Buddha Mommy

It didn’t start with Jeffrey, but he was a catalyst. Thru out the 1980’s and early 1990’s, Jeffrey was my friend and hairdresser. Jeffrey never hide his sexual preference. I could see his deterioration over time, slow and steady. He offered the name of his physician who I knew was one of the few people doing HIV care. Jeffrey loved Halloween. His birthday was three days before. Somehow, it was fitting that he was “found dead” in his cherished home on Halloween, 1993. Suicide or death by AIDS, I’ll never know. A thirty-three year old man shouldn’t have died. He left a hole in my life.

As I began nursing school in 1980, a new disease, as yet unnamed, was being acknowledged. By 1983 when I graduated, more definition to the disease was available. Fear was dominant, while understanding remained elusive.

I continue to try to understand I was never caught up in the fear. My first clinical nursing instructor in 1980 taught us never to wear gloves while taking care of a patient. It didn’t matter if you were dealing with blood, stool or any other body substance. Wearing gloves would (in her words) offend the patient. By 1983, if we cared for a patient with HIV/AIDS, we were required to wear eye gear, gloves, a mask and a full body cover. In three years we went from no protection to no contact. I followed the hospital rules. Despite several needle sticks or body substance exposures, I never worried about myself. Not to say I was careless, just not overly concerned. Today, trying to understand why I wasn’t caught up in the fear, all I can say is my gut (I call it my ”spider senses”) never warned me of danger. Fear is an emotion that divides us rather than unites us.

Fast forward to 1996. The merger of VMC and Community hospital resulted in the elimination of my position as clinical nurse specialist for the ICU at VMC. It was a job that fit me like a glove. I couldn’t imagine doing any else. No matter. Reality was it was time to do something different. I attended Fresno State to become a nurse practitioner.

When I graduated in 1998, I had no idea about what I would do as a nurse practitioner. All I knew was that I wanted to continue serving the underserved and that I particularly wanted to work with women. Late in 1999 when I was offered a position with UMC Special Services working primarily with HIV + woman, children and families, I knew this was it! Of course, my HIV knowledge was lacking, as the disease was already going underground. My wonderful colleagues, both nurses and doctors, helped me get up to speed. These were exciting years as new medications became available as never before. I thought often of Jeffrey. In 1996,three years after his death, HIV started to become a chronic illness thanks to potent new medications. Hope had been on the horizon.

The women and their children! We had many uninfected babies together. Each birth was a celebration, a relief. So many women are in my heart. Three in particular have come forward in my memory.

Susan. Susan and her husband were both infected. She had challenges with drugs and alcohol. The family, two adults and five children, were frequently homeless. When Susan found herself pregnant again in her mid forties, it was time to acknowledge her co-infection with HIV/Hep C. She had an AIDS diagnosis going into prenatal care. Her track record for medical care, in genera, was dismal. As many of my pregnant women were, Susan was high maintenance. Homeless, hungry with many mouths to feed, habits that frequently made her difficult to locate, and a husband who was more often an obstacle than a help. We couldn’t seem to engage her in her prenatal care. During her fifth month of pregnancy a chance circumstance brought me into a review process of infant deaths in Fresno County for the two years prior. As I reviewed the cases, I found one that helped me understand and care for Susan. It was the case of a 6-week old infant who, by all accounts, appeared healthy at birth and then suddenly died of pneumonia. The parents? Susan and her husband. I was stunned. In her prenatal history, there was no mention of this child or the pregnancy. On the statement of death, no explanation was posited as to a reason for why a healthy 6 week old would die from pneumonia. I knew why and how I might reach Susan.
After tracking her down, I sat down with Susan and asked her, “Tell me about Cisco”. Her eyes grew wide as she jumped out of her chair to run. In addition to other prior parenting issues, Cisco’s death had wrapped the family under the eye of CPS. Susan was a fierce mother bear and didn’t want her children taken away. I found out that she knew her HIV status during the pregnancy and never told her Doctor. She was also never tested during this pregnancy despite the 1995 recommendation that HIV testing be offered to all pregnant women.
This was our key to getting her to comply with our care plan for this baby. And she did comply and became the model patient. A healthy, uninfected baby boy was born. Two years later, once again not in care for herself, Susan died from fulminate liver failure from her Hep C. She left behind 6 boys.

