Drug Resistant

Randall Shook's body was at war with itself. Sitting on the concrete floor, Shook gathered his legs close to his chest and groaned. Chills traveled the lanky frame of his body, causing him to shake uncontrollably. His head burned from fever, and his heart beat rapidly.

Shook hollered down the hall for help, but when a Harris County Jail deputy showed up, the jailer refused to take him to the clinic. The clinic was shorthanded, he said. Two days later, still suffering the same symptoms, Shook asked another deputy to call the clinic.

"This is jail. You're not supposed to feel good," he allegedly replied.

In April, Shook had been pulled over on Greenbriar for driving the wrong way down a one-way street. He refused the Breathalyzer test. He pleaded guilty to DWI, prepared to do his time. What he wasn't prepared for was having the pills he took each day, the ones that kept him healthy, taken away from him during his incarceration.

Shook has been HIV-positive for 15 years and has had AIDS for the last four. A person with HIV develops AIDS when the T-cell count drops below 200. (An HIV-free person normally has 1,000 T-cells.)

Shook, whose T-cell count dipped to less than 100, did not see a triage nurse until ten days after his initial written request -- even though the jail's own policy mandates that a nurse should see a patient within 24 hours of a sick-call. It took 18 days for Shook to receive his pills after coming into custody, which seemed a matter of life or death to him because interrupting an HIV drug regimen can render the virus resistant to drugs.

"Should a DWI be a death sentence?" he wrote in a letter from jail.

With a population that fluctuated between 6,029 and 7,701 inmates in the last year, Harris County Jail is one of the largest jails in the country. Treating so many inmates is a complicated task, says Major Don McWilliams, who oversees the sheriff's department public services bureau.

Since 1990 Harris County has contracted with the University of Texas Health Science Center at Houston to provide medical care to inmates. Those who work in corrections praise Harris County Jail for its vast medical system, which functions much like an outpatient clinic. The on-site medical facilities include a pharmacy, laboratory, eye clinic, dental services, tuberculosis clinic, and specialists in infectious diseases, obstetrics- gynecology and nutrition. Its 11-year-old HIV counseling program has served as a model for other correctional facilities.

Yet some AIDS patients who recently served time complain they were deprived of HIV medication for weeks on end, were refused trips to the clinic when sick and were even exposed to an inmate with tuberculosis. Gay and transgender inmates report that guards constantly harassed them over their sexual orientation . Though the county jail may have decent procedures on paper, it does not seem to follow them.

At Christmas, Randall Shook told his mother that he didn't think he'd make it through the summer. A skilled hairstylist who once owned his own salon in Dallas, Shook made $1,200 a week cutting hair at a high-end Tanglewilde spa. But in late March he became too weak to stand up long enough to work. Racked by spells of simultaneous fever and chills, he hardly left his bed, and his mother and brother came to collect him. His younger brother carried him to the car from a near-empty house. Shook had already given most of his possessions away.

Shook spent ten days in Ben Taub for pneumonia. Days after his discharge, he visited Thomas Street Clinic, the Harris County Hospital District's AIDS facility. Five days later, on April 5, he was arrested for his third DWI. It had been seven years since his last DWI and five years since his last arrest. (In 1996 he served time in state jail when a bag with traces of cocaine was found on him.)

Shook instructed his mother not to bond him out because he planned to plead guilty and serve time. He, like everyone else, was made to strip, shower, trade civilian clothes for an orange jumpsuit and submit to a chest X-ray to screen for tuberculosis. Everyone also sees an intake nurse who asks a series of medical and psychiatric questions. By the time Shook saw a nurse and told her about the regimen of six different drugs he took, it was his second day in jail. Then he was called for classification, where inmates are assigned housing based on a number of factors, including criminal history, education and sexuality. On his third day, Shook was moved to a cell block on the eighth floor of 1301 Franklin (the county jail maintains three facilities, all located downtown) for men who are gay, bisexual or transgender.

For security reasons, people are not allowed to bring medication into the jail with them, says Dr. Michael Seale of the UT Health Science Center who serves as medical director of Harris County Jail. The only exception is someone who is participating in an experimental drug study.

"It's difficult to look at a vial of medication and see if it's been tampered with -- if perhaps with illegal substances. So what we choose to do is start fresh with our own supply," he says.

