part 1 of 2
September 15, 1994--Denver General Hospital
Dr. Adam Myers picks a surgical mask off the wall outside an isolation room on the ninth floor. Placing it over his mouth and nose and smoothing his short, silver-gray hair, he knocks on the door and enters.
The mask is to protect the heavyset young man propped up on the bed, not the doctor. This is 1994, and the medical community now knows you can't get AIDS by inhaling the virus that causes it. But for someone with an immune system as compromised as this patient's, even the lowly cold bug can prove deadly.
When Myers walks in, Brad is looking out the window. The sky is blue and clear, and a hint of autumn chills the air, although Brad, to his great regret, cannot feel it. He is 36 years old. And he is dying.
Still, he smiles when he sees his visitor.
"Hi, Brad. How are you feeling?" asks Myers. The lines around his blue eyes reveal that he, too, is smiling beneath the mask. He likes Brad, one of his longest-living patients from Denver General Hospital's HIV clinic, where Myers heads the oncology unit.
"Oh, hi, Dr. Myers," Brad says, then shrugs. "I've been better."
As he says this, he shakes and shivers despite the blankets and bright red sweatsuit he wears. His lips are pale blue and stretched thin over his chattering teeth. His breathing labors even with the tubes that run up his nose supplying oxygen.
He looks as though he lost a fight and lost it badly. A purple stain covers the right side of his face, spreading like spilled Kool-Aid beneath his dark, mussed beard and hair. His nose is the same grape color, and a red circle beneath his right eye completes the image of a beaten man. The discoloration is caused by a confused and leaky tangle of blood vessels that feed the tumors of his Kaposi's sarcoma, a formerly mild-mannered skin cancer that feasts on people with AIDS.
Myers isn't here to treat Brad for the Kaposi's, though. He faces far more imminent dangers: a dangerously low white blood count called neutropenia and a troubling cough he developed a few days earlier that sounds suspiciously like pneumonia.
Treatment now consists of keeping Brad pumped full of the antibiotics and fresh blood that drip from the plastic bags hanging from a metal post next to his bed and down through the tubes that lead to the intravenous needles in his arms.
It will be up to Brad to win this round. And even if he does, they both know it won't be for long. Not long at all.
Enormous medical strides have been made in the ten years since the mysterious killer of gay men and drug addicts was identified as a virus: the human immunodeficiency virus. But those gains have only been enough to win individual skirmishes with the host of opportunistic infections that do the dirty work after the virus has destroyed the body's immune system. Doctors like Myers can only prolong the inevitable.
For there is no answer to the ultimate question posed by AIDS: How do you stop it from eventually killing its victims? Whenever medical science finds a way to knock out one antagonist, another leaps up to take its place.
Brad has cheated death longer than anyone dared hope. But soon there will be nothing that Myers can do.
Aware of death's approach, Brad has been making final preparations and saying his farewells. He tells Myers about a recent trip to Atlantic City where he rendezvoused with four old high school friends from Indiana.
None of his friends was gay, none had had much exposure to anyone close to them suffering from AIDS. They hadn't even seen each other in fourteen, maybe fifteen years. Yet each dropped his busy schedule and left his family when Brad called and asked if they could take one last trip together.
They gambled and talked about the old days and old friends, and even went on a deep-sea fishing trip off the Jersey coast one night. They had a glorious time, Brad says, although he spent most of the evening laying on a bunk, too weak and seasick to join the fishermen. It was enough to hear their voices shouting and laughing...to remember when they were all young and strong and looking forward to a long life.
As Brad tells Myers about his adventure, he stops often to cough--a deep, liquid sound. The more he talks, the more he coughs. The purple splotches turn darker and the unblemished portions of his face flush red under the strain.
Myers counsels him to talk slower or not at all to conserve his strength. But Brad continues, rushing the words between coughing fits. There is so much to say, so little time left to say it.
Sitting on the radiator next to Brad's bed, Myers takes in the room. It is bare except for gauges and the other gleaming paraphernalia of medicine. Even flowers aren't allowed in isolation because of the potential health risks of bacteria.
The sterility is so foreign to Brad, an avid gardener. Myers recalls the times Brad arrived at the clinic with armloads of summer squash and a standing invitation to come see his pumpkin, his pride and joy. The only thing Brad had ever asked of Myers was to keep him alive long enough to harvest that pumpkin and carve it into a jack-o-lantern. And snow, he wanted to see snow once more.
