Nobody Gets Out of Here Alive

Patrick Gourley arrives at the Infectious Diseases Clinic on the fifth floor of the old city hospital and walks into his cramped office, which includes both a desk and an examination table.

Gourley, head of nursing at the clinic, pulls a small, clear plastic container out of his purse, sighs and begins his morning ritual.

The container has four compartments, each holding a variety of multi-colored pills. He opens one of the compartments and pours its contents onto the desk. He picks up the three orange capsules containing Sustiva, a non-nucleoside reverse transcriptase, first. He hates this drug the most, because one of the side effects jars his central nervous system, making him feel edgy and wired for two to three hours. He makes a face and quickly downs the pills with a gulp of water.

Next he picks up the rust-colored Zerit capsule, a nucleoside reverse transcript inhibitor, and swallows it. He hasn't noticed any side effects from this pill yet, though long-term he worries that it will poison his mitochondrion, the "engines" that make the cells in the body run. Mitochondrial toxicity can lead to muscle-wasting and nerve damage.

With the first two drugs out of the way, Gourley crunches up the five baby-blue caplets of Viracept, a protease inhibitor, and dumps them into the rest of the water. He prefers this method -- otherwise, the pills practically explode into powder when they come into contact with his saliva, choking him. Viracept is another drug that causes diarrhea in the short-term, though not yet for Gourley.

Worse -- at least for a man who laughs and calls himself "a vain old queen" -- is what the Viracept may be doing to his looks. Although it's unclear whether it's the drug or the HIV that's messing up patients' fat metabolism, doctors currently believe it's the former that's draining fat from its usual places -- in Gourley's case, his face, causing the skin to sag, and his ass, so that his pants have nothing to hang on -- and storing it in unusual places, such as the infamous "buffalo hump" of fatty deposits in the shoulders and neck, or in Gourley's pot belly. With one last sigh, he drains his blue "slurpee."

Having disposed of those nine pills, Gourley turns to the supplements: three capsules containing fish oil and three more pills containing 1,500 mg. of Niacin to lower his cholesterol and triglyceride levels, which have skyrocketed because of the Viracept. He then takes a pill each for calcium and magnesium because the drugs are thought to adversely affect bone density, a vitamin C and a multivitamin for general health, and a "baby aspirin" because, after all, he's 51 and has the high cholesterol and triglyceride levels that may precede a heart attack. He has to repeat the performance twice a day. At night he adds to the supplements with Coenzyme Q and something called NAC to help combat the mitochondrial toxicity.

That's eighteen drug pills and another dozen supplements that he has to take every single day of his life -- without fail. For Gourley, like many other AIDS survivors on the so-called drug cocktails, the cure sometimes seems worse than the disease -- but cruelly, this medicine doesn't even cure. If all goes well, the regimen merely keeps the disease in check. Even then, the drugs are so tough on body and soul that some survivors grow weary and give up the pills and either succumb to the disease or, for reasons doctors don't yet understand, live on.

In Gourley's case, however, the effort and the side effects certainly beat the alternative. A photo on the wall reminds him of that. It's a picture of five men standing in the sun outside a bed-and-breakfast inn at the San Juan Pueblo between Taos and Santa Fe. Two of the men in the photograph, including his lover of fifteen years, have died. Killed by a plague that also strangled a cause.

Patrick Gourley was born in 1949 and raised on a farm outside La Porte, Indiana, a farming community of a few thousand. His parents were Irish-Catholic, his father an even-keeled family man who didn't drink or carouse, his mother an OB/GYN nurse who loved babies, especially the five of her own. Gourley's parents didn't have a lot of money, but they insisted on sending their brood to Catholic schools overseen by an Irish order of Holy Cross nuns. They were Democrats, proud of their heritage and dedicated to the church even in the face of prejudice: Gourley's father recalled that when he was a boy of six in the 1920s, the Ku Klux Klan burned a cross at the end of the lane because his family was Catholic.