To confirm that a person has an illness, and to ascertain how far the disease has progressed, the jail diagnoses patients from scratch. Nurses draw blood for lab work, which is completed in-house. Patients must wait for the results and consult with a doctor, who writes a new prescription. Medication is dispensed from the jail pharmacy, which charges a $3 handling fee per bottle. Even those used to taking their medication daily must wait at least a week for lab results before getting their first dose.

Of the eight inmates interviewed for this story, six took medication daily, and all of those complained of a wait anywhere from seven to 21 days, from the time they first entered the jail. Four others wrote letters stating they also had not received drugs for HIV or mental illnesses in a timely manner.

John Phillips, who took ten different medications, says 21 days passed before he received his drugs. Phillips was charged with aggravated assault with a deadly weapon, the weapon being his HIV-infected blood (even though the virus can't live outside the body). Phillips had been suffering from hallucinations caused by one of his HIV drugs, Sustiva, when he left his mother's house to walk the dog. Officers found him climbing the rafters of a Montrose building and accused him of smearing his bloody hands on them. When he arrived at the jail, he didn't know his name and thought hidden radioactive cameras were taking his picture. He couldn't afford bail and eventually was found not guilty by reason of temporary insanity after sitting in jail for nine months.

Jerry Schwartz, a schoolteacher who has been HIV-positive since 1983, served 60 days for violating his probation, and says it took five days before he was even called for blood work and 11 days before he received his drugs.

"For someone who's been told, 'Don't miss a dose,' 11 days got me panicking," says Schwartz, who asked that his real name not be used.

With HIV drugs, it is crucial not to miss a single dose in order to maintain levels of medication in the bloodstream, says Steven Walker, executive director of the Donald R. Watkins Memorial Foundation, a nonprofit AIDS clinic for indigent people.

"Because the HIV virus mutates so rapidly, if people miss a single dose of medication, it can result in resistance," he says. And that's bad news not just for the patient but for everyone, because stronger strains of HIV will get passed around.

"If the person infects someone else, the person who is infected is also drug-resistant," he explains.

Seale acknowledges that someone could become drug-resistant in the week it takes to complete the jail's lab work, but says tests are necessary to make an accurate assessment. "There is no cookbook prescription for HIV medication. It's all individualized for the patient to meet his or her needs," he says.

Raul Carvajal, who directs the HIV and substance abuse counseling programs in the jail, insists, "It's impossible not to lose a week…People complain, but I don't know how to do it differently. If I said, 'I have a problem,' would you give me the medication just on my word?" Sometimes inmates are mistaken about having HIV or lie about it, he says. Confirming HIV takes two tests, the ELISA and Western Blot.

"Sometimes they assume they have HIV because they went to some place…and they might have had one ELISA and never come back, but it was a false positive…There is also a very small percentage of people who think that if they're HIV-positive they're going to get some privileges."

Once in a while, inmates can receive medication faster if the jail obtains medical records from the patient's outside physician, Seale says. But the inmate must sign a release, and not all doctors return phone calls, so shuffling paperwork from one place to another can take just as long. Also, the intake nurse can refer an inmate with urgent needs to a physician right away who might administer a dose of medication at that time. "Occasionally when a doctor is very comfortable with the history and very secure that the patient knows what he's talking about, we might initiate medication at that initial visit," Seale says.

However, none of the inmates interviewed for this story say those options were made available to them. In fact, Shook, Phillips and Schwartz had worried relatives who tried desperately to find ways to get medication to them. They informed the inmates' lawyers of the situation, tried to contact physicians and even medical staff at the jail. Jo Shook, Shook's mother, and a family friend even called the office of Texas Senator Mario Gallegos for help.

Some of the HIV specialists who work at the county jail also work at the county's Thomas Street Clinic, where Shook and Phillips had been receiving care. In fact, Shook eventually saw the same doctor inside the jail that he had seen at Thomas Street, yet his medical records were not made available to the jail.

When he finally received the pills, Shook suffered from another weeklong lapse when his refills did not come.

Following procedure, Shook filled out an Inmate Request Form, writing that his medication had not come. He deposited the form in the locked box labeled "medical" at the entrance of the cell block. The forms are distributed daily, but Shook says he never received an answer even though he wrote daily requests. His medication just appeared one day on the medicine cart that is wheeled around each floor by a nurse. Shook didn't know if he should take the pills again; starting and interrupting an HIV regimen repeatedly can cause more damage than taking no drugs at all. When he decided to take them again, he noticed new side effects immediately: nausea, fever and diarrhea.

