The People's Hospital: Hope and Peril in American Medicine: Hope and Peril in American Medicine by Ricardo Nuila

Author:Ricardo Nuila [Nuila, Ricardo]
Language: eng
Format: epub
Published: 2023-03-14T00:00:00+00:00

I. Stem cell transplants have long been used to treat leukemia. But use of stem cells for purposes other than creating new bone marrow hasn’t been proven to be effective.

II. Since men have one X and one Y chromosome, X-linked genetic disorders affect men more than they do women. Norma didn’t have Fabry disease because she had another X chromosome to balance out the one with the defective gene. Presumably, she passed the one with the faulty gene to Christian.

— 10 —

Miscalculations

I met Aqueria in September 2016 in one of the Ben Taub ER’s isolation rooms. It was my turn for an admission, and a text message flashed over my pager: “Diarrhea, Weight Loss.”

I noticed two things upon entering her room. First, Aqueria wore a thick sweatshirt atop multiple long-sleeved shirts and a ball cap that wobbled according to how animatedly she spoke. Second, there appeared to be another human being curled up in the stretcher with her, beneath the thin white hospital sheets. This person, I later learned, was Trachelle.

Aqueria and Trachelle were both twenty-one, though Aqueria looked younger. Whenever Aqueria said something during our conversation that Trachelle didn’t fully agree with, a segment of the bedsheets would shake abruptly. Sometimes the sheets emitted an “Uh-uh” or “You know that’s not how it is,” to which Aqueria responded with loving eye rolls.

Physically, that was about all she could do. At the time we met, she was incredibly thin. The weight had dropped off over the past six months. It was a case of simple math: too few calories in, too much fluid out. Anything she ate felt like it got stuck in the middle of her chest while going down and came right back up. The diarrhea never went away. And so her clothes began to sag off her body, she no longer had the energy to walk very far (“It’s like walking through sand”), and her core temperature had decreased. Aqueria had weighed 129 pounds. Now she weighed 79. She’d lost one-third of her body weight. “You’re gonna turn to dust,” Trachelle told her.

Aqueria knew exactly what was wrong with her. “I need my HIV medications,” she told me shortly after we met, the ball cap on her head bobbing again. She’d said the same to the doctors at all four of the ERs she’d visited before coming to Ben Taub, and they had each responded in kind: “You need insurance.”

This was true, and it wasn’t. Aqueria had what doctors call “wasting syndrome.” This was what AIDS looked like in the 1980s and early ’90s, a body vanquished by a virus. At the time, medications only partially treated AIDS. We solved the problem with HAART—highly active anti-retroviral treatment—which keeps the virus at bay, in many cases reducing it to undetectable levels. Today, thanks to these medications, more than seventeen million people worldwide have near-normal, if not fully normal, lives with HIV. This breakthrough may very well be the biggest medical marvel since the polio vaccine.

HAART may have solved the problem

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