I had never felt more helpless than I did standing naked in waist-deep water, watching Howie cough himself half to death. I didn’t know what to do. I tried slapping his back, but it didn’t seem to help. I kept waiting for the coughing fit to subside, but it went on and on. Howie was hacking so hard, he could barely breathe. His face was bright red.
I was about to go get him some water when it occurred to me that if Howie passed out in the pool while I was in the house, he would probably drown. I had to get him out first. He couldn’t stop coughing long enough to climb out himself, so I hooked my arms under his from behind and pulled him backwards to the shallow end. As I dragged him up the gradual incline from pool to patio, I could feel his heart hammering frantically against my hands. His chest was heaving.
“Hold on, Howie, I’m gonna get you some water,” I said, as I let go of him. I left him lying on the patio just long enough to run inside and grab a bottle of water. When I came back, he was crouching on his hands and knees with his head down, his whole body wracked with spasms as he continued to cough uncontrollably. “Here,” I said, twisting off the cap and thrusting the bottle toward him.
With a shaking hand, Howie reached up to take the bottle from me. Water sloshed onto the pavement as he tipped it clumsily toward his mouth, but he managed to swallow some before he started coughing again and spewed it back out. He raised the bottle to his lips a second time, and this time, the water stayed down. It seemed to help some; his coughing started to taper off to the point where he could talk again. “Thanks,” he rasped, setting the bottle down.
That was when I saw the blood. The rim and side of the bottle were streaked with red. My first thought was that Howie had hurt himself somehow, bit his tongue or clipped his chin on the edge of the pool during his coughing fit. “Hey, you’re bleeding. Look here,” I said, taking his face in my hands and gently tilting it up toward me. There were beads of blood and spit at the corners of his mouth, but I couldn’t see any cuts or abrasions. And then I realized: Howie had been coughing up blood.
“I don’t think you should wait till tomorrow to see a doctor,” I said shakily. Whether it was the sight of blood making me squeamish or the implication behind it, I don’t know, but suddenly, I felt sick to my stomach.
Howie nodded, not even bothering to argue with me. “Can you drive me to the hospital?” he asked hoarsely. As he looked up at me, I was startled to see that his eyes were filled with tears. I wasn’t sure if they were just watering from all the coughing, or if he was actually crying. Either way, he looked as miserable as he must have felt.
“Of course.” I helped him to his feet and wrapped my arm around him as we walked into the house, where we picked up the piles of clothing we’d left all over the floor and got dressed in a hurry.
As we climbed into my car and set off for Cedars-Sinai, I was struck with a sense of déjà vu, remembering how Lauren and I had rushed Howie to that same hospital on New Year’s Eve. I had sat in the back seat with his head in my lap while Lauren drove. This time, I was in the driver’s seat, and I didn’t know what I would do if Howie suddenly stopped breathing like he had before. I could hear him coughing and wheezing in the passenger seat, and when I looked over at him, I saw that his whole upper body was working hard for every labored breath he took. His shoulders were heaving up and down, his chest and stomach expanding and contracting rapidly as the air rattled in and out of his lungs. He had buckled his seatbelt, but kept pulling it away from his body like it was too tight.
“Hang in there, Howie,” I said anxiously, as I accelerated through a yellow light. “We’ll be there soon.”
“I know. Sorry about... all this,” Howie apologized, still panting heavily.
“No, I’m sorry,” I said, swerving around a slower car. “I didn’t mean for my sexy body to literally take your breath away.”
He started laughing, which led to another coughing fit. “Don’t... make me... laugh,” he gasped, gulping down some more water.
“Sorry,” I said again, giving him a nervous glance. “I’ll shut up now. Just keep breathing, okay? We’re almost there.”
Howie nodded, leaning his head against the window glass. His face had gone from red to gray. I drove even faster, knowing I needed to get him help soon. How had he gotten this sick so quickly? I wondered, as I sped down the highway, dodging traffic. His cough had concerned me, but Howie had insisted he felt fine. Now he could barely breathe. I couldn’t help but wonder if he’d been straight with me about his health, or if there was something he was hiding.