"I'm not saying it never happens. I'm not excusing it," Carvajal says. "But this is the system, and it works. It's very professional. It's a top-quality program."

In 1972 Lawrence R. Alberti filed a lawsuit against Harris County, claiming that overcrowded and poor conditions at Harris County Jail amounted to cruel and unusual punishment forbidden by the U.S. Constitution. The case, which later became a class-action suit, took 23 years to run its course. The settlement of the Alberti case recommended that medical services be outsourced to a professional service provider. Harris County used to employ its own physicians and health care staff, but in 1990 it contracted with the UT Health Science Center for physicians. UT provides four full-time primary care faculty members, including the medical director, as well as two full-time nurse practitioners and various on-site specialists. At any given time, there are one to three infectious-disease fellows rotating through the jail clinic who specialize in HIV management.

The most recent agreement stipulates that Harris County will pay UT $200,000 each month for its services. In addition, the sheriff's budget also includes roughly $2.4 million for medical services and drugs. This figure does not include the salaries of nurses and ancillary staff who are employed by the sheriff's department.

Finding people to work in a lockup setting can be a challenge. Harris County Jail has been short on nurses; however, all of Houston has suffered from a years-long nursing shortage, Seale says, and the jail is no worse off than any other Houston facility. (Seale was unable to provide a specific number of unfilled positions.) Still, he admits that jail is not a desirable place to work.

"In our situation it's doubly difficult, because for one, when you're a nurse or a doctor, you don't think of jail being a practice," Seale says. "I think what we've found is many of the people who work in correctional facilities really buy into it as almost a Peace Corps issue or a decision to provide care to the underserved."

"I think Dr. Seale does a wonderful job over there," says Dr. Grace Chao, a former medical director for the Texas Department of Criminal Justice hospital who once spent a month at Harris County Jail on a public health residency. "It's a very, very tough job he has. It's very difficult because the turnover is so huge, you just can't catch them and hold them long enough to do a whole lot."

Harris County Jail is one of only 12 detention facilities in Texas (out of 240 county jails, many private facilities and several INS detention centers) accredited by the National Committee on Correctional Health Care, based in Chicago. Since 1970, the private nongovernmental association has offered a voluntary accreditation program based on national standards. Harris County Jail has met that standard for more than five years, says Edward Harrison, the correctional health care group's president.

The jail also gets a thumbs-up from Terry Julian, executive director of the Texas Commission on Jail Standards, a state agency that conducts annual inspections.

"We're very pleased with them. If you could go down there to look and see what they do, it's just mind-boggling, to see the number of inmates that need to be taken to all the things they do…They are doing a superior job of taking care of inmates. I know they're on the cutting edge of technology as far as a large jail is concerned," Julian says.

However, according to records obtained by the Press through the Texas Public Information Act, at least 38 complaints concerning medical care, discrimination and harassment have been filed with the commission against the Harris County Jail since January 2000. Most of the complaints dealt with allegations of assaults on inmates -- either by other prisoners or by guards -- or the withholding of medication or legal services from inmates by jail staff. The complaints seemed to range in severity as well as veracity. For example, one inmate claimed that he was sexually assaulted by another inmate, but a physical examination of the reporting inmate revealed no evidence of an assault. Another set of correspondence to the commission indicates that inmate Garard Natiello was, however, wrongfully denied access to the jail law library. In June 2000 George Brown, director of the library, wrote to the commission stating that "this matter has been investigated and it was found that Mr. Natiello is now attending Law Library and his grievance is resolved."

Each of the 38 complaints eventually was ruled by the commission to be unfounded. The commission based each of its decisions on an assessment of an inmate claim provided to the commission by the sheriff's office. Often, the review by the sheriff's office included interviews with deputies and jail staff only -- no inmates. Each written response by the commission's executive director to the complaining inmate including form-letter language stating, "After reviewing the allegations with the staff of the Harris County jail, it was determined that no violation of standards was noted."

Critics like longtime inmate advocate and gadfly Ray Hill contend that the care provided to inmates borders on the inhumane. In 1993 Hill was part of a watchdog group called the Harris County Jail Citizens Medical Advisory, which accused the county of withholding medical treatment from inmates.

