HAART

Michelle stood in front of the mirror in her room, holding her jumper up so she could examine her increasingly concave stomach. Her dad was right, she wasn’t absorbing nutrients. She had known that for a while. She absently scratched at the crook of her elbow where she had been receiving IV nutrition for the past six months. It wasn’t helping. Nothing really was.

“Some of these drugs decrease in efficacy over time, sometimes your virus can mutate to make the medication ineffective against it, and you’ve been on them since early childhood.” Her doctor hadn’t looked up from her lab results as she spoke. Her voice was one of complete clinical detachment, but her posture revealed a profound sadness. She had been Michelle’s doctor for nineteen years. “We will keep trying, and we’ll find a solution. But you need to prepare yourself for the possibility that you’re going to get sicker. As your viral load increases you will get weaker, you may struggle to keep on weight, and you will get sick. If you’re lucky it will be thrush or a minor bacterial infection, but more likely than not you will contract pneumonia or tuberculosis or salmonella and be seriously ill.” 

“But that would be short term?” Michelle asked hopefully. “I could bounce back once we’ve found a med cocktail that works?” 

“You won’t get worse,” the words were clearly meant to sound hopeful, but the tone was so empty that it merely settled a cloud of melancholic realism over the two of them, the air suddenly steeped in bitterness. She had a very short window to fix this or she would die.

“Michelle?” Greg’s voice was thick with concern as he paused in front of her slightly ajar  door. 

“Oh! Greg!” Michelle shoved her jumper back down, smoothing it over her stomach. “Sorry, woolgathering.” 

“Michelle, honey, are you alright?” Greg took a hesitant step towards the door. Michelle shifted uncomfortably. 

“Nutritional malabsorption. It’s common, Dad has it too, to a lesser extent.” She smiled weakly. “I know it looks bad.” 

“It does,” Greg admitted quietly. “Look, I just wanted to say, if you don’t want Katie to know, you don’t have to tell her. Katie’s self esteem issues have been going on so much longer than she’s known you. That being said, I fully support you either way.” 

“I know I don’t have to. But, well, you’ve seen what I look like. She’s going to notice. And there’s always the chance I get worse, you know? I’d rather she knew in case that happens.” 

“Michelle, are you getting worse?” 

“No, no, but…I mean, I’m a realist and a chemist, Greg. It’s always a possibility.” Michelle tried to smile reassuringly, but she could tell from Greg’s face that her efforts were falling flat. 

~~~

Michelle had hoped that going to her lab for a little bit while she waited for Katie to get home from school would relax her and take her mind off of the conversation she had planned for that afternoon, but it wasn’t really helping. 

The rats who were part of her study got excited as she approached their cage, treats in hand. They squeaked joyously as she popped the cage open and they scrambled out into the improvised play area that she set up on the table. She mechanically went about her work, studying the new test results showing the various viral loads of the various rats, grimacing as she realised that none of them were improving. She mournfully turned to the final page of the report. Patient A’s T-cell count was 161. It stung, but not nearly as much as when the number had first dropped below 200, the cut off for an AIDS diagnosis.  

“You can live for years with AIDS,” her doctor reassured her softly as they went over the most recent test results. “It’s not a death sentence.” 

“Right, if we can get my virus to respond to meds.” Michelle wasn’t doing a great job of keeping her bitterness from her voice. 

“We’ll figure it out, Michelle. We can figure it out.” 

~~~

It was only a ten minute walk between the lab and her home, but it increasingly felt like an eternity. It didn’t take much to get her out of breath these days. She knew full well that she was experiencing the first stages of her body shutting down. She wasn’t getting enough nutrition to power even the most basic daily activities. She was terrified of touching doorknobs and railings, any sort of public surface that could carry the germs that she was increasingly aware would end her life. 

Mycroft lay on the couch, his breathing shallow and his forearm shielding his eyes. Pneumonia, on top of being a common cause of death in HIV+ people, was exhausting. Any breath too deep would set off a coughing fit. Thankfully, the infection was responding to treatment, but he was too exhausted to celebrate. 

“You feeling okay, Dad?” Michelle’s voice was muffled by the medical mask she was wearing. She placed a cup of tea next to him, then sat down across the room. 

“I’ll be fine,” Mycroft attempted to reassure her. “How about you, sweetheart, any symptoms?”

“Nope, feeling fine.” She smiled, not that he could see that through the mask. 

“Good, good,” Mycroft had to take a few breaths before he could continue, “I’m so grateful that you got treatment earlier than I did. I never want this for you.” Michelle shifted uncomfortably in her seat, so grateful that his eyes were closed. She opened her mouth to admit that her treatment wasn’t actually going well, but just then Mycroft dissolved into another coughing fit and Michelle’s jaw snapped closed again. 

Not right now, she decided. There would be time when he was feeling better.

~~~

Katie came home that day to find Michelle in the kitchen, fixing a pot of tea with shaking hands. 

“Hey Michelle!” Katie skipped over to her sister who beamed and turned to hug the young girl. “Dad said you had something you wanted to talk to me about.” Michelle nodded, grabbing the tea service and beckoning Katie over to the table. 

“I heard what you said while you were getting dressed for your dance.” Katie’s face fell, a flush settling in her cheeks. She started to say something, but Michelle cut her off. “I know what it’s like to be self conscious. I’m not mad at you at all. But I got a little worried that you would try to lose a crazy amount of weight to try to look like me.” 

“I want to lose weight,” Katie pointed out. 

“I did too when I was your age. But the reason I’m so skinny, Katie, is because I’m sick.” Katie raised her eyebrows, a deep concern creasing her forehead. 

“Something catching?” She asked hesitantly.

“No, well, sort of. Do you know what HIV is?” 

“The virus that causes AIDS?” Michelle nodded and watched as realisation dawned on Katie’s face. “You’re really, really sick then.” 

“I’m pretty sick. Not as bad as you’re thinking, but I am very sick.” 

“Why does it make you so skinny?” 

“I don’t absorb nutrients as well as most people can,” Michelle explained. “So no matter how much food I eat, I just don’t get enough nutrients to gain weight.” 

“Can that kill you?” 

“I get extra nutrition through IVs. I won’t starve.” Michelle was very careful not to insinuate that her disease wouldn’t ultimately end up killing her, she wouldn’t promise that, not at this point. Katie nodded, swallowing against the lump in her throat. 

“I love you, Michelle, I’m sorry about what I said.” 

“You have nothing to apologise for, kiddo,” Michelle squeezed the little girl’s hand with a comforting smile. “I love you too.” The two girls finished their tea, chatting of nothing of consequence, both of them happy and relaxed. Michelle hardly even took notice of the fact that during the conversation, Katie sneezed three times.