Legacy - 22. Police Work - Paul Manning

Thursday, May 16, 2024 - Nineteen Years Earlier

“Sam!” I called out and waved to my friend as he exited airport security. His whole face lit up when he spotted me and in no time we were in each other’s warm embrace. Sam was going to be staying with us for the next six months or more while he underwent treatment at Johns Hopkins.

“Welcome to Baltimore,” I added as we separated.

Laughing, he said, “It’s not like I haven’t been here before.”

“Yeah, but you always took the train down from New York, and later you drove. This is your first time flying to BWI,” I noted.

“It still seems strange to visit without my car,” he replied. “I hate to be dependent on you guys for wheels.”

“Sam,” I countered, “it was one thing to drive when you were just coming for a brief visit, or when you were here for your initial work-up and for the bone marrow harvest. Parking downtown for a few days or a week is pricey but doable. The cost of parking for six months would be prohibitive and it’s not like you’re going to be going anywhere. Trust me, I know from Linda’s experience with this. You’re not going to be up to driving, much less doing anything.”

“Which is why I should be staying at a hotel rather than with you guys,” Sam challenged.

“Let’s not go there, Sam,” I replied. “We’ve been through this a thousand times and this makes it a thousand and one. You’re family, Sam. You’re like a brother to me . . . to Linda too. We’ve already been through the treatment with Linda and we know exactly what to expect and how to make you comfortable. Why should you go through it all alone when you can be cared for by people who love you?”

Sighing, he said, “I should have had the treatment back home, where Sally could have looked out for me.”

“But the treatment was invented here,” I pointed out, “and Sally can’t just take off for six months and you know it. It’s not like she’s a hotshot lawyer in private practice. As lead council for the Center for Advanced Research, she has her obligations. Linda and I have much more flexible schedules and, between the two of us, we can take care of you. This way Sally can come visit as she has the time. Besides, you were with me every chance you had when I went through my procedure . . . and ya know, I needed that . . . just think of it as payback time.

“Now let’s go get your luggage and blow this place.” I added.

Smiling at each other, we walked off to baggage claim and, with some eighty pounds of luggage in tow, headed to the parking structure across from the terminal, where my car was parked in a spot reserved for police officers.

A half-hour later, we pulled into the underground parking structure of our high-rise condo building. Taking the elevator to the twenty-second floor, Linda greeted us at the door to our spacious 2200 square-foot luxury apartment. With two bedrooms, two-and-a-half bathrooms and a den, we had more than enough space for Sam to stay with us while he underwent treatment. Our living room and dining room had floor-to-ceiling windows overlooking Downtown Baltimore and the famed Inner Harbor. The views from the bedrooms were equally spectacular. We also had a huge eat-in kitchen that we’d remodeled ourselves, removing the wall between it and the living room and giving the whole apartment an open, airy feel. We loved our condo in the sky.

Opening her arms wide, Linda engulfed Sam in a warm embrace and said, “Sam, it’s always a pleasure to see you. Consider our home your home for the next six months.”

“Well the first two or three months of it will be spent in strict isolation,” Sam pointed out.

“How well I know it,” Linda acknowledged. “I know just how lonely it can get in there but, trust me, you won’t be alone. Paul and I will come visit you every day and, if you ever need anything, both our jobs are flexible enough that we can be there in an instant.” That was certainly true. As a detective in Baltimore’s Major Crimes unit, my schedule was more or less my own. As a social worker in the Baltimore City Schools, Linda could also set her own schedule so long as she saw all her clients. Together we would see to it that Sam never felt alone.

That evening, Sam made us one of his famous gourmet meals as a token of his appreciation. Sam’s cooking was one of the things we’d missed the most since moving to Baltimore, not to mention his friendship. Of course we also missed our families and other friends, but Baltimore was a much more exciting city in which to be a detective. The rate of violent crime here was several times that back home. The family situations Linda faced as a social worker in the Baltimore City Schools were also much more challenging. Whereas most people fled Baltimore’s high crime rate, we’d flocked there because of it.

The next day Linda and I accompanied Sam to Johns Hopkins University Hospital - his home for the next two to three months. Having been through the program with Linda just a few years before, we knew exactly what Sam would be going through. The first phase of the treatment had already started six months before, when Sam’s bone marrow was harvested. Since then, his stem cells had been grown in culture and, enhanced by growth factors, cells with positive markers for HIV had been gradually tagged and eliminated.

The process was supposed to be 96% effective overall, which of course meant there was a 4% failure rate in phase one alone. Just a few years ago, when Linda underwent her treatment, the failure rate was 11%. In some centers, the failure rate was still as high as 16% in phase one, which was one of the main reasons we wanted Sam to be treated at Hopkins.

With the completion of phase one and with an ample supply of Sam’s own bone marrow, grown in culture and presumably free of HIV, phase two began. This involved the complete and total destruction of his natural immune system. Using an intense regimen of high-dose radiation and chemotherapy, Sam was rendered unable to generate any blood cells on his own. He became dependent on frequent blood transfusions to supply red blood cells and platelets, most of which Sam had donated for himself over the months leading up to the procedure.