I wished I’d been there for him these last few weeks, instead of in Tennessee. Having time to myself had been nice at first, but then it had just gotten boring and lonely. As much as I hated to admit it to myself, I had missed Howie. I’d missed his companionship, and, of course, I’d missed the sex. Now I worried I’d waited too long to come back to him, to tell him how I felt. What if he was really sick? What if he was dying? I didn’t even want to consider that possibility, but it was hard not to when he was sitting in my passenger seat, struggling to breathe.
When we got to the hospital, I handed my keys off to the valet so I could go inside with Howie. As we walked into the emergency room, I was hit with the strong smell of antiseptic and another wave of déjà vu. At least this time, Howie was conscious and standing on his own two feet.
The triage nurse who checked him in took his vitals and decided his condition was serious enough to be seen right away. Although it was a relief to not have to wait, it gave me even more reason to worry.
A nurse named Ashley arrived with a wheelchair to take Howie to an exam room. I walked alongside her as she wheeled Howie down the hallway, helping to answer her questions about his medical history. “He’s HIV-positive,” I told her, “and he had a liver transplant this past January. He was just in the hospital like a month ago for rejection, but he’s been doing better since then.”
“Thanks, Nicky,” Howie whispered, reaching out to grab my hand.
“No problem. I got you, buddy,” I replied, squeezing his hand back.
When we got to the room, we were met by another nurse and a doctor. “Hi, I’m Dr. Robinson,” the doctor introduced herself, as the two nurses helped Howie out of the wheelchair and onto the bed.
“This is Howie Dorough, forty-one, presenting with dyspnea and hemoptysis,” said the first nurse, Ashley, rattling off his vital signs. “Heart rate is tachy at 120, resps 30 and shallow, B.P. 140 over 90, temp 99.5.”
“Let’s get him on a monitor,” said Dr. Robinson, as the nurse continued to fill her in on Howie’s medical history.
“Mr. Dorough is HIV-positive, with a history of liver disease. He underwent a transplant ten months ago and was recently treated for an episode of acute rejection.”
“Can you tell me what medications you’re currently taking, sir?” the doctor asked Howie, as the other nurse hooked him up to the monitoring equipment. She had taken his shirt off and was attaching electrodes to his chest.
Howie reached carefully around the wires to the back pocket of his pants and removed his wallet. “Here,” he said, taking out a piece of paper and handing it to the doctor. “That has everything on it.”
I shook my head as I caught a glimpse of the long list of medications and dosages he’d written out. Leave it to Howie to be prepared like that. I wouldn’t have had a clue.
“That’s very helpful, thank you,” said the doctor, scanning the list. “What was the diagnosis that led to your need for a liver transplant?”
“Acute liver failure,” answered Howie, still breathing heavily. “Because of an overdose.”
“Drugs or alcohol?”
Howie closed his eyes. “Both.”
“Are you on anything now, besides your prescribed medications?”
“Any history of heart or lung problems?” Dr. Robinson asked, reaching for her stethoscope.
Howie shook his head. “No.”
“Okay. Let’s take a listen,” said the doctor, slipping the stethoscope into her ears. She pressed the end to Howie’s chest, paused to listen for a few seconds, then moved it to a different position. “When did you first start having trouble breathing?” she asked.
“I dunno... half an hour ago?” Howie said uncertainly, glancing up at me. I shrugged helplessly. I had no idea what time it was.
Dr. Robinson moved the stethoscope to Howie’s back. “What were you doing when the shortness of breath occurred?”
I felt my face redden and saw Howie’s eyes widen. “We were swimming,” I said quickly, before he could answer with anything more specific than that. Howie winked at me, the corners of his mouth curving into a tiny smile.
“Could you have accidentally inhaled any water?”
“I don’t think so,” said Howie, his voice cutting off as he started to cough again.
“He said he’s had that cough for a few days,” I told the doctor. “He started coughing like that when we were in the pool and couldn’t catch his breath. He was coughing up blood.”
“Doctor, his sats are dropping,” one of the nurses said suddenly. “Down to 88 on room air.”
Dr. Robinson looked up at the monitor over Howie’s head. “Let’s start him on supplemental 02, five liters per minute by mask,” she said, then turned to me. “I’m sorry, I didn’t catch your name.”
