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Forget the name calling! How do you talk to someone who is high on heroin when they come to see you? The Methadone pad is out of order! What next? Can't help wonder how many bottles of hiv meds are stashed up in his closet while claiming that he's 100% compliant and practicing safe-sex only. Ah, almost forgot to tell... he's a call girl! Part of my daily outreach.
Thank you for disagreeing so blatantly. Suffice to say several of my comments hit a nerve with Christopher. There is too much here for me to take point by point and I don't really think it's constructive. I will say it was offensive to label my note as a "complaint". That was inaccurate. I would like to suggest that speaking in generalities is only one approach for others who care to read my post and then attach to the abstractions offered hopefully finding their own meaning. This follows a Socratic approach in communication and teaching, I am confident this comes as no surprise to those of you that teach without lecturing. What works for me, and the youth that I have taught for over five years may not work for someone else depending on the aspects that I mentioned, ageism, socio-economics, etc. Its great Richard does what he does and that Christopher does what he does although specifics were not mentioned in Chris' post either. I trust that one who speaks with such passion must have an effective and self-defined structure and that you, Christopher are having some success. I certainly hope so. More than being right about anything I have written, I hope each of us finds a strategy that works and so, I offer you sincere congratulations. For your edification I would like you to know that I developed a strategy while living in northern California caring for my friends who died of AIDS in the early and mid-nineties, in some cases they died just months before antiretrovirals finally appeared. I was in my twenties and had very little life experience to draw from - but I focused on the good times we shared, and gradually allowed myself to really feel the pain and the grief of their passing. BONUS: I got to feel it sober. Somehow I found a balance to continue on - rarely with the grace I had hoped for but I am here, thriving and speaking out. I developed various strategies sitting on suicide hotlines just after I got sober during about the same period trying to relate to family members of veterans from the first gulf war - having no real experience to offer so I went for the generalized human experience and some how managed to talk people back from the edge - literally. That lasted just over 2 years. I continued to develop generalized strategies based on clichés which must have meant something to over 800 of my students who gave me some of the highest ever evaluations at two universities on the west coast - one with a strong pre-college program for students 14-17 years old, they smoked too. Whether volunteering with students, teaching them, doing media outreach in central California in the late 1980's as a PWA - (one of the first), or holding friends hands during their final death rattle and trying to explain to family members what AIDS was - what their gay sons died from - I draw from some experience. Through my art, through my documentary film projects I work to combine the bizarre abstraction of experiences whether being gay, living with AIDS, or being a survivor of childhood abuse, with media that communicates and hopefully educates speaking to people with an authentic voice and in a manner I hope is somehow understood without being so black and white. In my mind the absolute can be absolutely dismissed. I do this as best I can - sometimes I succeed, mostly I fail but I do keep trying. I see that you do too. My approaches and my strategies are not Richard's experience, nor are they Christopher's experience; they are mine and abstractly they become our experiences collectively. After the detonation of this life the "rose-colored glasses" approach seemed to be all that remained. Well, that is not true there is always cynicism but that is really a deep and shitty hole. So here is to boundless, uniformed optimism and all the people who told me it helped them get through tough times. Here is to the friends I have counseled this week, trying to stay sober from crystal meth, living with AIDS and trying against all odds to have a loving relationship... Here is to one of my childhood girlfriends who along with me thought I would not live to see 40. She is now dying of ovarian cancer. She will never see her 11 year-old son graduate from high school probably not even see him start school next fall. I did not tell her it was going to be okay, I told her to tell her son she was dying because he already knows. Christopher, I stand by every word I wrote and every thought, every cliché and every Polly Anna statement. I am proud to believe you will do the same and together we will find the others that resonate with our different strategies and approaches. I believe together we will get through this abstraction called life. Finally, there is nothing magical the elder glbt community members can offer except by living by example. Seems like one predictable cliché would be a sloppy drunk and lecherous old man falling off a bar stool or one can decide to be a person who is mature, engaged, creative, communicative and caring. What kind of example will you set? Patrick
I think we have greated a monster of a divide in the gay community. There is an "us and them" mentality out there that we have been ignoring for way too long. Those of us in AA here it all the time. Those of us in the "rooms" talk about "the others" or "the civilians" that just don't get it. Kind of sounds like an episode of "Lost" if you ask me. And maybe that is exactly what is wrong with our community today...we are lost. Perhaps if we all just took a moment to slow down, judge less, and stop trying to immediately "fix" things the God of our understanding plan would become clearer.