It was tough enough watching Sam go through each cycle of intense chemotherapy . . . watching his hair fall out and being there with him through his countless bouts of vomiting and diarrhea but, because the destruction of his immune system was so complete, he was defenseless against any kind of infection. Like the ‘boy in the bubble’, he had to be kept in strict isolation to ensure he never came in contact with a single germ until the time his bone marrow would be restored.

We weren’t even allowed to be in the same room as Sam - not even wearing a gown, gloves and mask. His environment was sealed and his food had to be irradiated before it could be fed to him. Not even a conventional airlock could provide adequate protection and, hence, all human interactions with Sam were through a pair of ‘space suits’ built into one of the walls of the room he was in. We had to literally step into the flexible plastic garment, such that there was always a barrier between us and Sam. Even the doctors and nurses had to go through the same procedure to interact with Sam, or they made use of a set of robotic arms. With the exception of food, water and intravenous medications, all of the supplies needed, from needles to tubing, were kept inside the sealed environment of his room.

Phase three was the most difficult part of the treatment. While phase two made him sick as a dog, phase three could have killed him. Using powerful growth factors injected directly into the brain and spinal cord, Sam’s doctors forced the HIV-infected cells in his nervous system to express surface antigens specific to HIV. Monoclonal antibodies were then used to destroy the HIV-infected cells and the process was repeated several times to ensure that no infected cells remained from which re-infection of his immune system could occur.

Each cycle of therapy produced an acute encephalitis that left Sam delirious and unable to remember who he was, let alone who we were. Although every precaution was taken to prevent it, long-term brain damage was a remote possibility. Not a day went by that we didn’t pray for his full recovery.

More concerning was the fact that phase three treatment was only about 80% effective in eliminating HIV and relapses were not uncommon. Between phase one and phase three failures and other causes, the overall failure rate was reported to be around 26% at Hopkins and as high as 35% elsewhere. Even considering the potential for secondary cancers some twenty years down the road, most people with HIV were more than willing to take a chance on a cure rate as low as 65%.

The final phase in the treatment was the bone marrow transplant itself, in which Sam’s harvested and cultured stem cells were reintroduced into his body to repopulate his bone marrow. He would still need to remain in isolation for a time until his cell counts returned to a high enough level to fight off infections and, after that, he would need to remain with us for another three or more months while he underwent frequent testing and treatment with growth factors.

Because of occasional fevers and some mild difficulties tolerating the growth factors used during phase three, Sam spent a total of seventeen weeks in the hospital at Hopkins rather than the target of three months. This sort of delay was not uncommon. The day we were finally able to pick Sam up and take him home was one of the most joyous of our lives. It was unfortunate that Sally couldn’t be there but then she’d only visited twice during the entire course of Sam’s treatment and, even then, not during the most critical points. It made us wonder if they were experiencing marital problems but this was not the time to ask them about it.

Besides which, we had our own bit of drama with which to contend. About a month into Sam’s treatment, Linda came to me one morning and said, “Paul, I’m late.”

“What do you mean you’re late?” I asked innocently enough. “You’ve got plenty of time to make your first appointment,” I went on, totally missing what she was trying to say.

“No, Honey,” she reiterated, “I’m late . . . nearly a month late.”

Still looking at her quizzically, I just wasn’t getting it. She arched her eyebrows and went on, “I’ve never been this late before.”

Still, her meaning was eluding me when I suddenly understood. “Oh my God! You’re l‑a‑t‑e! You’re too young to be starting menopause,” I added. “Maybe you’d better see Dr. Williford . . . something could be wrong.” Dr. Williford was our internist. The possibility of Linda being pregnant never even entered into my mind. After all, I was sterile, so there was absolutely no possibility - not unless she had cheated on me, and I had absolute faith she’d never do that.

Shaking her head, she continued, “No, Paul. There’s nothing wrong with me . . . actually, it’s something right . . . something very right.”

“What are you getting at, Doll?” I asked innocently enough. I still just wasn’t getting it.

“I took a test, Paul . . . a home pregnancy test . . . and . . . we’re going to be parents.”

“But that’s impossible!” I countered. “I’m sterile. There’s absolutely no way you could be pregnant.”

“I guess maybe the treatment restored your fertility,” she challenged, “’cause I sure haven’t had sex with anyone else . . . not since Cliff passed away.”

“I know you haven’t,” I replied. I really did trust her implicitly.

“When the baby’s born, we’ll get a paternity test anyway,” Linda stated, surprising me. Didn’t she trust my trust of her? However, she went on to say, “Although you may have complete faith in me, there are others who may not. I never want there to be any suspicion as to the legitimacy of our daughter or son.”

That certainly made sense but I was still skeptical of the whole thing. “I still think you should see Dr. Williford,” I reiterated. “There could be something really wrong like a tumor or something. It could be a false positive pregnancy test.”

