Medicine

New Books in May

Jump-start your summer reading with one of our new titles this May!

In Coral Empire Ann Elias traces the history of two explorers whose photographs and films of tropical reefs in the 1920s cast corals and the sea as an unexplored territory to be exploited in ways that tied the tropics and reefs to colonialism, racism, and the human domination of nature.

The contributors to Remaking New Orleans, edited by Thomas Jessen Adams and Matt Sakakeeny, challenge the uncritical acceptance of New Orleans-as-exceptional narratives, showing how they flatten the diversity, experience, and culture of the city’s residents and obscure other possible understandings.

The ChasersRenato Rosaldo’s new prose poetry collection, The Chasers, shares his experiences and those of his group of twelve Mexican-American Tucson High School friends known as the Chasers as they grew up, graduated, and fell out of touch, conveying the realities of Chicano life on the borderlands from the 1950s to the present.

In Queering Black Atlantic Religions Roberto Strongman examines three Afro-diasporic religions—Hatian Vodou, Cuban Lucumí/Santería, and Brazilian Candomblé—to demonstrate how the commingling of humans and the divine during trance possession produce subjectivities whose genders are unconstrained by biological sex.

Written in 1937, published in Spanish in 1973, and appearing here in English for the first time, Freddy Prestol Castillo’s novel You Can Cross the Massacre on Foot is one of the few accounts of the 1937 massacre of tens of thousands of Haitians living in the Dominican Republic.

Book Reports

In Book Reports, a generous collection of book reviews and literary essays, rock critic Robert Christgau shows readers a different side to his esteemed career with reviews of books ranging from musical autobiographies, criticism, and histories to novels, literary memoirs, and cultural theory.

The contributors to From Russia with Code, edited by Mario Biagioli and Vincent Antonin Lépinay, examine Russian computer scientists, programmers, and hackers in and outside of Russia within the context of new international labor markets and the economic, technological, and political changes in post-Soviet Russia.

In Camp TV Quinlan Miller reframes American television history by tracing a camp aesthetic and the common appearance of trans queer gender characters in both iconic and lesser known sitcoms throughout the 1950s and 1960s.

The coauthors of Decolonizing Ethnography integrate ethnography with activist work in a New Jersey center for undocumented workers, showing how anthropology can function as a vehicle for activism and as a tool for marginalized people to theorize their own experiences.

In Work! Elspeth H. Brown traces modeling’s history from the advent of photographic modeling in the early twentieth century to the rise of the supermodel in the 1980s, showing how it is both the quintessential occupation of a modern consumer economy and a practice that has been shaped by queer sensibilities.

In Figures of Time Toni Pape examines contemporary television that often presents a conflict-laden conclusion first before relaying the events that led up to that inevitable ending, showing how this narrative structure attunes audiences to the fear-based political doctrine of preemption—a logic that justifies preemptive action to nullify a perceived future threat.

In Anti-Japan Leo T. S. Ching traces the complex dynamics that shape persisting negative attitudes toward Japan throughout East Asia, showing how anti-Japanism stems from the failed efforts at decolonization and reconciliation, the U.S. military presence, and shifting geopolitical and economic conditions in the region.

The Cuba Reader

Tracking Cuban history from 1492 to the present, this revised and expanded second edition of The Cuba Reader presents myriad perspectives on Cuba’s history, culture, and politics, including a new section that explores the changes and continuities in Cuba since Fidel Castro stepped down from power in 2006.

The Fernando Coronil Reader, a posthumously published collection of anthropologist Fernando Coronil’s most important work, highlights his deep concern with the global South, Latin American state formation, theories of nature, empire and postcolonialism, and anthrohistory as an intellectual and ethical approach.

The extensively updated and revised third edition of the bestselling Social Medicine Reader (Volume I and Volume II) provides a survey of the challenging issues facing today’s health care providers, patients, and caregivers with writings by scholars in medicine, the social sciences, and the humanities. It will be a great addition to courses in public health, medicine, nursing, and more.