"I'll tell you something about all of this," Brad says, sweeping a hand to indicate his surroundings. "Sometimes it's overwhelming. I feel so beaten down...it's always one thing after another." The doctor reaches for a box of tissues as another round of coughing erupts.
When he recovers, Brad whispers, "But I wonder if it's time to let go."
The two men are quiet. Brad reconsiders. "Then again, I think that there's some health in me...if I can just get over this cough."
Myers nods. He's heard the same determination in the men--and an increasing number of women, now that AIDS has breached the heterosexual wall--who come to the clinic. As an oncologist, he has witnessed enormous bravery in cancer patients. But nothing compares with the will to live just a little longer, despite the pain and suffering, that he sees in so many of his AIDS patients. Perhaps it is because they are so young.
He wonders--as he often has since reluctantly accepting the mantle of "AIDS doctor" nearly ten years ago--where his patients find the courage and strength to go on. How did clinic nurse Georgia Caven put it the other day? Imagine having the worst flu of your life; now imagine it lasting not two or three days, but months, even years.
And yet most of the patients he sees in the HIV clinic he once thought of as fags, pansies, queers, fairies. Once the mere thought of their personal lives left him uncomfortable, disgusted. And yet...over the years he had witnessed these men in the most selfless acts of love and tenderness and commitment to each other.
It had changed Myers as a human being and as a doctor. It had renewed his faith.
So many had died. So many more will die, including, without a doubt, Brad, who suppresses a cough to ask about taxol--a new treatment made from the bark of the yew tree that he's heard has shown some promise fighting Kaposi's.
Myers looks at him, balancing the hard facts against his patient's morale.
"Taxol is not an FDA-approved treatment for Kaposi's," Myers says. He hesitates, then adds, "It's had about a 30 to 35 percent response, and even that's only a partial response."
Brad bites his lower lip. "I guess I should look at this realistically. There are only so many things left to try." He turns away. "I need to face reality."
Myers senses that it's time to drop the man-of-science bedside manner.
"We have options," he says. They both know that it is a game, but as long as Brad is willing to pick up the ball, Myers is willing to catch it. He owes it to the patient and to his own memories.
"But let's sit down and talk about them after we get this thing licked."
Brad looks back at Myers and nods just as he is seized by another fit of wet coughing. It's getting worse. "I wish I could do something to make it stop," he cries softly. Myers immediately summons a nurse. When she arrives, he asks for a cough suppressant. "With codeine," he adds, "as soon as possible."
An hour has passed since he walked in the door, and it's time to leave. Myers draws a deep breath and tells Brad that he will be gone for the next three days. He's flying to New Jersey to see his mother.
For a moment, Brad's eyes widen and he starts to say something. But he catches himself and chokes back whatever it was. Instead, he says, "That will be good...to see your mother."
"Is there anything else I can do for you before I leave?" Myers asks as he rubs Brad's shoulders. On his right hand is Brad's graduation ring, which Brad gave him a few weeks earlier when he began tidying up his affairs.
Brad shakes his head. "Having you here for a visit was a nice enough event. Don't worry about me."
"I'll see you Sunday night when I get back," Myers says.
"I'll probably still be here," Brad says before realizing how that sounds. With a croaking laugh, he quickly adds, "In the hospital, that is."
In the hallway outside the room, Myers wipes at his eyes. He's not sure how many more of these partings he can take.
He feels guilty about leaving for the weekend. He may have said his last goodbye to a gentle, brave man he has come to know as a friend.
But there's nothing he can do for Brad--and his mother needs him. If it wasn't for her, he wouldn't even be a doctor. This afternoon, as he steps on the elevator, he's not sure whether he should thank or curse her for that.
Boyhood, the Bogeyman, and a Friend
Young Adam Matthew Myers Jr. had reached the bottom of the steps outside the old rowhouse where his family lived when a man dressed in black jumped out from behind the building.
"Yaaaaah! Ruuuuunnnnn! I'm the boooogeyman, and I'm gonna get ya!" the man yelled.
Adam ran screaming down the sidewalk. He didn't stop until he could hear the man laughing in the distance. He and his neighbor had been playing this game for years. Still, there was a certain rush to running from the bogeyman. It was a little like cheating death.
And Adam was afraid of death.
