroviral drugs until the count reaches 200 or lower, but the option is available once you hit 350."

"So, you'll give me medicine and I'll get better?"

Copyright © 2006 by Luis Cortés, Jr.