Attorney James Randall Smith represented an HIV-positive client six years ago who did not receive any HIV medication while he was held at Harris County Jail. Smith says he filed an order with Judge Mike McSpadden to force the county to treat the client. The treatment? Giving him a whole bunch of aspirin, Smith says. He is thankful that his client committed a federal crime, he says, because then he was moved into federal custody, where he had access to better care.

"I mean, honest to God, if any doctor treats their clients on the outside the way inmates are treated by doctors in prison or jail, there would be such a huge outcry, it would be all over the front page of every newspaper…So long as we're dealing with criminals, it's perfectly all right to mistreat them."

Troy Cimini was arrested on July 14 and sent up from booking without any shoes. By the time he wrote to the Press more than a month later, he still was walking barefoot despite filing repeated requests. This was not his only concern that went unanswered.

"It's been a week since I wrote a request saying I am going to commit suicide, and they still haven't done anything," he wrote in a letter. "I know animals can't be treated this bad, why should we?"

Some inmates who are acutely ill live on a medical floor for observation. The Mental Health and Mental Retardation Authority of Harris County also operates a floor within the jail for severely mentally ill patients. All other inmates must fill out request forms for help, which should arrive in 24 hours, according to both Seale and jail spokesperson Lt. Robert Van Pelt. (However, the "Inmate Health Services Plan" submitted by the county to the Texas Commission on Jail Standards says requests should be handled in 48 hours.)

In case of a medical emergency, inmates should notify the floor deputy, who should in turn alert medical staff, according to Van Pelt and Seale. However, inmates say deputies frequently ignore their requests for help.

Van Pelt says all deputies and jailers attend a three-week jail school as mandated by the Texas Commission on Law Enforcement Education and Standards, which includes training on identifying procedures for prompt and efficient care. Raul Carvajal, head of the HIV counseling program, says he and his counselors visit the school about every six months to conduct an HIV education workshop.

Guards should alert medical staff to every inmate who asks for help, and not decide for themselves if someone looks sick enough, Seale says. "We ask them to not really make that decision, to not make a medical decision and to call the nurse, but that is a challenge."

Edward Harrison, president of the National Committee on Correctional Health Care, says if security fails to alert medical personnel, that constitutes a "big violation" of their standards -- even if security suspects an inmate is faking an illness.

"It's not their call," he says.

Shook (who was twice refused clinic visits) and five other inmates say they tried to get help for two dying AIDS patients who lived in their cell block. Both had dementia, symptomatic of the final stages of AIDS, and would talk to themselves and behave irrationally. One of them could not control his bowel movements and would relieve himself all over the cell block several times a week. Childlike, he once hid the feces under a bed. Another time he covered it up with newspaper. Deputies called him Shitty, Shook says.

Despite repeated requests by cellmates to move the men to medical or MHMRA, the men sometimes were taken out of the cell block but always returned after several days.

Inmates also complain that they were rarely provided with proper supplies to clean up the incontinent inmate's mess. They bought bleach on the black market from floor workers by trading $2.50 worth of commissary soup for a soda bottle half-filled with beach. The shower was mold-infested and the floors filthy. Jerry Schwartz once went to the medical floor for an eye infection and says he was left for three hours in a cell with feces and dried blood on the floor. When he pointed this out, he says, nothing was done.

In a written statement, Van Pelt says Harris County adheres to jail standards for cleanliness. "We pride ourselves in the cleanliness of our facilities and are constantly vigilant in maintaining a clean, healthful and sanitary environment in which our inmate population live, and our staff work in."

The jail seems to have violated its own rules concerning quarantines. Inmate Chester Dickerson, himself a doctor, first contacted the Press in April when an inmate prescribed with TB medication was brought into the cell block. He sometimes wore a face mask. According to several inmates, the man with TB claimed that he was offered a choice between isolation or the gay cell block. He chose the latter because it had a TV.

Seale says containing tuberculosis is tricky because not everyone who has TB is contagious. Medications can suppress TB, but inmates say this man did not comply with his regimen. Dickerson and other inmates with AIDS were afraid the inmate would be the death of them, and asked to be quarantined and tested for exposure. After Dickerson filed a grievance, on May 5 the cell block was quarantined for two days while inmates were given a skin test and chest X-ray. At least one person, Brian Moreland, tested positive.

"I was angry, but I felt helpless. There was nothing I could do," Moreland says.