“I know with your police work, you often see the worst in the world, but this is not the time to be a pessimist,” she said with a smile. “I called Dr. Williford’s office and they told me that the latest tests are nearly 100% accurate. False negatives are rare, and false positives almost unheard of. They gave me the name of an obstetrician and I’ve already made an appointment. You’re going to be a papa, Sweetheart.”

“You’re really pregnant,” I said. “Really, really pregnant,” I repeated as a huge grin took over my face.

An equally large grin appeared on my wife’s face as she said, “We’re really, really pregnant.”

“We?” I asked as I arched my eyebrows. “Last time I checked, you’re the one who’s going to have to go through being pregnant, labor and delivery.”

“Oh don’t I know it? I’m already feeling a little nauseous in the morning. I meant it figuratively,” she explained.

You’re going to be a momma and I’m going to be a poppa,” I reiterated with a smile, and then we kissed. . . .

By the time Sam was discharged from the hospital and came back to stay with us, Linda was already into her second trimester. The amnio went fine and our son had a normal set of chromosomes. He did not have any evidence of my Down’s Syndrome.

Over the course of the next few months, Sam completed the outpatient phase of his treatment while Linda continued her job with the Baltimore City School System, even as the effects of the pregnancy became more and more pronounced.

No matter how debilitated Sam was by the effects of his treatment, he doted over Linda as if she was having his baby. In a way, she really was having his nephew. Sam and I were as close as any brothers could be.

One thing both Linda and I noticed during Sam’s stay with us was how infrequently he spoke with Sally, or even of Sally. Whenever Linda and I were apart, we called each other every day without fail. Sam and Sally seemed to speak only once a week, if that.

One afternoon when Sam and I were watching a Colts game, I asked him about it. Although the quarterback, Billy Mathews, was a close friend of ours, the game was quickly forgotten.

“Is everything OK between you and Sally?” I asked.

“What do you mean, Paul?” he asked in return. “Why wouldn’t it be?”

“I don’t know, Sam,” I started to explain, “it’s just a feeling I get. It’s not like the two of you talk to each other very often. In fact, when you call her, it sounds more like you’re resigned to it than it being something you’re looking forward to.”

Sighing, Sam answered, “I never could keep anything from you, Paul. Sometimes I think you know me better than I know myself.”

Taking a deep breath, he went on, “We still love each other very much, but it’s . . . frustrating.”

When I just continued to look at him expectantly, he continued. “We really like being intimate . . . we want to be intimate . . . but we can’t.”

“What do you mean you can’t be intimate?” I asked. Just because you’re HIV-positive doesn’t mean you can’t have sex and, once you’re cured, you’ll be able to have sex all you want without fear of Sally catching the virus from you.”

“It’s not that, Paul,” Sam explained, “it’s just that when we try, things get out of hand. Most of the time I’m able to control myself, but there have been a few times when I’ve lost control. I’ve held her down, I’ve forced myself on her . . . hell, I’ve even hit her. Now, she’s afraid of me and I’m afraid of hurting her, so we just don’t do it anymore.”

“You don’t have sex?” I asked with incredulity. “You two must be horny as hell . . . all the time!”

“I jerk off a lot,” Sam sheepishly admitted, “which takes care of the physical pressure that all guys feel, but it leaves Sally high and dry, so to speak. This whole situation’s pushing us apart.”

“Have you talked to her about Gary?” I asked.

“She knows the basics,” Sam went on, “but I can’t bring myself to talk to her about it . . . to explain to her why I am the way I am.”

“She’s not a dummy, Sam,” I admonished my friend. “She knows you’re not a violent person. She’s gotta know something’s up. You’ve gotta talk to her, Sam. She deserves to know . . . all of it. Open communication is the only way.”

“I know, Paul,” he replied. “Believe me, I know. It’s just hard, you know? Really hard.”

“I can only imagine, but you managed to tell me.” I pointed out.

“Yeah, but it’s different with a wife,” Sam countered, but I interrupted.

“How is it different?” I asked. “We were and are best friends, but isn’t your wife supposed to be your best friend too? We even had sex . . . not that we went all the way, but we sure had a lot of fun messing around. Yet you never once were violent with me.”

“But that’s just it, Paul,” Sam challenged. “The sex you and I had was just for fun. Sally and I make love but, thanks to Gary, the love and the violence get mixed up in my mind.”

“Making love with your wife is supposed to be fun too,” I countered. “When we messed around, it was making love . . . just a different kind of love.” Then changing tack, I continued, “Maybe you and Sally should get some counseling. You used to see a shrink when you were a kid . . .”

“And in spite of all those years of counseling, I’m still pretty fucked up.”

“Maybe so,” I agreed, “but didn’t you yourself used to say you couldn’t have made it without it?”

Sam just sat there with a thoughtful look on his face for a while before he spoke, and then he said, “You’re right, Paul. I did used to say that and I meant it, too. It didn’t cure me but it helped me keep my sanity. Maybe Sally and I should see a shrink.”

“It couldn’t hurt,” I agreed.

“Thanks Paul . . . for everything,” Sam said, and then he hugged me. I hugged him back.