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Mother and Child

ANNIE BARELY LOOKED HUMAN when I first saw her. She was admitted with an allergic reaction to one of her medicines. Bactrim had made her skin slough off almost entirely. The tissues underneath her skin weeped fluid and pus. The drug she was given for her pneumonia, the alternative to Bactrim, dropped her blood sugar, which led to seizures. She lay in her hospital bed intubated, unconscious, and twitching continuously. I thought to myself, “We’ll never save this one.”

Over the next week she slowly improved. When her seizures were controlled with medication, she woke up. She was extubated and breathing on her own the following day, and her skin started to heal. At one point the new skin was a considerably different color from the remaining crusted old skin. She had a marbleized appearance, and I was worried she would be left looking grotesque. By the time she was ready to be discharged, though, she had her normal coffee-brown skin back again. Her swollen amorphous face had turned back into that of a young woman. She was short, neither fat nor thin, animated, and inquisitive.

I saw her name on my clinic appointment list two weeks later. When I came into the examining room, I was surprised to see a four-



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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Mother and Child ANNIE BARELY LOOKED HUMAN when I first saw her. She was admitted with an allergic reaction to one of her medicines. Bactrim had made her skin slough off almost entirely. The tissues underneath her skin weeped fluid and pus. The drug she was given for her pneumonia, the alternative to Bactrim, dropped her blood sugar, which led to seizures. She lay in her hospital bed intubated, unconscious, and twitching continuously. I thought to myself, “We’ll never save this one.” Over the next week she slowly improved. When her seizures were controlled with medication, she woke up. She was extubated and breathing on her own the following day, and her skin started to heal. At one point the new skin was a considerably different color from the remaining crusted old skin. She had a marbleized appearance, and I was worried she would be left looking grotesque. By the time she was ready to be discharged, though, she had her normal coffee-brown skin back again. Her swollen amorphous face had turned back into that of a young woman. She was short, neither fat nor thin, animated, and inquisitive. I saw her name on my clinic appointment list two weeks later. When I came into the examining room, I was surprised to see a four-

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti month-old baby in a stroller next to her. She asked if I minded if she heated up the baby’s bottle in the sink while we talked. She was very concerned and attentive toward her child. Several times as we talked the baby cried and she went over to him and tried to get him to take a pacifier. She was 27. She had used drugs heavily as a teenager. Now she was married to an auto mechanic. She hoped to return to school to get her high school equivalency diploma. Four months after her child was born she was admitted to the hospital with pneumocystis pneumonia. We had already seen some children with AIDS, but this baby boy seemed healthy enough, though, husky and laughing robustly. In the middle of a sentence, as we were talking, Annie shrieked and jumped off the examining table. She ran to the sink, where she had put her baby’s bottle to warm up. The bottle had blocked the drain and the sink was overflowing with hot water. A large puddle was soaking into the rug underneath the sink. She couldn’t get the bottle out of the drain because the water was so hot. Her shriek had frightened her child, who was positioned between the sink and me. He started to howl. Since she had put her examining gown on backward, it opened in the front as she jumped off the examining table, and her breasts jumped up and down furiously as she bolted from the examining table to the sink. With no regard for her own modesty, she tried unsuccessfully to shut the water off in the sink and remove the bottle with one hand and give the baby his pacifier with the other. Finally, I shut off the water while she pulled her baby from his stroller and nestled him between her breasts. There, between her breasts, the pacifier, and the bottle, he eventually returned to his former state of contentment. The nurses in the clinic had heard the screaming and were pounding on the door. “Just a little accident. Nothing to worry about,” I told them and I found myself chuckling despite myself. Annie’s child made her a “research interest” to the faculty studying how children got AIDS. She asked me if it were possible that her baby and her husband might have the disease also. I told her it was a

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti possibility. The baby barely whimpered when the blood sample was taken. Annie comforted him with a lullaby that was curiously twisted: “Hush baby, don’t you cry, momma’s gonna be all right.” The numbers of AIDS patients I was caring for and the overwhelming nature of their problems were beginning to numb me. This was particularly true for my Haitian patients, in whom I saw the same vicious cycle repeated again and again. AIDS led to loss of work, which led to enormous social and economic problems and ultimately to death. Although I could talk to them only through a translator, and although I could do precious little to treat their illness or help with their social problems, they continued to smile and thank me after each visit. In terms of sheer numbers, however, the Haitians were decreasing while the numbers of gays and drug users were exploding. It seemed the epidemic was evolving out of control. Every time we figured out a piece of the puzzle it changed into a whole new puzzle. Time passed week by week, and the number of patients I cared for continued to grow. I can no longer remember the details of each case. Usually, when someone missed an appointment, it meant they had been hospitalized or, worse, had died. Each Thursday some of the patients who came to the clinic were sick enough to require immediate hospital admission. The housestaff began to dread being on call on Thursdays. AIDS had intruded into my daily life more than I could have imagined. The phone rang and awoke me from sleep all too frequently, with calls from sick or anxious patients. Real and imagined problems surfaced daily. Even during breakfast, as I sipped my coffee and read the newspaper, I recognized an alarming number of names in the obituaries Meanwhile, Annie was in the hospital three times with pneumonia. Between admissions she suffered with painful swallowing and existed on a liquid nutrition supplement. Unlike many of the patients, her strength did not erode after each acute illness. When I saw her after she was discharged from the hospital, she would usually

