@notWWJDjswgc: Diaspora: Remembering Boston’s AIDS Care Project, The Hospital Satellite Clinics

This is the third in a series of posts over the next few weeks @notWWJD that will testify to the legacy of the Boston public health clinic Pathways to Wellness. Offering free and low-cost acupuncture and herbal medicine on a sliding scale that made certain no one was turned away for inability to pay, Pathways to Wellness began in 1989 as the AIDS Care Project (ACP). Twenty-five years later a series of unfortunate circumstances forced the clinic to close, but as Boston’s South End News proclaimed in an October 2014 headline, “Despite Closing its Doors, Pathways Continues to Heal.” This is possible in part because the original AIDS Care Project will likely live on in Diaspora as a series of hospital satellite clinics and home visit programs after Pathways’ bricks and mortar are gone. It’s an important legacy to preserve: in 1998 the AIDS Action Committee of Massachusetts recognized ACP’s work by bestowing on it the Committee’s only award voted on by the members of the HIV/AIDS community themselves. As I testified in the first post of this series concerning my own time at ACP from 1993-1999, no place—and no community—taught me more of what it means to get out of your own way so God can use you. The second post remembered ACP’s main clinic; this one moves on to the Diaspora to remember a lesson from one of ACP’s satellite hospital clinics, circa 1997.

 

Shattuck Hospital

“You know I don’t believe in any of this,” my client told me.  We were in a former janitor’s closet on a locked ward in the state hospital, a deep sink in which mops used to be rinsed and in which I could now wash my hands permitting its conversion into a treatment room under OSHA guidelines, two padded blue portable massage tables pressed into service on either side of its narrow green tiled space, the same width as the room’s single window that looked out across pale institutional brick toward a public golf course and Massachusetts’ low-lying hills.  I weighed a mere one hundred thirty pounds, but when I pivoted from the window to face the open door frame each of my hips brushed one of those massage tables in turn.

Believe in what?” I asked.

“This,” he waved his arms at my sparse Tuesday and Thursday afternoon accommodations.  The wall hosted a framed picture I had taken of a painting in Bali: the hero Bima transforming himself once he had come to realize that the divine dwelt within him and not in the depths of the oceans nor the heights of the mountains, and that true heroism therefore took neither travel nor travails, but the daring to look within.  Bima’s fierce yet festive countenance looked over a desk strewn with treatment notes, a stack of patient files, a tray arranged as a clean field for an array of disposable sterile needles, swabs of cotton, alcohol wipes, a stick of pressed mugwort, gray ash at its end like a cigar.

“That’s okay,” I informed my patient, “you do understand treatment is optional; it’s recommended, but not a mandatory part of your program.  You don’t have to see me.”

“I know,” my new acquaintance assented.  “I’m going to come—I just want you to know I don’t believe that it will help me.”

A lot of the residents on the unit began their treatments with me in this manner.  Many were there by court order; usually arrested on a non-violent charge related to drug possession without intent to sell, someone in the system had had the foresight and compassion to advocate that these residents be sent to a locked ward for treatment rather than a lock-up for punishment: all of these clients were HIV positive and having trouble managing their illness due to issues of addiction that incarceration would only exacerbate.  Furthermore, studies at Bronx-Lebanon Hospital had shown acupuncture to be efficacious in managing drug withdrawal symptoms; as a complement to a full roster of therapists and physicians, ACP had therefore been asked to provide acupuncture as an option for these residents.  Most took the option, but not initially for the right reasons: unable to leave a unit that was less square footage than one of nearby Jamaica Plains’ newly gentrified triple-deckers, but that they shared with twenty-four other addicts—each going through their own set of issues—a lot of residents came to me as a concession to get out of at least one group therapy session a week; a group therapy session they would otherwise have to attend with the same people they saw every day, at all moments of the day, in the hallway, in the kitchen, at the nurse’s station, in the only room they could go to other than their own eight by eight cell, each furnished with an identical set of desk, chair, bed, and dresser.

“I’m just here to get out of group,” my new client informed me of what I already knew, “but I know it’s not going to work, so I don’t want you to be disappointed.”