Several of his uncles had died of complications caused by diabetes. His uncle Bill, a big, tough police captain in the New Jersey borough where they lived, had succumbed to Hodgkins lymphoma--a cancer for which there was no treatment. The last time Adam had seen him, his uncle seemed to have shrunk into a pile of living bones and yellow skin.
Adam was not at all sure that he should accede to his mother's fervent wish that he become a doctor. Doctor shows were popular on television, and someone always seemed to be dying on them. If that was what it was like to be a doctor, well, Adam thought there must be easier ways to make a living.
And day-to-day life was even more frightening than television. Every summer the government issued warnings about going to movie theaters and other crowded places. Poliomyelitis--polio, that viral wrecking ball of young bodies--was running amok in the population.
It was as feared as the plague. Which is why Adam would never forget that summer day in 1955 when he was standing in the kitchen with his mother. The radio show they had been listening to was interrupted by a news flash: A team led by Dr. Jonas Salk had developed a vaccine made from a weakened strain of the virus that would protect the population from polio.
Adam and his mother hugged and danced about the kitchen. It was a miracle. And if there was anything in his young life that steered Adam toward his ultimate career, it was this realization of the power of modern medicine. Maybe being a doctor wouldn't be so bad if it meant destroying such terrors.
Eva Myers had been drilling the idea of medical school into her son ever since he could remember. Born to German immigrants, she'd had a father who didn't believe in wasting effort on affection and insisted that his children leave school after the sixth grade. Eva labored twelve hours a day in a silk mill, swearing that someday her own children would be educated.
A short, strikingly beautiful woman, she left her parents' home as soon as she could and married Adam Matthew Myers, a quiet, soft-spoken man who played center field for a semipro baseball team. The game had been his life and love, but he hung up his cleats to marry Eva and took a job as a singing waiter in his brother-in-law's restaurant. The couple had three daughters. Then Adam Jr. was born in 1941.
Eva cleaned rooms in the boardinghouse where they lived near Jersey City. They were so poor that his father would often skip dinner so that his kids had enough to eat. One evening Adam Sr., whose supper had consisted of the water in which the potatoes were boiled, passed out at the dinner table.
He eventually found work as a welder and took every opportunity to work overtime. Already thin, he would lose as much as ten pounds sweating in the shop between morning and evening when he returned home, exhausted. But as tired as he was, he never refused his son's request to grab his glove, a bat and a ball and go "hit 'em out" at the neighborhood park.
One afternoon, the two Adams were in the basement when the boy noticed his father's old cleats on a shelf.
"Why don't you put them on, and we'll go hit 'em out,'" young Adam said.
His father looked at the shoes. He hadn't worn them since before his wedding. He smiled his tired smile and reached for them. But years of neglect in damp basements had rotted the stitching and wasted the leather. The shoes crumbled.
He stood there for a moment with the remains of his youth in his hands. Then, looking at Adam's worried face, he placed the shoes back on the shelf, patted his son on the shoulder and said, "Come on, let's go hit 'em out."
Eva loved her husband. But she also took great pains to educate herself beyond her meager schooling, reading Plato and Socrates and Shakespeare. She wanted the status that education represented and, unable to achieve that for herself, she had high hopes for her son.
When Adam wrote a paper in the eighth grade about the practice of medicine in the Navy, Eva was ecstastic.
Adam accepted her hugs. He certainly hadn't ruled out medical school, but he had doubts. He couldn't bring himself to tell his mother, but engineering sounded awfully good--and safe--and he'd even toyed with the idea of becoming a priest.
Adam went to school with the sons and daughters of successful Jewish families. He envied them the fact that they would go on to college using their parents' money. He had no such options and worked every minute he could spare from his studies.
Adam was working at the neighborhood meat market when his sister spotted an advertisement in the local newspaper for a veterinarian's assistant. The next day he applied at the office of Norman Simels, doctor of veterinary medicine.
Adam thought he had made a good impression, but for two weeks there was no word. He had just about given up when Simels called. "Do you still want the job?" the veterinarian asked abruptly. "If you do, come in and let's talk."
Simels told Adam he considered his assistant's position to be more than a job. "This is an opportunity for you to grow as a person," he said. "I expect whoever I hire to be someone who can accept responsibility, someone I can trust and who can work independently. In exchange, I will be more than a boss; I will be your guide. So what do you say--are you that kind of person?"
