meds (thank you gary)

i arrived home on a friday night in august to find a message from an nyu study nurse. he said he got the results of my latest blood work back and he wanted me to give him a call. it didn't take a genius to guess that the results weren't good. i debated whether to call him back then or wait until the next week; i decided to call him back then and hear whatever presumably bad news he had for me immediately instead of waiting until monday and probably worrying about it all weekend. i called him back and he was very concerned, my cd4 count had returned to below 300 and my vl was 56k or something like that. he recommended that i talk to my doctor, he's probably not available tonight he said, but i should call him monday. he told me that he thought i should be on meds. i did not want to hear this. i did not want to hear any of it. it was news that i wanted to wait another 10 years for. i was somewhat surly during the conversation and when he told me that it wasn't as if something was going to happen next week i asked him if that was a guarantee and laughed, long and loud, so i don't know what his answer was to my smartassed and insincere question.

i understood that he was being nice and that there was no reason for me to be angry with him, but i was angry with him. i rationalized that he wasn't my usual study nurse and he didn't know what my numbers had looked like through the last couple of months (though he could have easily flipped through my binder and checked), i thought that he hadn't looked at the percentage of cd4s but only the base number, which can fluctuate and in some ways i felt was not as meaningful as the percentage which he had not given me (i'm sure as a study nurse who had been working with hiv for years he knew that though). i latched on to the fact he left this message late on friday, which is generally not the best time to leave someone with medical information that they can do nothing with until monday. all of these gripes/reasons, while true, hardly cover why i was upset. like i said, i really didn't want to go on meds so, to that end, i did not call my doctor on monday. i called and left a detailed message on wednesday with the relevant numbers. he called back to let me know he got my message, but said nothing about the numbers so i took that as license to ignore the information my study nurse gave me and go along with the plan of getting blood work done at the end of august and seeing my doctor around the middle of september. i knew, on some level, that seeing him or getting my blood work done earlier would be a good idea, but, as my doctor had said nothing about it, i was up to not saying or doing anything about it either.

somehow, are there really any actions we take or don't take that can be covered by 'somehow'? i submit that there are not. instead of ‘somehow’, for one reason or another, this topic never came up in my sessions with my therapist until the day before my doctor’s appointment. i had been thinking about it off and on before then and i'm surprised i didn't bring it up with her the week after it happened. in the intervening weeks i had calmed down a quite a bit from my unreasonable anger with the study nurse and had been thinking about sending him a note to thank him for calling me and to apologize for being such an ass, at the same time mentioning that friday evening isn’t the best time to leave a message like that (i still haven’t gotten around to sending that note). maybe i didn't want to discuss it because i didn't want to acknowledge the possibility that i would need to go on meds, i suppose it took until right before i was to see my doctor for the impact of what the study nurse had told me to distill into a more easily digestible form; or, more likely, i could put it off no longer and wanted to at least address the possibility with my therapist before i faced the reality with my doctor. i knew that unless the cd4s went up it would be difficult to rationalize any delay of therapy, the antiretroviral kind that is. i told her about it and came to the conclusion that i should have moved things up like my study nurse had suggested, but by that time there wasn’t much i could do except to acknowledge the wisdom behind that missed course of action.

i saw my doctor the next day and my cd4s had indeed gone down. as always, he asked me what i wanted to do. i had held out against starting antiretroviral therapy because i felt it wasn’t quite necessary (i had always been able to cling to something to justify not taking meds), i didn’t want to take medication for the rest of my life and because i always try to do without medication, whatever the ailment. oh yeah, and most importantly, taking medication would reinforce the fact or the idea that i was sick. i was constantly clinging to the hope that my cd4's which had been slowly climbing despite truly stellar vl numbers would continue, or at this point resume, their slow ascent. during a previous visit i had asked why my vl was so high and yet my cd4 count was still going up; he told me that it may be that the virus was naturally not as fit and although there were many copies they weren't particularly good at bringing my cd4s down, he had also said something else, less to my liking, but the possibility of a slightly ineffective viral strain was appealing enough to me to allow me to ignore anything else he had mentioned and focus on what i wanted to hear: that i didn’t need to start taking meds. it reminds me of when i received my positive results and they told me that there was the slightest possibility that it was a false positive because the diagnosis they were giving me was based on viral load instead of the hiv antibody tests, which had not come back at that time. this was very unlikely because of the high vl the test found, but they did say it was a possibility, and i rode that horse of hopefulness for as long as i could, then the antibody tests came back and confirmed that i was indeed positive. getting back to my conversation with my doctor, and answering his question with a question of my own: i asked him what he thought and, as if i didn’t know, he thought i should be on therapy.

i was ready to admit that i needed pharmacological help at this point. i had been thinking about it for almost a month, since my conversation with the study nurse from nyu. i wasn’t happy about it, but i agreed that, with this second test showing a falling cd4 count, i would begin therapy. he then asked when i wanted to begin. (i thought it was an odd question and assumed that once you decide to start you would naturally start right away) and i replied that i supposed the sooner the better if i’m going to do it, he agreed.

i left my doctor’s office with my prescriptions and a certain sense of sadness and disappointment. though it may sound silly i petted my hand on the subway as i rode back to brooklyn and gave myself and my t-cells a little pep talk. i told myself/us that we put up a good fight, but in any war reinforcements are needed and there was no shame in taking meds, there is no shame in needing help.

i then proceeded to shore up my resolve to take meds by coming up with good reasons to do so. the two foremost are that at least i am doing something, that i am taking some action against this virus instead of my usual passive stance of waiting to see what will happen. the second reason is that when, or even if, i tell my parents about my status and they ask if i'm taking anything if i were to reply, 'no' they would freak out even more; not the best reason, but one that made me laugh.