“No disappointment at all,” I told him, “I’ll do what I do, and we’ll see what happens.”

He looked at me, confused.

“Yeah, but, I thought, like, you had to believe in this shit for anything to happen.”

I nodded.

“Well, any medicine—aspirin, an appendectomy, acupuncture—it all seems to get better results when the patient believes it’s going to work.”

“Placebo,” he interjected.”

“Yeah, and just the opposite, too.  Nocebo: treatments seem to work less well, or less often, when patients don’t believe they will be effective.  It doesn’t mean that aspirin doesn’t have its methods, or removing an inflamed appendix doesn’t remove an infection.  Same thing with acupuncture.”

“So you’re saying I don’t have to believe it.”

“Nope,” I told him.  “It might help, and it certainly wouldn’t hurt, but it’s not necessary.  Meantime, if you do get better, at least we’ll know it’s not all in your head.”

The ward’s new resident gave me a hardened stare, sizing me up; he was thin, wiry, with a goatee that bristled—even the hair on top of his head seemed to strain in opposition to gravity’s suggestions.

“Well, I don’t want needles,” he told me, as if thinking that would have me stumped: how can you have acupuncture without needles?

I paused for a moment, to respect his assertion rather than dismiss it out of hand by providing too ready a response.  After a suitable silence so as to appear as if he had stumped me, I stepped in with a solution.

"We can start you off with herbal teas that you can take on your own through the week—they’re not medicated, but the herbs have a calming effect that will help with cravings, a natural sweetener that you can use instead of the sugar and caffeine in the kitchen that do nothing for the nervousness this place can create, and it will also flush your liver and kidneys.  On the days I come in we can do massage or we can use magnets in place of pins.”

I always called them pins; although acupuncture needles aren’t hollow, nothing at all like getting a shot, addicts were often unaware or unimpressed by this distinction and therefore didn’t like the sound of needles, thinking the treatment’s similar form of delivery may be a source of temptation, reminding them of a past both painful and pleasant.  Once these clients had experienced acupuncture they typically didn’t give it a second thought, no longer seeing any association between their weekly treatments and former habit, but you had to help them over this hurdle.

“I don’t want to be touched,” he told me in response to the massage.  “I especially don’t want to be touched by a man.”

“Okay, then we’ll use magnets—is that okay?”  I showed him the little tablet sized circles of silver, explained to him their strength, their purpose, how one would be taped into place with a small square of surgical tape, others then stacked on top, self–adhering until we got to the proper gauss.

He had headaches.  Severe headaches.  They made him dizzy.  Nauseated.  Sometimes he blacked out.  He had become addicted to painkillers, at first legal, and then not.  But that’s not how he contracted HIV.  Not shooting up.  He was careful, never shared works.  He had cut himself shaving.  Somebody else’s razor.  In prison.  He wasn’t gay.  And he wasn’t stupid; he shot up, but he wasn’t stupid.  And he wasn’t gay.  He just had headaches.  Headaches that wouldn’t go away.  Nothing helped the headaches.  Acupuncture wouldn’t help with the headaches.  But it was better than group.  He just didn’t want to be touched, and he didn’t want needles, or pins, or whatever else I wanted to call them.

Okay.

Over the weeks his headaches got better.  He served his sentence and was released from the unit; still he came for treatment at our main clinic, every time telling me that it wasn’t the acupuncture—he now acquiesced to needles, or pins, or whatever I wanted to call them—and that it wasn’t the teas, or the more specialized formulae of herbs I now wrote out for him to get filled at the pharmacy in Chinatown, and which he took faithfully, even though he said they tasted terrible and were totally unnecessary—his headaches were gone.  He didn’t know why, he just knew it couldn’t be the acupuncture.  He didn’t believe it.

I laughed.

“You present with symptoms, I make a diagnosis, I provide a treatment based on that diagnosis, and you get better: what’s not to understand?” I asked him good-naturedly.

“I don’t believe in it,” he smiled.  “And I don’t like the shirt you’re wearing.  It looks like a pajama top.  You shouldn’t wear it.  Please don’t wear it next week when I come for my treatment.”

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