Saturday, December 1, 2007

World AIDS Day(s) Observation: The Women's Clinic at Ward 86, San Francisco General Hospital - Part 1

This is the first year - in many ways my own reclusive fault - I have been invited to nothing, or heard of nothing, honoring World AIDS Day (other than Regan Hofmann's October blog post on POZ Blogs comparing Breast Cancer Awareness Month's pink ribbon presence with World AIDS Day's faded, - my word red ones).

So: my way of honoring World AIDS Day is to do a four day series on the Women's Clinic at SFGH's famous - see And The Band Played On again - Ward 86. This writing is taken from a "participant observation" paper I wrote for an anthropology class at City College of San Francisco in February of 2004 - The characters and place are not altered or exaggerated. I haven't seen the women I described in detail in a long time. But not a whole lot has changed at the clinic since I wrote this, that I can tell. Always new classes of meds; patients have died; patients have survived; and disappeared for their own reasons - and the bats were outlawed by the fire marshal, (you'll see, read on...):

Positive Participant Observation: The Women's AIDS Clinic at San Francisco General Hospital

Every Thusday morning between 9:30 and 11:00, in "Women's Clinic" at the AIDS/Oncology Ward at San Francisco General Hospital. I do not know if people with non-AIDS-related cancers are eger treated at "AIDS/ Oncology," or if both conditions are listed together as a confound to protect the confidentiality of HIV-status - similar to the was that the appointment reminder mailings used to say they were from a euphemistic, "Positive Health Practice," and now a generic "Community Health Network." Although I have been receiving these appointment reminders in the mail at least every other month since before there was a seperate clinic-time for women alone, I'm surprised at how many details of a place so familiar to me - like its name - I do not have real explanations for.

Ward 86, the clinic's least revealing (and most famous) title, is the sixth floor of the second (not up to seismic safety level code) brick building of the old section of San Francisco General. Old brass elevator doors, deco details, and impractical hallways are consolingly humanizing compared to the cold symmetry of the newer main buildings and emergency rooms. Except for a methadone clinic somewhere on the first, I don't know what the other floors in this building are used for , but in the elevator going up, I distract myself with wondering who is going, besides me, to mine. Most of the health-care workers don't wear scrubs, so I can't always distinguish who are patients, and who treat patients. I wonder this time if two men in the elevator could possibly wonder where I am going also, but I know better. The doors open at my/our destination facing a wide, colorful reception area, over which is a long paper banner announcing "TB Test Week" in blue tempera paint. (Annual maintenance testing and vaccinating are organized into little seasons here: TB Testing Week, STD-testing Week. hepatitis vaccine week, flu shot week...). Before checking in, patients first have to go left down the hall to a small room - which everyone seems to know to do, although I, this time, - writing in my head with fresh eyes- notice I don't see any posted instructions. There is a brief wait in line to get into the small room which contains two crowded desk cubicles facing away form each other. Every inch of the cubicle I'm called to is covered with stuff - photographs of little girls wearing pink ruffled dresses and white maryjanes, postcards from tropical-looking beaches, a cross, plastic rosary, and dried flowers; a blown up color xerox of Doctor Paul Volberding smiling shyly in a tuxedo. A large, dark-skinned woman asks (with an accent I can't identify) for my hospital number, as she has done for years. I still haven't learned it and give her my social security number instead. Every ornately-tipped finger of her typing hands is articulate by a gold ring. She verifies my address, and I go to a loud, tired-sounding machine that spits out my temporary hospital ID card, and then back to check on at the initial reception area.

Once officially here, I am directed unnecessarily to the waiting room down the hal in the opposite direction. I pass a few men sitting in uncomfortable-looking, mismatched plastic chairs in the hallway, and enter what is temporarily the snctum of my kind, bright with morning light from two large windows, which look out over small volunteer-tened gardens with benches way below, past the iron gates and Potrero. over bright houses in the Mission, to the hills just South of Castro. The same mismatched chairs don't look so uncomfortable in here. There are, I'm guessing, twelve women total at the time being, coming ang=d going as called. The number is not including the case-workers - all women, and peer advocates standing guard over the doughnuts, and at the door. (Some times new male patients, or male patients who aren't focused on what time of the day of the week it is, drift in and are abruptly barred by peer advocates from entering.) I'm asked for my birth date as if it were a special secret code.

Today there are oranges donated from somewhere along with the now-standard bagels and doughnuts. I am greeted and issued a paper plate and handed a doughnut I'm not allowed to reach for. For some reason, I am not allowed to serve myself coffee either, and am told to wait for a peer advocate to come fix it for me. I change my mind about wanting coffee and weave through what I imagine would seem from the outside to be a surprisingly cheerful din, to the back corner of the room, as usual, to watch, as usual.

The back corner is the meeting point of two wall-long bulletin boards scattered eit postings, (no glossy, smiling, pumped-up pharmaceutical ads here). One posting requests donations of unused medications for collection and distribution in Africa; most advertise opportunities for participation in clinical trials. (There was an especially memorable opportunity a few years back offering $500 for voluntary spinal taps - two per year for a certain number of years with $1000 bonus for completing the series.) A lot of us here participate in a comparatively painless study which involves fifteen minutes of answering questions about any sexual activity we have, or have not, engaged in since the last time we were here, for which we get $25. I think I am atypical in viewing my $25 dollars as participation in research. From my longitudinal eavesdropping I think it is more common to consider the $25 as $25 without having to sell or do much. The results are the same.

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