Catherine Waldby traces how the history of the valuing of human oocytes—the reproductive cells specific to women—intersects with the biological and social life of women in her new book The Oocyte Economy.

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Poem of the Week

Comfort Measures OnlyApril is National Poetry Month, so we are offering a poem each Monday for the next four weeks. Today’s poem is from Rafael Campo’s latest book, Comfort Measures Only: New and Selected Poems, 1994-2016. Campo, a physician, writes from his work and life experience with great empathy. Martin Espada says, “The luminous language and the luminous vision offer proof that poetry, too, is a healing art, that storytelling is medicinal. In these times, we need poets of eloquent empathy more than ever, and there is no poet more eloquent or empathetic than Rafael Campo.”

As We Die

My parents gripe about their health. I think
about when I was young, and tried to force
from them an explanation of — what else
could it have been, but death? Back then, the ink

that clotted in my mother’s brush was black
as my ungrateful, doubting soul; my father’s
huge plush armchair, tilted slightly back, offered
what seemed eternal rest. Their talk is bleak,

their diverticulosis like a pit
that swallows them, their heart disease an ache
these old emotions only aggravate.
I guess I look to them as giants yet,

immortals who know secrets I cannot.
My father, hard of hearing now, reclines
a little farther back; her face now lined
with years of pain, my mother jabs at knots

of garish sunflowers, pretending we
might yet avoid the conversations that
have made their marks on us. Not what I thought —
past death, at last, dreams keep us perfectly.

Rafael Campo is the author of six books of poetry with Duke University Press. He is Associate Professor of Medicine at Harvard Medical School.

New article looks at the rise and fall of Medicare’s Independent Payment Advisory Board

ddjhppl_42_3“Technocratic Dreams, Political Realities: The Rise and Demise of Medicare’s Independent Payment Advisory Board,” an article by Jonathan Oberlander and Steven B. Spivack in the Journal of Health Politics, Policy and Law (volume 43, issue 3), offers a groundbreaking, in-depth look at the troubled history of the Independent Payment Advisory Board (IPAB), enacted as part of the 2010 Patient Protection and Affordable Care Act (PPACA) and repealed in February 2018 when President Donald Trump signed the Bipartisan Budget Act of 2018.

This article addresses technocracy and healthcare through IPAB, a board of healthcare experts hailed for its innovation and designed to formulate Medicare policy recommendations based on evidence and reason rather than politics. Authors Oberlander and Spivack explore why Congress initially enacted IPAB, how we understand its broad appeal to the health policy community, and why IPAB failed to live up to its original hype and remained in political purgatory, paralyzed by controversy and partisanship.

Most health policy experts supported IPAB. The board was an ambitious way to combat the influence of interest groups and the health care industry on Medicare policy. It was also seen as an antidote to legislative inertia and Congress’s inability to manage Medicare. Experts, as well as some members of Congress, agreed that lawmakers could not make difficult decisions about Medicare and envisioned the board as an instrument of health services research and congressional self control. After the board’s establishment, industry groups attacked it, while many Republicans and some Democrats criticized IPAB and supported its repeal. Instead of realizing its aspirations, the board was mired in irrelevance. Prior to its repeal, IPAB existed as a shell under a presidential administration opposed to its existence.

“IPAB’s brief, troubled history offers a cautionary tale about the role of evidence, expertise, and independent panels in US health policy making,” Oberlander and Spivack write. “IPAB’s establishment reflected good intentions: to restructure Medicare governance so that program policy making was driven more by evidence and less by interest group pressures; to compel policy makers to consider and ultimately make difficult choices in Medicare reform; to prevent Congress from micromanaging and mismanaging Medicare; to ensure that, if Congress did not act, steps were still taken to restrain Medicare spending; and to create safeguards against excessive spending. Yet the aspirations to rationalize Medicare through IPAB have floundered against political realities.”

For more information regarding the Journal of Health Politics, Policy and Law, please visit dukeupress.edu/jhppl.

Read the full article here.