“Nick. I’m Howie’s... friend,” I said awkwardly, glancing over at Howie. Even with an oxygen mask strapped to his face, the look he gave me was clear enough to communicate what he was thinking: Friends don’t fuck friends in pools. Clearing my throat, I asked, “What do you think is causing this?”
“It could be an infection,” she answered. “We won’t know until we run some tests.”
Turning to the two nurses, she added, “Ashley, order a portable chest X-ray. Deanna, start a peripheral line so we can get a blood sample to send to the lab. I want to collect urine and sputum samples, too.”
I stood in the corner of the room, trying to stay out of the way as the women worked on Howie. After a while, a technician brought in an X-ray machine, and I was asked to step out for a few minutes.
I wandered down the hallway until I found a small waiting area and collapsed into a chair, dropping my head into my hands. After all the excitement of the last hour, I felt emotionally drained. It didn’t seem possible that I had been sitting at the AIDS clinic as a patient earlier that same day, getting my good news. That felt so long ago, even though it had only been a couple of hours. Now here I was at the hospital with Howie, and this time, he was the patient. Somehow, I knew he wasn’t going to get the same sort of prognosis.***
“How ya doin’?” I asked Howie when I went back into the room.
He just nodded and gave me a thumbs up. Maybe it was hard for him to talk with the oxygen mask over his face, but it worried me that he was no longer saying, “Nick, I’m fine.” Obviously, he wasn’t fine and hadn’t been fine the whole time he’d been telling me he was, but it still made me feel better to hear him say the words. If Howie believed he was going to be fine, then I could believe it, too. This time, I wasn’t so sure.
The uneasiness must have shown on my face, because one of the nurses noticed. “He’s just tired from working so hard to breathe,” she assured me, as she adjusted the IV line that was hooked into the back of Howie’s left hand. “But his sats are better, look.” She pointed out the number 92 on the monitor over Howie’s head. “That’s the percentage of oxygen in his blood.”
“What’s it supposed to be?” I asked, wondering if 92% was high enough to get an “A.”
“Normal is 95 and above, but anything in the nineties is acceptable. We just don’t want to see it drop below 90 again.”
I nodded. So Howie was getting a “B” in breathing. Not bad.
“Here’s why he’s been short of breath,” said Dr. Robinson, stepping back so I could see the X-ray film that was hanging on the wall. The bright light behind it illuminated the black and white image of Howie’s chest. “The black spaces here and here are his lungs, and this solid white shape in the middle is his heart,” she explained, pointing out the different parts of the X-ray. “But you see these cloudy white patches? That’s fluid that has infiltrated the air sacs in his lungs, making it harder for him to breathe.”
I frowned as my eyes followed her finger over the wispy white spots on the X-ray. “What caused that?”
The doctor shook her head. “It’s still looking like it could be an infection, but we won’t know for sure until we get the lab results back. Even then, we may need to run more tests to rule out other conditions.”
What other conditions? I wondered, but I didn’t ask, deciding I might be better off not knowing what else it could be. An infection sounded bad enough, with Howie’s immune system being suppressed. I didn’t even want to consider the worse-case scenario.
Turning to Howie, Dr. Robinson said, “I need to check on my other patients now, but I’ll be back soon. Let one of the nurses know if you need anything.”
Once she was gone, I went to sit in one of the chairs on the side of the room.
“Sorry, Nick,” I heard Howie say, his voice muffled by the mask.
“What are you sorry for?” I asked, shaking my head. “This isn’t your fault.”
“Yeah, but... we were supposed to be... celebrating.” Even with the extra oxygen, he had to pause every few words to take a breath. “Don’t feel like... you have to stay here.” He was still fighting for every one, his chest and shoulders heaving each time he inhaled. No wonder he was tired.
“What are you talking about?” I asked, frowning at him. “Of course I’m staying.”
“Just saying... you don’t have to.”
I rolled my eyes. “What, you think I would go home and leave you here? Fuck that. You said it yourself earlier: We’re in this together. That means you’re stuck with me, so shut your mouth and stop being such a fucking martyr.”
