There's not much sense lecturing someone in an HIV clinic about the long-term hazards of smoking, although Myers suspects a link between smoking and Kaposi's ability to attack the lungs of people with AIDS.
Sam has a more immediate concern. At first, the Daunoxome reduced the swelling in his face and legs, but lately he seems to be having a reaction to the drug. After the last chemotherapy treatment two weeks ago, he vomited for four days straight.
"And now my knee's the size of a football and I can't see," Sam says.
Myers asks him to strip off his shirt and pants. Kaposi's lesions mottle Sam's entire body. He is so thin that his skin seems to cover only bones.
Myers asks about his appetite. Sam, hopeful, notes that he gained two pounds since his last visit.
"Well, it could be water," Myers says. Seeing Sam's smile start to fade, he adds, "but let's consider it muscle." Sam flexes a stick-figure arm and they both laugh.
The laughter stops when Myers tells Sam the bad news. He can't have this week's chemotherapy treatment--his white blood cell count is too low to tolerate the drugs. Sam doesn't say anything, but his disappointment is palpable.
Myers sympathizes: It's hard to do nothing. In the days before AIDS, his approach as an oncologist was to attack a cancer with every weapon he had at his disposal and beat it into remission.
When AIDS-related Kaposi's showed up, it was thought that as an aggressive cancer, it should be treated aggressively. But chemotherapy suppresses the immune system. For people whose natural defenses were already compromised by acquired immune deficiency syndrome, further suppression only invited infections that were more dangerous in the short term than the cancer. Oncologists like Myers had to learn to strike a balance between treating the cancer and creating a bigger problem.
Myers explains to Sam that treating purple spots for cosmetic reasons or even to relieve the swelling in his face wouldn't be acceptable if it opened the door to a more dangerous opportunistic infection.
"We're not trying to cure you," he says. "We're trying to make you more comfortable and hopefully put the brakes on the progress of the disease."
Myers tries to pick up Sam's spirits by prescribing Neupogen, a new medicine that increases the bone marrow's production of white blood cells. "It should get your levels up to where we can get you back on course next week," he says.
Sam squints at Stephen and they both nod. Where there's life...
Myers leaves Sam with a pat on the shoulder. In the waiting area he spots one of his favorite patients, Frank.
The young man sits in a corner with his head on his mother's shoulder. They both smile, and Frank opens his eyes--though he doesn't lift his head--when Myers walks up.
Frank, who's in his mid-twenties, is an inventor who recently came up with the idea of painting Disney characters on venetian blinds that appear when the blinds are closed. Disney was interested in his idea and, the last Myers heard, was negotiating about the rights to the innovation.
As he looks at Frank, Myers knows that the young man won't live to see the deal close. He's just a little guy, maybe all of five-foot-three. And somewhere beneath the distorting edema of Kaposi's is a boyish face that until recently was accompanied by an infectious laugh and Peter Pan impishness. Maybe that was why children always flocked to Frank, who spent his free time taking underprivileged city kids to the mountains for hikes and picnics.
Frank has been a patient for a year and had been holding his own until six weeks ago. But now he's beset by the wasting syndrome and unable to keep food down. Already he looks like a ghost with hollow, ringed eyes and pale complexion.
He's weak and can only nod when Myers asks how he is feeling. His mother rubs his cheek, as though comforting a little boy, and her eyes fill with tears.
Myers reaches down to tousle Frank's hair, then quickly turns away to regain his own composure. Although they had chased death off a number of times, it wouldn't be long now before the bogeyman caught Frank.
Probably this summer, Myers thinks to himself. Maybe sooner. He hates to predict such things, but he has seen too many people die not to know when time is running out.
Not all of the clinic's patients are such angels. Kirk is somewhere on the other end of the spectrum.
Hunched over in his wheelchair, an oxygen mask strapped to his face and connected to the blue bottle behind his chair, Kirk complains about almost everything. In a high, raspy whine, he voices his displeasure about his medication, the time he has to wait to see a doctor, the attitude of certain nurses, his ailments and the failures of medical science in general.