Read To Respond: Feminism and Women’s Rights


R2R final logoOur “Read to Respond” series addresses the current climate of misinformation by highlighting articles and books that encourage thoughtful, educated debate on today’s most pressing issues. This post focuses on feminism and women’s rights with articles tackling topics from abortion laws, maternity leave, Islamic feminism, and more. Read, reflect, and share these resources in and out of the classroom to keep these important conversations going.

Feminism and Women’s Rights

These articles are freely available until December 15, 2017. Follow along with the series over the next several months and share your thoughts with #ReadtoRespond.

Personhood Is a Weapon by Eli Clare

Today’s post is an excerpt from Brilliant Imperfection: Grappling with Cure by Eli Clare, with an introduction by the author.

In this political moment as hate violence is on the rise, Trump is trying to ban Muslim refugees from the country, and the Attorney General has blamed disabled students for the lack of civility and disciplinbrilliant-imperfection-covere in public schools; so many groups of marginalized peoples are being treated as unworthy and disposable, essentially denied full personhood. The following meditation on personhood is excerpted from my newly released book, Brilliant Imperfection: Grappling with Cure. I wrote it thinking about white disabled woman Terri Schiavo, who died over a decade ago after a well-publicized and protracted legal struggle over ending her life. But I could as easily have been writing about significantly disabled Black lesbian teenager Jerika Bolan, who after expressing a desire to die wasn’t provided counseling and community support. Rather she was allowed to commit medically sanctioned suicide six months ago. Or I could have written about the unnamed Salvadoran asylum seeker, who in mid-February collapsed at a Texas ICE detention center, was taken to a hospital, diagnosed with a brain tumor, and then in the midst of treatment forcibly taken back to the detention center. If Jerika Bolan had been granted full personhood, she’d still be alive; if the Salvadoran asylum seeker had been granted full personhood, she wouldn’t be locked up in a detention center. More than ever, I believe personhood can be used as a weapon.

Some of us are granted personhood as our birthright, but others are required to prove and defend it every day. And when we fail this perverse test, we’re in trouble. Listen. I want us to remember Terri Schiavo. Debates about her raged in the news in 2004 and 2005.

Whatever happens after we die, our body-minds composting back to earth and air, I hope it’s more peaceful than Terri Schiavo’s last few days as she died of dehydration. Everyone — her parents, her husband, her doctors, the media — had an opinion about her and the feeding tube that had just been removed from her stomach.

She was a white woman who collapsed one day, her body-mind changing radically in a matter of minutes as oxygen stopped flowing to her brain and then started again. Some say she lost her ability to communicate, to think, to feel. Or perhaps we lost our capacity to listen. We’ll never know what floated beneath her skin. I want us to mourn for her.

Pundits and reporters, activists and scholars have written about her endlessly. I don’t know why I’m adding to their pile of words, except my memory of her won’t leave me alone.

She was a heterosexual woman whose husband decided she’d rather die than be disabled. Her hands curled, stiffened, joints freezing into contraction. He asserted his patriarchal ownership, refusing to let nurses slide rolled towels into her hands to help loosen her muscles. Nor would he allow them to teach her to swallow again, even though there was every sign that she could. He spent all his court-awarded settlement money on lawyers rather than care, comfort, and assistive technology. What words or fluttering images did she hold in her muscles and bones?

So many people surrounding Terri Schiavo assumed that she knew and felt nothing. Over and over again neurologists, journalists, judges made decisions about her body-mind based on the beliefs that language and self-awareness make us worthy, that death is better than disability, that withdrawing the basic human rights of food and water can be acts of compassion.

I could ponder self-consciousness, spiritual connection, and the divide between human and nonhuman. I could argue with the bioethicists who separate humanness from personhood, declaring pigs and chimpanzees to have more value than infants and significantly disabled people. But really, I’m not interested. I want us to rage for her.

She was a woman living in a hospital bed, referred to as a vegetable more than once. Did she lie in a river of shadow and light, pressure and sound? That too, we will never know. When she died, did we call her name?