Sharon. I wish I could say that under my watch, no infected babies were born at UMC. That of course, is ego and impossible. The women carried for by our Special Services program during their entire pregnancy gave birth to uninfected babies. Once in awhile, an infected woman, not in our care, would give birth to an infected baby. One such woman was Sharon. Sharon showed up in the emergency room, seven months pregnant, known HIV infected, with severely infected abscesses from her on going heroin use. A captive audience in the hospital on antibiotics, we began her antiretroviral treatment. At seven months gestation, there was a chance that the fetus wasn’t yet infected. A short period of time into her ARV therapy, Sharon suffered a complication of pregnancy called abruptio placenta. Samantha’s birth was early, traumatic and resulted in maternal/child transmission of HIV. Samantha ended up in the NICU where she became the darling of all the nurses. Meanwhile, Sharon struggled with AIDS, severe blood loss, heart failure, withdrawal and social obstacles. Sharon’s elderly, ill mother wanted to take Samantha into her life but was unable. Samantha’s father, a heroin user himself, was not in a position to parent. A wonderful nurse, who frequently provided foster care to infants from the NICU, took Samantha into her heart and her home. Over time, Sharon granted adoption to the nurse, and Samantha became a full ledged family member. Sharon died three years after the birth from the complications of her years of abuse. She was a beautiful woman with a great love for her daughter.

Tanya/Honduras. I was heating up my lunch when I got a page from the Woman’s Health Clinic. An HIV pregnant woman could cause a terror in the hearts of staff in the clinic. Add in the fact that the woman is non-English speaking, and panic escalates. What I found was a young woman in her late twenties, very pregnant, holding a bottle of Combivir (a combination pill of two HIV medications). Her sister, who spoke limited English, accompanied her. The young woman was from Honduras. I will call her this as our staff nicknamed her this as a term of affection. She was 8 pregnant months. She walked from Honduras to Central California to find help for herself and her baby. Her young husband had recently died from complications of AIDS and tuberculosis. She had a daughter, age 6 that she had left in Honduras under the care of family. The bottle of Combivir came to her courtesy of family in Florida. They had purchased black market Combivir and instructed her to take one every once in awhile to help the baby. She did.

We took her to the perinatal diagnostic center to take her history, ultrasound her and figure out our next steps. Honduras looked like a deer in the headlights as it all was happening so quickly. Through her sister and other translators I assured her she was safe, that we would care for her and her baby. She burst into tears, thanking me profusely for giving her the medicines she knew she needed for her baby. Never before had someone been so thankful for the harsh medicines she would need to take! As we went thru our process of evaluating her, we discovered Honduras had PCP pneumonia, active tuberculosis and a female fetus that appeared a little over 8 months of gestation. She was admitted into the hospital into isolation for her tuberculosis and PCP. Now she was really frightened! But she was too sick to fight.
Honduras and I spent a lot time together in her isolation room, talking about her journey from her home to the Central Valley. As sick as she was, I couldn’t imagine the stamina and courage it took to make this trek. Whenever I start to whine about hiking a long distance with a pack on my back, I think of her.
We saw her slowly improve over the next weeks. When baby Gabby was born, the whole department breathed a collective sigh of relief. Unlike Sharon’s baby, Gabby was HIV negative. Honduras pined for her 6 year old and we tried to get her brought to the USA. Eventually, with the help of her family in Florida, Honduras, Gabby and the 6-year-old daughter were reunited.

There were so many women over the years. Each with a unique story. Each one is my hero. They showed me what determination, sacrifice and love means. I feel honored to be part of a team of nurses, social workers and doctors that these women have allowed into their life, at a most vulnerable and intimate time. As I cared for each woman, I saw Jeffrey and my own brother Jim. Jim struggled and died from substance abuse related problems. Remembering Jim while working with women like Susan and Sharon, gave me patience to never give up on them. I often hoped that someone would patiently care for Jim during his bad times.
Why do I like caring for HIV infected people? There are few specialties in medicine today that are so dynamic. Caring for those which HIV is the truest blend of social work, medicine and nursing. Every skill you possess, professionally and personally, is challenged daily. But I think the main reason I chose this path is because of people. HIV is a comprehensive condition that effects the whole individual: body, mind, spirit. Patch Adams, MD said, ”When you care, you are the answer”. We may be decades off from a cure or prevention for HIV. Meantime, care is what we all can do.