tridd dot com, LGBT in East Texas, Damned Hook, 1of3

The Damned Hook, pt 1 of 3

The instructions for dentists working on HIV patients must go something like this:

Step 1: Avoid the tedium of “drilling and filling” cavities by simply extracting the affected tooth. If in doubt, also extract surrounding teeth.

Tooth extraction has the double advantage of “marking” the patient, making one’s indigent status more obvious in public places, and assuring other service agencies can provide the proper level of care to the various social strata. Who would have guessed such a simple procedure could transform even the most staid and solemn patients into a goofy caricature of their previous selves? If you haven’t seen them, the “before & after” photos will certainly provoke a chuckle!

In all fairness, the real reason dentists are more likely to extract than repair the teeth of HIV/AIDS patients probably has more to do with dollars than “social branding.” They’re simply “repairing” the affected patient using the cheapest solution available, which is removing the tooth altogether. This solution carries the secondary effect of assuring the patient won’t return later with further complications – at least not for the same tooth. The resulting “social branding” is simply an auxiliary result – an unexpected side effect of our current cost-cutting measures.

My tooth had been extracted a year and a half ago, shortly after arriving in East Texas, though it came with the promise that I’d get a bridge or implant to replace the missing tooth. This, it turned out, was one of those things doctors tell their patients so they don’t struggle against the foregone conclusion – which is the fact that I was in a tooth extraction factory, rather than the dental college their sign had indicated. After a year of being rejected for a replacement tooth, I finally gave up & asked my doctor for a “retainer.”

After several further months of asking, I found myself still without an appointment… without a tooth… and of course without the little plastic thingy that included a fake plastic tooth. So I took up the habit of “camping out” – which is to say I would show up at the clinic on designated “dentist days,” hoping to have a word with the good doctor – to convince him of my need.

I was finally granted a brief audience, during which the dentist agreed to make my “temporary partial” – all the while feeling like some 45-year-old version of Oliver Twist, holding up to him an empty bowl and pleading, “Please, sir, I want some more.”

A few weeks later, the dentist’s technician handed me my little plastic thingy. It didn’t fit exactly, but I didn’t care. I was simply thrilled to have the object that might help remove some of the social stigma – my “branding.” I went to Wal-Mart & bought a Dremel tool & returned home to work. After several tedious hours, I had shaped the “thingy” into an object that would fit semi-comfortably into my mouth. Though speaking was difficult (since it filled much of the space under my tongue), I reasoned that I’d be able to work through it – and after several weeks, I was able to speak, for the most part, without a lisp.

The “retainer” thingy lasted for several months… all the way up until two days ago, when I accidentally crushed it. You see, the object was never very comfortable, and I certainly had to remove it to eat, due to the uncomfortable way food would sandwich between my gums and the plastic. I was in the habit of wrapping it in a napkin and placing it in my pocket. On this occasion, it had somehow worked its way onto the floor -- and I had picked it up, thinking it was garbage, and crushed it….

How my bad week really started…

I should have known something was up over a month ago, when my favorite pen went missing. It’s a matte black collapsible job that fits easily into my jeans pocket, so that I always have the writing utensil I’ll often end up needing. A lot of technology goes into them, even if they don’t cost very much these days. Dubbed the “Fisher Space Pen” and nicknamed the “Bullet Pen” (presumably because the collapsed version resembles a bullet) they were developed back in the late 1960s for the Apollo astronauts, featuring pressurized, zero-gravity-proof ink, and a formulation that writes well in temperature extremes. They were made available to the general public back in the mid 1970s, and I promptly bought one. It was one of the only personal objects I brought with me to the Air Force Academy, where I considered it a type of good luck charm, especially considering my dream at that time was to become an astronaut – and ended up using it as a tool to help disassemble my rifle… Oh, and to write with. Back then, they only made one version, and it was chrome silver, though nowadays they sport many options, from colored enamels to the matte black version I had just lost….

No, wait… let’s start at the beginning…

I’m constantly amazed at how severely and how completely the human body is ravaged by the AIDS virus. Since being diagnosed a short two years ago, I’ve been visited by a variety of unusual illnesses from a bizarre strain of pneumonia to thrush to a wicked disease called “Mycobacterium Avium Complex” or “MAC”, which is itself actually an assortment of smaller wicked diseases and which landed me in the hospital for the first time in my life, shortly after arriving in Tyler, TX – where I had presumed I was coming to simply die.

The point of telling you all that is to explain why my doctor wasn’t surprised, four months ago, when my TB test came back positive. “It’s probably not TB,” he explained, “because once you’ve had MAC, you will likely present positive TB results (which is a hardened nodule at the site of the injection) from now on.”

Still, in the interest of prudence, he advised that I proceed with a chest x-ray, hopefully to rule out the possibility of further complications – and this started the process I’ve become all-too-familiar with over the past two years. Once again, I would find myself, like the child in Dickens’ novel, holding up an empty bowl and asking “more, please.” Call it what you like…. I call it “begging” -- begging for healthcare.

When you have AIDS, then there is typically (though not always) a mechanism in place where you can get AIDS medication and treatment. But these structures tend to have strict guidelines that prevent practitioners from assisting patients with most of the opportunistic conditions that almost always arise as a direct result of a compromised immune system. It’s as though the federal government placed placards in the office of every healthcare provider in the country that says, “Uncle Sam has to give you AIDS medications to keep this from looking like genocide, but we truly have no interest in your survival.” In fact, Uncle Sam doesn’t have to do any such thing. There is no federal guarantee of AIDS assistance whatsoever, leaving the decision to each state of whether or not to help.

Fortunately, my doc hooked me up with the county health department, who happened to have an agreement with a local hospital. And while it took them three full months to get me scheduled, I was finally given an appointment for chest x-rays, all at a reasonable cost of under $100 (though when one is on disability, a more reasonable price might have been zero dollars).

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