Adam glanced up. Simels was a big man who had played football for Texas A&M. A respected member of the Jewish community, he was disappointed that, so far, neither of his two sons had shown any indication that they would be worth a damn.
"Yes," Adam said.
Simels soon proved he was as good as his word.
"`Ain't?'" he would ask when Adam slipped into street vernacular. "What kind of a word is that? How are you going to get anywhere if you don't speak proper English?"
Or, if he caught Adam watching the floor as he walked, he'd stop him and scold, "Hold your head up, Adam. Watch where you're going in the world."
Adam nearly fainted at the sight of blood during his first operation. When Simels noticed his young assistant's pallor, he gruffly told him, "Only one patient in here needs to sleep...and he has four paws."
That pulled Adam out of it. As Simels continued, discussing each part of the procedure as though he were talking to a veterinary student, Adam forgot his stomach and found himself fascinated.
When Simels wasn't busy, they talked about life and dreams and Adam's upcoming decisions about college. But most of what Adam learned from Simels he learned by observation.
Such as the lesson about compassion Adam got the day the man who owned the local pet shop, a good friend of the veterinarian, brought in a blind boxer puppy. It was obvious that no one would ever buy a blind puppy. Even so, the pet-shop owner said he wanted to have the dog's ears and tail bobbed, as though he expected to sell it. Simels took the puppy to the operating room where Adam waited to assist him.
Adam looked up as Simels approached the dog with a hypodermic needle. His eyes grew wide when he saw the amount of anesthesia in the hypodermic, far too much for a small puppy. Unless...
Simels didn't say anything, but there were tears in his eyes as he plunged in the needle and then proceeded to operate as though this were just another ordinary procedure.
When he finished, Simels announced that the puppy had died. There would be no charge, he told his friend.
Simels never spoke about the incident. Nor did Adam. He wasn't sure that anyone would understood that Simels had done what he did out of compassion. But Adam could not imagine a more gentle man or a better friend.
It wasn't long after that Adam learned a far uglier lesson about human nature.
One afternoon a rich woman brought her dog into the clinic. The animal had been struck by a car, and it was quickly apparent that the animal would not live. Simels tried to explain the circumstances, but the hysterical woman insisted that something be done to save her precious pet. "Please," she begged. "You have to do something."
Moved by the woman's pleas, Simels took the dog back into the operating room and for hours tried to perform a miracle. But finally, he had to give up. With Adam following, he went out into the waiting room and quietly told the woman that her dog was dead.
"You goddamn Jew," the woman spat. "You killed my dog."
Shocked, Adam looked at the woman. Then he looked at his mentor, who was flushing red from the top of his balding head to where his neck disappeared into his shirt. The boy could tell that Simels was angry, but he held his tongue while the woman continued her harangue and then slammed out of the office.
Adam tried to tell Simels how sorry he was for what she had said.
Simels nodded. "We did our best, but she's angry and hurt about her dog," he said. Then he sent Adam home and returned to work.
So impressed was Adam with the gentle veterinarian that one afternoon, while they were sitting in the office eating their lunches, he offhandedly remarked that perhaps he would go to college to become a veterinarian.
He'd actually been thinking about it for some time and thought that Simels might be flattered. He was surprised when the big man shook his head and adamantly said, "Don't do it. You will make a fine doctor--of people. I think you should go to medical school."
Adam looked at the man. What was it that he saw in the veterinarian's eyes? Regret? But Adam just nodded and went back to his sandwich.
May 5, 1994--Infectious Diseases/AIDS Clinic, Denver General Hospital
Dr. Adam Myers pulls open the back door and slips into the brick building that housed the old hospital. After an interminable wait, the elevator arrives and carries him to the fifth floor and the clinic.
Supplies are stacked along the walls, and boxes of nutritional supplements block the entryway to the nutritionist's office. The boxes are mute testimony to one of the most common ways in which AIDS kills in the 1990s: wasting syndrome. The other top three killers are microbacterium avium complex, fungus and cytomegalovirus.
Like their predecessors of the early 1980s--pneumocystis carinii pneumonia and Kaposi's sarcoma--these four horsemen of the viral apocalypse were practically unheard of before AIDS. Now, like hungry ravens, they peck away at their victims' ability to withstand yet another infection until death wins by default.
On the east and west walls of the clinic are tiny examination rooms. Myers passes them as he walks to a slightly larger room on the north end that the staff uses to discuss cases out of earshot of clients, examine X-rays and records, and generally get away for a moment or two.