Body-minds have value. Certainly I mean our own human selves, but I also mean heron, firefly, weeping willow. I mean dragonfly, birch, barn swallow. I mean goat and bantam rooster, mosquito and wood frog, fox and vulture — the multitude of beings that make home on this planet. I mean all body-minds, regardless of personhood.

She appeared to track the motion of balloons across her hospital room and grinned lopsidedly into the camera. Her life hung between a husband who said one thing and parents who said another, between legal pronouncements and diagnostic judgments. Do we remember her? I don’t mean the editorials, the pro-life versus pro-choice rhetoric, the religious and secular arguments, the political protest and vigil staged outside her hospice, the last-minute drama as Florida’s governor Jeb Bush and the U.S. Congress tried to intervene. I mean: do we remember her?

Too many of us acted as if Terri Schiavo’s body-mind stopped being her own. Depending on who we were and what stake we had in her life or death, we projected our fear, belief, hope, disgust, love, certainty onto her.

I’m trying to say that life and death sometimes hangs on an acknowledgement of personhood. Trying to say that personhood is used all too often as a weapon. Trying to say that while personhood holds tremendous power, its definitions are always arbitrary. Trying to say—I stutter over the gravity of those words.

Copyright Duke University Press, 2017. To order Brilliant Imperfection from us at a 30% discount, enter coupon code E17CLARE at checkout.

 

Call for Papers: Policy Analysis and the Politics of Health Policy

ddjhppl_41_1How, when, and where does academic policy analysis about the health care system enter the policymaking process?  How have healthcare policymakers seen and used policy analysis in the development, implementation, and perhaps repeal of the Affordable Care Act?  As the US moves from a more technocratic to a more populist administration, how is the role of policy analysis likely to shift? We invite papers for a conference at the Wagner School, New York University in spring 2017 to explore the role of policy analysis in the political process, focusing particularly on the Affordable Care Act. The Journal of Health Politics, Policy and Law will accept five to seven papers from the conference to run in a special issue after undergoing peer review. Sherry Glied, Dean of the NYU Wagner School of Public Service, is Guest Editor of this Special Issue of JHPPL.

Background

The relationship between scholars in health policy and policymakers has long been contested.  Back in 1966, following the passage of Medicare and Medicaid, Odin Anderson, reviewing the relationship between research and policy, reported that he was “pessimistic” and concluded a dispiriting review by asking “what is then the value of social and economic research in the health field?”  In the ensuing 50 years, health policy scholars have continued to publish and policymakers have continued to legislate and implement health policy.  Funders increasingly demand dissemination plans to ensure that the findings of the research they support are influential in the policy process.  A new scholarly field of “knowledge translation” has emerged.  Yet many observers remain pessimistic about the influence of evidence on policymaking.

Many aspects of the Affordable Care Act’s development and implementation offered opportunities for scholarship to influence the process – from the initial decision to focus on health reform, to the design of the exchanges and the Medicaid expansion, to the investment in comparative effectiveness research and delivery system improvements, through the most recent repeal-and-replace debates.  The Law’s path has wound through Congress, the Federal Executive Branch, the Courts, and through State Legislatures and Governor’s Offices.  How, where, and when did policy-related scholarship play a part in these processes?  How, where, and when should it have played such a part?  The purpose of this research conference is to explore these questions both positively and normatively.  While the focus of the conference will be on the Affordable Care Act, we are also open to papers that consider other aspects of health policymaking.

Possible Paper Topics and Target Audience

We seek to cast a broad net and are open to studies by political scientists, economists, sociologists, historians, health services researchers, and others. Papers could examine differences and similarities in how research evidence is used in the various institutions of government (committees, budget agencies, executive branch departments, the judiciary); how evidence plays into lobbying and stakeholder engagement; the uses of evidence in the context of Federal/State relations; the role of the technocracy (expert advisory panels, budget agencies, actuaries, regulatory impact analyses, budget scores); how policymakers address conflicting research findings (for example, in the discussions of job loss); how Congress acts when evidence is sparse (as in the case of the CLASS Act), how partisanship affects the use of evidence; as well as papers that explore more normative issues, such as the relationship between scholarship and accountability.