On August 1 another quarantine began in the same cell block one day before Shook was to be interviewed by the Press. It lasted for 20 days and was lifted the day after Shook was released from custody. The quarantine was for shingles, a painful eruption of blisters caused by a resurfacing of the chicken pox virus. Those who have never had chicken pox can catch it from someone with shingles.

Seale says the length of quarantines varies, depending on what the communicable disease is. Typically, an infection-control nurse looks at and interviews everyone to determine who is already immune to chicken pox, he says.

However, inmates say that they were kept in the dark about what shingles was until a nurse visited them nine days after the quarantine began. (She asked each inmate to spin around for her, fully clothed, and although she asked if anyone had burning blisters, she did not ask about chicken pox history, inmates say.) In the meantime, they were fed on Styrofoam plates and could not receive commissary goods or mail. Toilets backed up for two days. William Ward and another inmate scooped waste out so they could use them.

By that time, the inmate who allegedly had shingles had come back from isolation and was housed in an adjoining cell block, inmates report. One inmate, Ryan Chuston, confused as to why the quarantine continued if that inmate had been placed in different living quarters, filed a grievance, signed by 30 others. They stated that many people were moved around during the quarantine (in violation of the jail's policy, which prohibits any movement -- no court, no recreation, no law library). The only people who can leave are those being released from custody.

On the second day of the quarantine, the residents of the cell block rioted, and deputies took the inmates out of the cell block and into the hallway while they went through their bunks. Days later, two new inmates also were brought in. On August 14, Shook and another inmate got into a fight and were moved to solitary confinement.

"If we really had shingles, that whole jail would have it by now," Shook says of the frequent movement.

"Obviously inmates don't move on their own volition. They don't decide, 'I'm going to move to the other side of the building,' you know," Seale says. "So that had to be a decision made by someone in the security chain of command. And why the quarantine was not followed, I really can't answer."

Van Pelt said he could not comment on the quarantine until he had more specific information. When given specifics, he said he would seek answers, but was not able to obtain them by the time this paper went to press.

Ever since the June flood, Raul Carvajal has worked in a mostly empty building. Two days after the flood, inmates were cuffed two by two at the ankles and marched down the darkened stairwell of 1301 Franklin. The power and water had gone out. They were then loaded into buses and crowded into 701 San Jacinto.

Carvajal, who heads the substance abuse and HIV counseling programs, managed to get a small office for his counselors to work out of at 701 San Jacinto as well as 1307 Baker Street, the women's jail.

The HIV counseling program began in 1989 with a federal grant, which has been renewed continuously to the present day. The money, which comes from the Centers for Disease Control in Atlanta, passes through the Texas Department of Health on its way to the Harris County sheriff's department. The grant, about $400,000, covers 80 percent of the salaries for eight staff members (Carvajal, four HIV counselors, an assistant counselor and two STD-prevention counselors). The sheriff's department supplies the rest of the salaries, as well as equipment and office space. The state health department inspects the premises twice a year, and Carvajal must supply them with a monthly report.

Carvajal, an animated man who speaks with pride and enthusiasm about the program, estimates that it has provided education to 100,000 people. Counselors conduct educational workshops on the floors (for which inmates can sign up). Inmates also can request one-on-one talks with counselors.

The program serves as an advocate for inmates and operates separately from the infectious diseases clinic, where doctors specializing in HIV visit twice a week and see an average of 16 patients per day, Carvajal says.

Brenda Thomas, an HIV educator, toured the jail HIV facility several years ago and found it impressive. "That's a big surprise to me [that inmates complain] because they have one of the best HIV programs in the country down there," she says. "At one time it was considered a model program for all jails."

Carvajal admits the program has not been operating optimally, but that's because it lost funding three years ago for two case managers who helped link inmates leaving the jail with outside resources. As it stands now, inmates are given pamphlets for clinics and are released with little more than whatever's left of their medication. Carvajal recently obtained another grant to fill those two positions this month. Then, it will be a perfect program again, he says. Not being a permanent part of the sheriff's budget worries him. There is always the chance that the grants will be denied.

Carvajal says he has "cried in everybody's coffee," trying to find more funding. However, grants are hard to come by for the sheriff's department. The Ryan White Planning Council, a county-level group that receives money straight from the federal government and distributes it to community organizations, is prohibited from giving funds to jails or prison, because by law inmates are the responsibility of the incarcerating institution.