The doctor deposits his briefcase, noting the bag of summer squash on the table--Brad's apparently been in--and leaves to look in on the Library, once a quiet corner of the hospital where medical students caught up on their studies.
There are no books in the Library today, and only a smattering of magazines. This is now the place where patients are hooked up to intravenous bags for chemotherapy or blood transfusions.
It's early afternoon, and only two men sit in the room's overstuffed chairs. Above their heads hang bags filled with liquid. In one bag the liquid is clear; the other glows with a fluorescent orange reminiscent of sweet-and-sour sauce at a bad Chinese restaurant. The men will sit here for hours as the stuff drips slowly down through the tubes and needles and into their thin, outstretched arms.
One of the men dozes. The other, as gaunt as a concentration-camp survivor, sits patting his head with his free hand over and over and over again. Myers touches him on the shoulder, is hardly noticed, and moves on.
Outside in the waiting area, there is a good deal of laughter and teasing between staff and the patients who have begun to arrive. At the reception desk, they're playing with a whoopee cushion, giggling uproariously every time the device makes its noise. Suddenly aware of the doctor's quizzical expression, a receptionist shrugs. "Laughter's the best medicine, you know."
The staff does what it can to relieve the tension. After all, this is not a clinic where patients go to be cured. If they're here, they're going to die--much sooner and more horribly than they ever dreamed. The only questions that remain--the reason they're here--are how soon and how horribly.
No one on staff wears the typical white clinician coats, not even the doctors. It's part of their effort to remove any kind of barrier between themselves and their patients. The onus of AIDS has created so many obstacles already: Many have been abandoned by family and friends, stigmatized and despised by society. But here they are all called by their first names, and there is a great deal of touching and hugging.
The room is filling with patients for the Thursday afternoon oncology clinic. Some are in wheelchairs, others walk with canes, and some seem perfectly healthy. Today they are all men, most between their twenties and early forties.
Many of the patients wear scarves or hats to hide the effects of chemotherapy. Some sit and stare with dark-rimmed eyes in haunted, skeletal faces that reflect bout after bout with one infection after another.
Some have come with family members. Others have come alone. But most are with their male companions, holding hands or keeping an arm around a shoulder as they sit and wait.
The telltale purple of Kaposi's sarcoma splashes across many of their faces. Kaposi's is the principal culprit Myers deals with as the clinic's chief oncologist, though he must also treat non-Hodgkin's lymphoma and a host of other cancers that he suspects are attributable to AIDS but not yet officially recognized as such. On other days, other doctors deal with infectious diseases, skin and lung problems--even a psychiatrist to help with the stress of dying.
Myers's main weapon is chemotherapy--poisons that hopefully will do more damage to cancer cells than to healthy ones. There are a number of complex and sometimes interrelated chemotherapy alternatives; currently, the oncology clinic is taking part in a study of a new drug, Daunoxome.
The clinic is one of only sixteen sites in the United States where Daunoxome is available. Myers successfully lobbied to be made part of the study after a Houston hospital failed to follow the strict protocol and was removed from the project. Because DGH is a test site, Myers can also give the drug to patients who don't otherwise qualify for the study under what is known as "compassionate care."
Myers's first patient is Sam, a man in his twenties with a Texas accent who hobbles into the examination room using a walker. He's accompanied by his companion, Stephen, a short, tan individual with thick, dark, curly hair.
Sam's face is so swollen from edema--fluid buildup around the tumors--that he can see only by prying his eyelids apart with his fingers. His skin looks as taut as a water balloon and his nose and the side of his face are covered with purple splotches. His hair is thin and patchy from the chemotherapy.
His disfigurement is a marked contrast to his lover's looks. Stephen is fit and healthy. He could walk away from these sad final days, but it's evident from the way he looks at Sam, from the small touches as he stands by, that he's not going anywhere. Not while there is still time.
"How are you, Sam?" Myers asks.
"Well, I'm here," says Sam, dabbing with a handkerchief at the drainage that leaks from his eyes.
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Myers spots a rectangular bulge in the front pocket of Sam's jeans. "And what's this?" he asks, patting the rectangle.
"Well, couldn't you have at least put them in a back pocket so I wouldn't see them?" Myers teases.
"I can't reach them in my back pocket," Sam says and matter-of-factly demonstrates the difficulty he has turning.
end of part 1