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti come into the clinic as saucy as ever. I breathed a silent sigh of relief each time I saw that her child continued to grow and stay healthy. One day she asked me straight out, “Am I going to die?” “So far no one has lived longer than four years. We can only hope that in the near future we’ll find a treatment or a cure.” “It was that damned dope!” she sobbed quietly. “Everyone was doing it. We just thought of it like candy.” She cried uncontrollably for 10 minutes or longer, and I just sat there. “What about my baby?” “You mean, if you die?” I tried to dodge the issue of whether her child would get AIDS or not. “He’s just a baby. He’d be all alone in the world without his momma.” “I suggest you make whatever plans and arrangements you can now, while you’re still fairly healthy.” “I’m not coming here anymore, Dr. Fournier. I mean I appreciate what you are trying to do for me and all, but why should I pay my husband’s hard-earned money when I’m going to die anyway?” With that statement she got off the examining table and began to change without even waiting for me to leave. I made her make a return appointment in case she changed her mind. At the same time, Herminio was undergoing a slow physical and mental descent into something less than human. He seemed to age a decade between each monthly visit to the clinic. His hair was now totally white. His gums were receding. Large gaps showed between his teeth, so that when he smiled he looked like a jack-o’-lantern. His clothes looked shabbier, and with each visit his belt buckle grew one notch tighter. Soon stains began to show from the back. He let his beard grow, and his hair became matted and greasy. He refused to go to a nursing home. He continued to live with his mother, to whom he still refused to tell his diagnosis, and a wizened old uncle, who was rapidly looking younger than he did. Toward the end, Herminio was too weak to walk unassisted. They

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti would help him into the clinic by supporting him under each arm. Upon seeing me he would shout with glee, “Dr. Fournier!” His uncle, who spoke only Spanish, would signal to me that he was crazy, by circling a finger next to his ear. While I saw him, he would alternate between laughing and crying. He had an unusual kind of tuberculosis throughout his body, and he was not responding to treatment. At one point he disappeared for several months and I thought for sure he had died. Then he returned to the clinic, looking worse but still surviving. He was admitted to the hospital for the final time while I was away on a trip. After I returned, Margaret told me she had admitted him but had decided not to continue any of his treatments and to just make him comfortable. I told her I felt this was the right decision and that I would stop by to see him. She said she thought that he would appreciate that. He turned his face from the window as he heard me enter his room. The nurses had shaved him and washed his hair. This restored something of his former appearance. He greeted me with a look of pleasant surprise. “Dr. Fournier, I didn’t know if you would come.” “I was away when you were admitted. Otherwise I would have had you on my own service.” “I think it’s time to call the priest and the florist.” He managed a faint laugh. “I’m afraid this time you could be right.” “I’m sorry, Dr. Fournier.” “It’s not your fault.” “Yes, it is.” With this he turned his face back toward the window. “Do you want me to say anything to your mother?” “No, I don’t want her to know anything about this.” “Don’t you think she may have guessed?” “I don’t care whether she guesses or not; I just don’t want her to be told.” We were both quiet for several minutes. I was beginning to feel

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti uncomfortable and tried to think of the right thing to say before leaving. Herminio spoke first. “You are like God to me, Dr. Fournier.” He raised his voice and called out to nameless people passing in the corridor: “Dr. Fournier is God!” He grabbed my hand and kissed it. “Whenever I see you, it gives me hope.” “Look at you. Can you seriously believe that? I’ve been your doctor for the past year and a half, and you’ve gotten continuously worse.” “No matter. When I see you there is hope.” “We’re not giving you medicines anymore. You will be going to a nursing home as soon as they can locate one that will accept you.” I left the room and quickly found a sink to wash my hands. Herminio’s kiss had unnerved me. I visited Herminio two more times. The third time I stopped by his room it was occupied by another patient. The social worker on the floor informed me that she had found a place for him and that he had been transferred there earlier that morning. Although he was given a follow-up appointment, he never came. I assumed he did not last long in the nursing home.