Five Quarts_ A Personal and Natural History of Blood - Bill Hayes [10]
But that faith is tested. Every three months Steve gets his blood drawn. Where, historically, the removal of blood was a remedy for disease, in modern-day phlebotomy it’s done for diagnostic purposes and to gauge how a treatment is working. Nothing brings Steve and me more down to earth than the reality of bad blood counts. Nothing launches us higher than when the results say his virus is “undetectable,” which has lately been the trend. That it’s found to be undetectable is a delicious oxymoron. What this means technically is that so few “copies” of HIV exist in his bloodstream that it cannot be measured. The virus, in essence, is neutralized, not rapidly replicating and therefore less capable of inflicting harm. It also speaks to the limits of present technology. The amount of virus Steve has simply falls below the radar. While, in truth, an undetectable virus is as much of an illusion as Galen’s Vital Spirits, the word nonetheless carries tremendous weight. Right now, it’s the closest we have to “cure.”
To the extent that one can manage a life-threatening disease, Steve has been unusually successful, adhering without fail for years to a difficult regimen of pill taking. “Comply or die” is his motto, though I doubt ACT UP will make a T-shirt of it. Since starting on protease inhibitors in late 1995, he’s had no AIDS-related illnesses, although painful nerve damage caused by earlier drugs (a condition called peripheral neuropathy) persists. Along with his meds, he does everything he can to keep his mind, body, and blood as healthy as possible. I would fault his one bad habit—an overly fond attachment to Diet Mountain Dew—were I not similarly addicted.
Steve has blood drawn about two weeks before his scheduled doctor’s appointments, so that the results will be waiting when he arrives. The logistics are no more complicated than that. It’s a cakewalk compared with how convoluted taking blood became in the Middle Ages. In the fifteenth century, for example, the process depended on a fussy convergence of factors, owing more to celestial bodies than to the patients’. A physician took into account the influence of the sun and moon, the principle being that earthly tides were reflected in the flow of humors. Signs of the zodiac were, in turn, linked to body parts. Aries, for example, was matched to the head, so in late March blood would only be let from the temple. In time, the calculations got so Byzantine that a doctor had to rely on bloodletting calendars and handheld devices adopted from astronomy to determine the right moment to snip a vein.
Steve’s quarterly blood draw has always been a joint ritual, in which I drive the car and provide companionship. After all these years, it’s still nerve-wracking, yet, thankfully, we’ve come a long way from the time when the results were so consistently poor that his doctor stopped testing his blood altogether. For the past ten years Steve has used a lab called Immunodiagnostic Laboratories, located in a downtown medical building. The door to IDL looks like a private eye’s office in a film noir: hand-painted black lettering on thick mottled glass, a dark oak frame, a well-worn mail slot. Unless you had business within, you’d be hard-pressed to guess what’s behind it. The tiny waiting room inside is narrow and dim, an overheated den dominated by old magazines.
Same magazines, different location: the old-fashioned barbershop, alive and well today in small-town America, with its trademark candy-cane pole out front. This, like IDL, is a descendant of medieval bloodletting establishments. Back in thirteenth-century Europe, venesection was the specialty of the “Surgeons of the Short Robe,” who were also called barbers. (“Surgeons of the Long Robe” performed more elaborate operations.) Barbers also cut hair, stitched minor wounds, gave enemas, and extracted teeth. At this stage of worldly enlightenment, it was considered healthy for an individual to be bled a couple times