Patrick, The original post described a real situation objectively. Your complaint seems to be grounded in a lot of abstractions. You say: "the issue is what is happening to our gay youth" Richard's post above was an attempt to describe what is happening, at least as he sees it in his experience; "and what are the elders in the glbt community allowing to happen to our glbt youth?" Allowing? Really? Do our "elders" have some magical power to prevent it? "What kind of example are we setting for them to follow? If you don't believe your actions affect others you better turn in your gay card and check your humanity." The example Richard seems to be setting is, that he is working in medicine to try to improve the situation, as opposed to relaxing on Palm Beach or whatever. What precisely in his description leads to to suggest that he has stopped believing in his actions' ability to affect others? There is a stark black/white dichotomy here which disturbs me--to you, it would seem, anyone who does not have a Pollyanna-like optimism is a cynic worthy of having his membership in humanity revoked? I could go through Patrick's post line by line, but frankly the level of glittering generality is pretty uninteresting to me. If you want to describe reality then do so. But I find strange the suggestion, implicit throughout, that Richard is not doing anything productive to help the young men he describes. After all he does say: "...I suggest that all of life's problems not answered by pills, potions, and other forms of magic. Life sometimes takes work....Sometime I do something really foolish. I offer a plan on how they may consider changing their lives. No one really listens. They just shuffle out of my office." So he tries. This is real life experience. As a teacher who sees a stream of young people pass through the classroom I know exactly how difficult it can be to communicate with the young. Have you ever talked with a very clever and very stupid 17-year-old who is determined to prove that there is nothing harmful about smoking cigarettes, and who thinks that he already knows everything and that anyone over 30 is by virtue of his age alone obsolete and has nothing of interest to say to him? I'm sorry if I'm being harsh, Patrick, but one thing in life I can't stand is to see people come with airy rhetoric to criticize the hard truths of people dealing with reality. If you want to get into the trenches and talk about real-life strategies for improving the lives of the people we come into contact with, that might be helpful. Give an example of how you personally have dealt with people like the boys described in the OP. Focus on content rather than attacking the language. Richard was trying to dramatize the spectacle before him in the office of young men on multiple chemicals, and test-tube boys was a way of doing that. He did not call them that to their face. Extruding a stream of cliches about "humanity" and "agism" and the "hypocrisy and hate" of the "conservative right" and the "glbt community" and "objectifying" people--this is not helpful. I can't even see real human life behind the fog emitted by all this abstraction.
The issue is not whether this is an arrogant point of view, the issue is what is happening to our gay youth and what are the elders in the glbt community allowing to happen to our glbt youth? What kind of example are we setting for them to follow? If you don't believe your actions affect others you better turn in your gay card and check your humanity. Do we see the glbt youth as any thing other than young, beautiful play things? I would hope not. I would hope that as we have aged and have the recall of our experiences that we would choose not to mistreat our youth, i.e., don't use them to work out our own dysfunction. Without protecting them and mentoring our youth, how else will we create trusting friendships and alliances between the various groups within the glbt community? This is not the time for us to divide ourselves along ageist, socio-economic class, racial, gender, or any other possible groupings - we have got to respect ourselves and as well as respect others in our community - otherwise each of us is unwittingly doing the work the conservative right is working towards. Do you really want to be in partnership with that kind of hypocrisy and hate? As far as the article goes, how about starting support groups - even if they are one-on-one. Listen to one another and connect with the part in another that resonates within your being, doctor? Remember, the glbt community is remarkable in what we have brought and continue to bring to societies and cultures. We can choose to behave in a life-affirming and respectful manner to our community and beyond while articulating, demanding and winning equal rights, by building alliances with all people. Referring to someone as a test-tube boy objectifies him, separates us and as a strategy is counter productive. Next time a man-boy comes to your office speak to him like you would speak to yourself - you said yourself he is a reminder, i.e., reflection of yourself in years gone by. What you needed then may be exactly what he needs now - he has come to you for help, not judgment. Be with him as each of us should be with one another. Apparently the alternative is not working for anyone. There are many ways to be gay, lesbian, bi-sexual or transgendered - there is one way to be human. I am 48 years old, sober since 1986, HIV positive since 1987. Patrick