"There is this attitude that everyone needs help, but the criminal deserves less help than the noncriminal," Carvajal says. "We have limited money, so why give it to criminals? [Funders] have that attitude, but no one says it."

According to records obtained by the Press, Harris County Jail has tested 33,312 inmates for HIV from 1996 to 2000. In that time the rate of people testing positive has fallen from 9.26 percent to 3.49 percent.

However, testing is voluntary, not mandatory, so it's hard to discern exactly how many people are infected. A blind study by the CDC, the City of Houston and the Harris County sheriff's department found that 5.67 percent of the jail population was positive.

HIV-positive inmates are not segregated, because that would give a false sense of security for others to behave in a risky manner, and anyone can have HIV, Carvajal says. Although Harris County Jail requires all inmates to be screened for tuberculosis, it does not require the same for HIV. Neither does the Texas Department of Criminal Justice, leaving authorities guessing as to how much the epidemic has spread.

Among the flower shops that line Fannin in the Museum District, the Donald R. Watkins Memorial Foundation clinic sits quietly. Started by Dr. Joseph Gathe, a nationally known HIV specialist, the clinic serves about 800 low-income clients, most of whom are African-American. About 30 percent of the clients have been incarcerated, according to executive director Steven Walker, and the clinic receives roughly five to ten requests per week from people leaving prison or jail.

A 1999 CDC study of prison inmates from 1994 to 1996 reported that the prevalence of AIDS was six times higher among them than the national rate. According to data from TDCJ (which runs 114 institutions across the state), 714 inmates tested positive for HIV last year and 837 did in 1999. More than 900 inmates with HIV are living in Houston-area facilities.

To Walker, it seems like the prison and jail systems could be doing more to stem the rate of infection. "Everybody seems to deny sexual contact happens in the prison system," Walker says.

Walker has noticed that many patients leaving long-term detention facilities were taking single-drug therapy even though the more effective multiple-drug therapy has been standard practice for the last five years.

HIV-positive convicts don't stay in prison forever, Walker points out. And many people in county jail serve short sentences, or are simply waiting for court dates.

"Some people may not even know they are HIV-positive and return to normal lives and spread HIV in the community," Walker says. At the Watkins clinic, half of the African-American female clients were infected by males who were incarcerated.

This year the city's Community Planning Group, which gives recommendations on identifying at-risk populations, declared the incarcerated population as its No. 1 priority.

Kirby Powell, who heads the city's HIV-prevention task force on incarcerated people, says most inmates he has encountered have very little knowledge about HIV. Most still think of it as a white gay male epidemic.

"Some of them think it was put here to kill a certain population of people. Some people have the notion that we're going to die of something anyway. Others think it's a conspiracy, that it was put here by the government, something like that."

Community HIV and AIDS organizations also seem to lack information on incarcerated HIV patients, or they just don't want to talk about it. Several local organizations contacted by the Press had little to say on the subject.

"We really have no comment on that," said AIDS Foundation Houston spokesperson Laura Rupport. Rupport said she didn't know of any HIV organizations that worked in prisons. Yet her own organization has teamed up with the Montrose Counseling Center to provide case management to inmates at several state jails.

That leaves inmates feeling like they're on their own. Shook says a guard once berated him when he disclosed he had AIDS while showing him a permission slip signed by a doctor that allowed him to cover up with a blanket during the day. (Inmates are not allowed under covers until 6 p.m.)

"Is it airborne? I better not catch it," the guard allegedly said before adding that he should knock Shook's teeth down his throat.

"Are they not educated on HIV? Why was he so hateful and afraid? I was in fear. He put me in danger, telling the whole dorm my condition," Shook says.

On August 19 at 3:36 a.m., Jo Shook picked up her son from Harris County Jail. Randall Shook now lives with his mother because he has lost his home. While he was incarcerated, his boyfriend of six years left him and neglected to pay rent on their house. Shook saw a doctor twice during his four-month-long sentence. About three weeks before his release he saw a doctor, who examined new test results and delivered bad news: The drugs were not working. Was he not taking his meds, the doctor asked? He did not know that Shook's regimen had been interrupted.

Now, Shook waits to see a new doctor. The other day he drove out to his old work place to have his hair cut by a co-worker. Just driving back and forth exhausted him and required a nap. He just tries to take it one day at a time, he says.

"We have to see if we can keep him longer," his mother says. "I'd like for him to make it through the holidays, if possible."

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