The pace at which Gail disappears from his life has slowed, a loss that is spread out over time, bits and pieces that break down and gradually disintegrate. He recalls mornings when, waking first, he would see the room take shape around him and turn to find her curled away, her hair sweeping up across the pillows, away from her neck. He would place his lips there, her skin smelling of the sheets, of warmth.
Every Sunday, he drives to the cemetery. Often, he sees Clara. On his most recent visit, he had lain his own small offering down, then he had taken a cloth and cleaned the dirt and grass from the marker. He told her passing things, the grocery list, jokes, ramblings. Quotidian details that they have always shared. He heard her voice, Did you sleep well?, Did you dream?, What shall we do today?, And then, my love, what then?
At 10:30, Ansel has an appointment with a new patient, Alistair Cameron. A nurse at the AIDS outreach clinic has referred him here. According to the file, he has already been hit three times with pneumonia, once with Kaposi’s and once with CMV retinitis. “Symptoms suggestive of TB infection. No previous BCG vaccination.” Ansel reads the history closely, seeing an immune-compromised patient with probable tuberculosis, a diagnosis that he has no wish to give.
Thirty minutes go by and Alistair Cameron does not arrive.
Sitting in his office, he turns to the cassette player he keeps beside his desk. After a moment, he picks up the headphones and slides them on. He rests one finger on the controls, hesitating, but he cannot help himself. All he wants is to hear her voice. He hits Play, and a young man begins to speak, reading from the letters of Franz Kafka. “I shall never get well again. Just because what we are dealing with here is not tuberculosis that can be nursed back to health in a sanatorium deckchair but a weapon that remains indispensable as long as I live. It and I cannot go on living together – or apart from each other.”
A slight pause, then a voice reading from a “Dispensary Instruction Sheet,” an artifact from the 1930s. “No fondling or kissing of other members of the family, particularly not of children. Married Partners to sleep in separate beds preferably separated by a partition. Most important: Family members must immediately notify the dispensary of the death of the patient.”
“The history of tuberculosis, the white death, is deeply embedded in the history of the modern world.” Gail’s radio voice is much the same as her usual voice. Only here the pauses are more deliberate, her tone intimate. “Influenza, the Black Plague, syphilis and AIDS – these diseases, like tuberculosis, have their own personalities in much the same way that nations have historic periods. Tuberculosis rose with the Industrial Revolution, in a time of poverty and cramped living conditions, among the child labourers of the nineteenth century and in the inhabitants of bohemia on the Left Bank. It came to prominence again between the two world wars, and reappears now in developing nations and in the urban ghettoes of North America. Tuberculosis, as the saying goes, is the perfect expression of an imperfect civilization.”
A year after they met, Gail had begun working on this documentary. Since its completion, he has kept a copy in his office, lending it to students, colleagues or interested patients. Now, occasionally, he plays it to hear her voice, preserved and distinct, as if she is in the room there with him. He closes his eyes, bows his head under the weight of the headphones, and the sound runs over him.
Canned music starts up, and then a man’s voice reminiscent of the late 1950s. “The beginning of the end came in 1943, when Selman Abraham Waksman observed that certain bacteria and micro-organisms in the soil could inhibit others. These inhibitors made use of certain chemical substances, known to us now as antibiotics.” The commentator goes on to describe the case of Patricia S., a twenty-one-year-old woman in the terminal stages of pulmonary and disseminated tb. “She responded to Waksman’s inhibitor at once. Like a fairy tale, she got up and left the hospital, completely cured.”
The music slides to silence, and Gail’s voice returns to the forefront. “The tuberculosis bacillus, discovered by Robert Koch in 1882, became famous to doctors and even the general public. A slender, elegantly curved rod, so small that a dozen or more could fit inside a medium-sized tissue cell.”
“My name is John de Vreede. I’m the director of New York City Tuberculosis Control. On August 30, 1991, the United States Centre for Disease Control reported four small outbreaks of tuberculosis. Three of the outbreaks occurred here, in New York City. Almost all the patients were HIV-positive, drug users or alcoholics. We knew, at that time, that there were as many as seven million cases in the developing world. But here in America, tuberculosis, consumption – in the public perception this disease was gone. Eradicated. It was a character in a folk memory.”
When they first met, Gail had been using a portable DAT machine. Interviewing Ansel for this piece, she had listened to his voice using a set of headphones, saying that his voice was being funnelled directly into her ears, through the canals of her brain, woven into her thoughts forever.
“Dr. Ressing.”
“To counter the possibility of drug resistance, we now treat each patient with four different drugs: isoniazad, rifampicin, pyrazinamide and ethambutol. If they don’t respond, if they are multi-drug resistant, then we have nothing. No medical treatment for the disease. We’re back to the eighteen hundreds.”
Ansel has his eyes open, but he can see Gail listening. He can see her glancing down at her notes, at the needle on the recorder. There was something in her manner that Ansel recognized early on, something that others were always drawn to in her. You believed you could trust her – whatever you said, whatever you confided – that she would hold that trust as something sacred.
The intercom buzzes, startling him. When he touches the button, Pauline’s voice comes through in a crackle of static. “Your 10:30 just checked in. Room Three.”
He thanks her, then stands, shrugging on his lab coat. He starts down the corridor, the file flipped open, reading as he goes.
Inside the room, a young man sits on the examining table. He is wearing a frayed windbreaker over a thin T-shirt and jeans. There is a ball cap in his right hand. His face has the inquisitiveness of a young boy, though he is pale and clearly ill. “Hi, Alistair, I’m Dr. Ressing.”
“Al is okay.”
“Call me Ansel.”
“You look young, Doctor, if you don’t mind me saying it.”
“Thirty-eight.” Ansel opens the file and looks at it again. “We were born in the same year.”
Alistair Cameron nods. “The similarities end there, I think.”
“You’re from Alaska?”
“Juneau. And you?”
“Vancouver.”
“Lucky you.”
Ansel wheels a chair out and sits across from Al Cameron. He orders his thoughts, unclips the pen from his lab coat, and begins to take a case history. Born in 1961, parents came up from Nebraska. High school education. Came to Vancouver when he was thirty-six. HIV positive for three years. Full blown AIDS since last September. His only family is a younger sister who lives in Victoria. Al spills it out like something memorized a long time ago. “There it is,” he says, shrugging. He lifts his right hand and turns it over as if looking for dust. “This time? Tuberculosis, hopefully not drug-resistant. Picked up in one of the shelters probably. It travels through the air, could be dangerous for someone like me.” He pauses and touches the side of his neck. “Lymph nodes swollen and sore. Definitely a bad sign.”
Ansel places his hand against the man’s neck. He does a thorough physical. Febrile to 103, and his pulse is high. Through his stethoscope, Ansel can hear the faintest of crackles in the upper part of the left lung. He does the tuberculin test, and Alistair looks away as the liquid is injected just below the surface of the skin. A reaction develops almost immediately.