The target audiences for these papers include academic researchers; funders; and health policy makers at the local, state, and federal levels. Papers should be written so as to be accessible to all of these audiences.

Submission Guidelines

Interested authors should submit a 1-3 page proposal by March 1, 2017 by email to Jennifer Costanza, Managing Editor of JHPPL, at jhppl[at]brown[dot]edu. Please put “Policy Analysis Conference” in the subject line of the message. JHPPL will respond to the proposals by March 15, 2017.  Accepted authors will present completed papers at the conference at NYU on May 2, 2017.  The papers will then undergo peer review for a special issue of the journal.

Call for Papers: The Political Beliefs and Civic Engagement of Physicians in an Era of Polarization

ddjhppl_41_6To what extent do doctors’ political beliefs, identities, and ideologies influence their professional decisions in the medical exam room? How do these political views shape what doctors do in their role as citizens, including their political participation on contested issues, such as abortion, gun control, and Obamacare? We invite papers for a conference at Tufts University in fall 2017 to explore the political beliefs and civic engagement of physicians in an era of partisan polarization. The Journal of Health Politics, Policy and Law will accept five to seven papers from the conference to run in a special issue after undergoing peer review.

Background

Physicians have substantial autonomy in treating patients according to their best judgment. To be sure, doctors must uphold standards of professional conduct. They are also subject to the incentives and constraints of insurance plans, payment systems, and malpractice rules. Yet the role of a physician is defined loosely enough that doctors can bring to their work predispositions about how their jobs ought to be done. These predispositions can come from many sources, including medical school training, prior experiences, peer effects, individual personality and—the subject of this call for papers—politics.

A recent study in the Proceedings of the National Academy of Science (Hersh and Goldenberg 2016) demonstrates that physicians allow their political worldviews to influence their professional decisions on certain politically salient issues. For example, doctors who identify with the Democratic Party are more likely to urge patients against storing firearms in the home, while Republican physicians are more likely to counsel patients on the mental health risks of abortion and to urge patients to cut down on marijuana use. Yet many questions remain unanswered:  How important and far-reaching is the influence of physicians’ political beliefs? What factors shape the emergence and development of these beliefs? Does the influence of physicians’ political beliefs on their professional behavior benefit or harm patients? Does it significantly affect variation in medical spending and health outcomes? In addition to these questions about how physicians’ political views affect medical practice, there are a range of questions about how physicians engage in politics, such as the level and variety of political activism among physicians and their professional associations.

Possible Paper Topics and Target Audience

We seek to cast a broad net and are open to studies by political scientists, economists, sociologists, health services researchers, and others. Papers could examine how doctors form their political ideologies and identities, whether there are significant differences in beliefs or belief formation across variables such as gender, age, region, training, residency, practice type, or medical specialization, as well as the implications for health outcomes. We are also interested in papers that examine the political participation of doctors in areas including but not limited to voting, testifying, letter writing, participation in agency rulemaking, contributing money to candidates or PACs, bundling donations, running for office, making public speeches and media appearances, and formal or informal lobbying. We are primarily interested in the political views and behavior of U.S. physicians, but papers that offer a comparative perspective are welcome.

The target audiences for these papers include academic researchers; health policy makers at the local, state, and federal levels; and health legal practitioners. Papers should be written so as to be accessible to all of these audiences.

Submission Guidelines

Interested authors should submit a 1-3 page proposal by March 3, 2017 by email to Jennifer Costanza, Managing Editor of JHPPL, at jhppl[at]brown[dot]edu. Please put “Physicians and Politics Submission” in the subject line of the message. JHPPL will respond to the proposals by April 21, 2017. Accepted authors will present completed papers at the conference in October/November 2017, at Tufts University in Boston. The papers will then undergo peer review for a special issue of the journal.