Hi Richard, Indeed I was very far from wishing to suggest, and certainly hope I did not sound as if I were suggesting, that we shouldn't take anti-HIV medicines when they become necessary. My metaphor (I=Poland, HIV=Nazis, Meds=Soviet Union)may have been a poor one if it suggested that the meds were as bad or almost as bad as the disease, although as long as I hear about possibilities of things like long-term liver damage it will not lose its appeal. I shall certainly take the medicines when "the time comes"--even if bad things are possible with the meds, they are certain without them. But that leads to the next question--when does the time come? When T-cells hit 350? 200? 400? I've been following the debate with some anxiety; in the three years since I became HIV+ my T-cells have been fluctuating between 825 and 550, and while the average is in the 700's my last test was 547, the lowest yet, suggesting that the time to decide may be sooner rather than later. I'm still committed to putting off the meds as long as is reasonable--but how long is that? My doctor, whom I trust, is of the "before 350" camp--but saying "before 350" is like saying to someone on the bus who has asked for directions "Just watch me and get off one stop before I do." In fact, in writing my last comment, I wasn't really thinking about HIV at all. Most of the apparently healthy adults I know--I'm talking about people who do not have HIV--have a whole array of little orange medicine bottles in their homes. What are they? cholesterol-lowering, blood-pressure-lowering, sleeping-pills, anti-depressants, who knows what else? I have no idea how necessary or helpful all this medication is on an individual level, but I can't help but thinking that at least some of all this is excessive. For me the symbol of our wrong-headedness is the fish-oil pill, the garlic pill, and the green-tea pill. It seems to me that if a sane man becomes convinced that garlic is good for him (which it is) the next step will be to eat garlic or incorportate it into his cooking a lot more. Same with green tea, fish, etc. Instead, we put it into pill form. That taking a pill occurs to us more naturally than simply eating a food in its natural state suggests something very odd indeed about our mentality.
As a man of medicine I agree with the assertion that the dependence on medications as the "fix" for people's problems is indeed humbling. I see it every day. However, let me make it clear right here and now that many people, myself included, need to take medications to stay alive. I have AIDS and not matter how well I live my life in regards to diet, drinking, exercise does NOT negate that I need antiretroviral medications in my body to keep my HIV infection in check but the point I think you are raising is the same one I have been. There are no magic pills or solutions. We all have to make changes in our lives and change can be hard. For some it is impossible. But the issue is complicated and I sometimes boil it down to some crude basics out of my frustration of seeing lives deferred. But I suppose I always come back to what we are teaching our youth by what how we live our lives. Just because I am unrepentant social liberal does not mean I do not believe in self-responsibility. Far from it. My mother always told me it is important to keep my side of street clean and to help someone clean up their side when asked. She was right. So why can't we each just pick a broom now and then and help each other?
Richard Ferri
Sadly, Mario you have a very valid and major point. I have way too often been puzzled over the fact that some patients are just not "responding" to any HIV treatment until I do a genotype (resistance testing) or a therapeutic drug level and find that there isn't ANY HIV drug in their body. While this has happened to me many more times than I care to omit I am still mystified about it. I take great pains before starting HAART to review options, choices (including NOT taking meds), and the risks and benefits. I tell patients over and over again that THEY ARE IN CHARGE of their health care. But still this fails at times. And, once again you are very right. When I start to get some "honest" answers I can 100% trace back the bullshit to substance abuse and/or sex work to support their habits. It simply never fails. I just had to "terminate" a patient from my practice because when I did a random drug screen urine on him (as is our protocol for patients on chronic pain management) his urine was totally negative for any substances. This means he was NOT taking his "much needed" pain meds and doing something else with them. Most likely selling them or trading them for sex. I see this everyday and I want to thank you for allowing me another avenue to vent my sometimes very frustrating clinical practice and to remind myself that "there but for the grace of God go I."
May 22, 2009