That made Howie smile.***
Over an hour passed before Dr. Robinson came back, accompanied by another doctor. By then, Howie was having an easier time breathing. With the help of the supplemental oxygen, his sats were up to 94%.
“How are you feeling, Mr. Dorough?” asked Dr. Robinson, as she listened to his lungs with her stethoscope.
“A little better,” answered Howie. “Just tired.”
“I’ll bet,” she said sympathetically. “How about we try taking off that mask and switching to a nasal cannula? That may make you more comfortable.”
Howie nodded. As soon as she slipped the oxygen mask off his face, I saw the number on the monitor start to fall, as Howie’s breathing became labored again. But once she’d put the cannula into his nose and connected it to the oxygen supply, the number began to climb again.
“There,” she said, as she taped the thin tubing in place behind Howie’s ears. “I bet that feels better. How’s your breathing?”
Howie took a few breaths before replying, his chest rising and falling as he inhaled and slowly exhaled. “Okay,” he answered finally.
“Good,” said Dr. Robinson, sounding satisfied. “I want to introduce you to a colleague of mine, Dr. Scott. She’s an infectious disease specialist. I’ve asked her to consult on your case.”
When I heard the words “infectious disease,” I instantly thought of Ebola. It had been in the news a lot in the last month, ever since those two nurses in Texas became infected. Could Howie have somehow contracted it, too? Was that why he’d coughed up blood? My heart started to race as I remembered what we had been doing when that happened. If Howie had come down with something contagious, I could be at risk too, I realized. It didn’t occur to me that HIV is considered an infectious disease.
“Nice to meet you, Mr. Dorough,” said the specialist, stepping forward to shake Howie’s hand as I sat in the background, silently freaking out about Ebola.
“Nick,” I said, when she turned to shake mine next.
“Nice to meet you both.” Turning her attention back to Howie, Dr. Scott cleared her throat and said, “We did get some of your test results back from the lab, and Dr. Robinson and I would like to go over them with you. Would you like Nick to step out or stay with you?”
“He can stay,” Howie replied quickly, glancing over at me. I pasted a fake smile on my face and gave him an encouraging nod, hoping for good news and silently praying I was just being paranoid about the whole Ebola thing.
“Okay. Well, your blood work does indicate a bacterial or fungal infection of some kind,” Dr. Scott began. “Unfortunately, we won’t know exactly what we’re dealing with for at least a few more days, until the cultures from the blood and sputum samples we took have time to grow. Based on your symptoms and history, however, I have my suspicions.”
I watched her face as she talked, trying to read the expression on it. How bad was this? I wondered. Ebola bad? The specialist wasn’t smiling, but maybe she was just used to being straight-faced. She did work with infectious diseases, after all. I bet she was good at playing poker, too.
“What do you think it is?” Howie asked hoarsely. Hearing the tremor of apprehension in his voice, I glanced over at him. He had wadded up a section of the bedsheet beneath him and was gripping it tightly, balling it up in his fist. I wanted to reach out and take his hand, but my own anxiety held me back. I kept my hands in my lap, nervously twisting them together as I waited to hear the doctor’s answer.
“Your CD4 count has fallen to 150, which opens you up to all kinds of opportunistic infections that don’t typically affect people with healthy immune systems. One that commonly affects people who are immunocompromised is a type of pneumonia called pneumocystis.”
Before I had even processed what she was saying, I saw the blood drain from Howie’s face. “That’s what Holden had,” he said softly. “My son... That’s how we found out about the HIV.”
My heart skipped a beat as I remembered how this whole nightmare situation had started one year ago, with Howie rushing home from Germany when Holden was hospitalized. Less than two weeks later, he came out to California to tell me to get tested. Neither of our lives had been the same since, and now here we were, dealing with the same diagnosis. In a weird way, it was like we had come full circle.
The doctor nodded. “It is one of the most common opportunistic infections in people with advanced HIV,” she acknowledged. “It’s also-”
“-an AIDS-defining illness,” whispered Howie. It’s hard to describe the look that was in his big, brown eyes, but the word that comes closest is “devastated.” It was a look of pure devastation.
Seeing it there made my own heart sink, along with the hope that he was going to get good news. That was when I realized what Howie had known all along: This was bad. This was really bad.