Article Published in Journal of Health Politics, Policy and Law Addresses Informed Consent

A recent study published in the Journal of Health Politics, Policy and Law, “Informed or Misinformed Consent? Abortion Policy in the United States,” by Cynthia R. Daniels, Janna Ferguson, Grace Howard, and Amanda Roberti, found that women considering abortions receive medically inaccurate information nearly one third of the time in states that require doctors to provide informed consent materials to their patients.

Since 2010, the United States has witnessed a dramatic expansion of state-based restrictions on abortion. The most common of these are informed consent statutes, which require that a woman seeking an abortion receive a state-authored informational packet before the abortion procedure can be performed.

The Rutgers study team defined medical accuracy as information that was both “truthful and nonmisleading,” constitutional standards set by the U.S. Supreme Court in Planned Parenthood of Southeastern Pennsylvania et al. v. Robert P. Casey et al. in 1992. “Our findings suggest these laws may produce ‘misinformed consent’ and may require the court to rethink the constitutionality of abortion-related informed consent laws as a whole,” Cynthia Daniels, lead author and head of the Informed Consent Project, concluded.

Read the article here. For more information, contact Cynthia Daniels.

Farewell to William G. Anlyan

Dr. William G. Anlyan, former dean of the Duke University School of Medicine and Chancellor for Health Affairs, died Sunday at the age of 90.

978-0-8223-3378-4_prAnlyan was the author of nine books with Duke University Press, two of which are still in print. The Future of Medical Education (1973) called for major reforms in U.S. medical education. Metamorphoses: Memoirs of a Life in Medicine (2004) recalled the changes in medicine and medical education in Anlyan’s forty -year career at Duke.

Born in Alexandria, Egypt, in 1925, and schooled in the British tradition, Anlyan attended Yale University as an undergraduate and medical student before coming to the relatively unknown medical school at Duke University in 1949 for an internship in general and thoracic surgery. He stayed on, first as a resident, then as a staff surgeon. By 1961, he was a full professor of surgery. In 1964, Anlyan was named dean of the medical school, the first in a series of administrative posts at the medical school and hospital. Anlyan’s role in the transformation of the Duke University Medical Center into an internationally renowned health system is manifest: he restructured the medical school and hospital and supervised the addition of almost four million square feet of new or renovated space. He hired outstanding administrators and directed a staff that instituted innovative programs and groundbreaking research centers, such as the Cancer Center and the Physician’s Assistant Program.

In Metamorphoses, Anlyan describes a series of metamorphoses in his own life, in the world of medicine, in Durham, and at Duke. At the time of his prep school upbringing in Egypt, medicine was a matter of controlling infectious diseases like tuberculosis and polio. As he became an immigrant medical student and then a young surgeon, he observed vast advances in medical practice and changes in the financing of medical care. During his tenure at Duke, Durham was transformed from a sleepy mill and tobacco town into the “City of Medicine,” a place where patients routinely travel for open-heart surgery and cutting-edge treatments for cancer and other diseases.

In a cover blurb for Metmorphoses, Anlyan’s successor, Ralph Snyderman (whose own memoir comes out from Duke University Press this fall) called Anlyan “a giant at Duke University and an important leader of twentieth-century academic medicine.” Former Surgeon General David Satcher said, “Bill Anlyan has been one of the most outstanding leaders in academic medicine. Knowing him has been one of the great pleasures of my life and career.”

The flags at Duke University have been lowered to half-staff in Anlyan’s honor.

Alternative Medicine: A Poem by Rafael Campo

978-0-8223-5587-8_prToday is World AIDS Day. Poet and doctor Rafael Campo has been caring for AIDS patients for decades and he often writes about his experiences. This poem is from his most recent collection, Alternative Medicine (2013).

 

Alternative Medicine

Wednesday afternoon HIV clinic

I. ADVERSE REACTION
“Pray for me,” she asks, her head covered in
a polyester scarf. She doesn’t hide
herself for shame; she’s lost her hair. We think
it was the AZT. She says that through
the walls of all her suffering, she thinks
she hears God’s distant voice when her young son
reads from his new storybook. She’s so proud
he’s learning English. “Pray for him,” she asks
before she leaves, “that he may have enough
to bury me in a fine new white dress!”

II. FAILURE TO THRIVE
He weighs less than ninety pounds. Years ago,
he was a bodybuilder. Muscular
and tanned, he looks like someone else back then,
the photograph he shows me faded now.
“You know, even my cock has shriveled up,”
he says. “No one would want to fuck me now.”
He undresses very slowly; I count
his ribs while he fumbles with the blue gown.
When I touch him, he avoids my eyes, stares
up at the blank ceiling instead, and cries.

III. LEUKOPENIA
I see him sometimes when I’m walking home.
He holds his children’s hands, refuses to
acknowledge me. I know his viral load,
his T cell count, his medication list,
as if these data somehow pinpoint him.
Enveloped in the park’s expanse of snow,
his two small children bobbing next to him
like life preservers, I remember that
he’s leukopenic. Snow begins to fall
again, innumerable tiny white flakes.

IV. ADVANCED DIRECTIVES
The rescue regimen is failing too.
He lives alone in an AIDS SRO,
once had two little shih-tzu mixes he
was forced to give up—the neighbors complained
about the barking. Not depressed, he says.
Not suicidal. Still taking his meds.
He watches Oprah, gets a hot lunch daily.
I write the orders in his chart. He says
it’s funny, since his mother always said
she wished he’d never been born anyway.

V. CARDIOMYOPATHY
He can’t tie his shoes anymore because
his feet are so swollen. Denies chest pain
but says his heart aches, whatever that means.
Ejection fraction less than thirty now.
Strange that it keeps progressing, since the meds
have kept his virus undetectable.
He says he doesn’t drink, is sober now
for fifteen years. Assessing the edema,
I leave the imprint of my fingertips
anywhere I press down on his taut skin

VI. RESISTANCE
I think she must be missing doses, since
she hasn’t yet disclosed her status to
her husband, who she fears will leave her—or
worse, if he finds out she’s positive now.
Good question—he probably exposed her,
but that’s not the point. Here’s her genotype:
clean, no resistance mutations at all.
Her virus is wild-type, and so she should
suppress on her twice-a-day regimen.
Either that, or she’s just not taking it.

VII. IVDU
“I envy you,” he says. “You got it all
figured.” I stare at the computer screen.
“IVDU. That means I’m on dope, right?
Just an addict, right?” Silently, I type.
“You got to write me a prescription, man.
IVDU? A-I-D-S. That’s AIDS.
Can’t you just be happy I’m gonna die
and give me my damn prescription?” I try
to hate him, but write “Percocet” instead.
“Now, that didn’t hurt much, did it?” he asks.

VIII. UNIVERSAL PRECAUTIONS
You tell me that like me you must wear gloves
at work, restoring precious paintings at
the MFA. Imagining you bent
intently over some scarred masterwork,
I wonder whether your light touch might heal,
but in another sense: I must protect
us all should suddenly you bleed, while you
expose us to the curious infection
of what is possible to know by life’s
wounds. Even through my gloves, your skin feels warm.

IX. OPPORTUNISTIC INFECTION
She tells me that her dream involved a cliff—
no, mountain—that she climbed until she reached
its peak. From there, she saw a pristine view:
unending valleys, white-gray glaciers, snow.
The air was thin and she could hardly breathe.
She suddenly began to cough, and blood
poured out of her like song. But in the dream,
she didn’t have tuberculosis yet;
she’s sure she was infected with a lie,
and inside her, it was the dream that died.

X. ALTERNATIVE MEDICINE
I won’t take antiretrovirals, don’t
eat processed foods, and remain celibate.
I will take echinacea for a cold—
I wish all medicines came from the earth
and not some toxic lab where they kill rats
with chemicals they claim “treat” HIV.
I exercise six times a week, and pray
to my own God. I believe that someday
we’ll find the cure, and I’ll be here to say
that one of us survived to celebrate.

Copyright Duke University Press, 2013.