part 2 of 2
The Clinic, Politics, and Wes Kennedy
By the late Eighties it was clear that the AIDS epidemic could not be dealt with as other epidemics had been in the past. Polio and tuberculosis, for example, affected people in specific ways that could be addressed by a primary physician or specialist.
AIDS, on the other hand, attacked on a variety of fronts and required the specialized skills of different members of the medical community all working in conjunction. In the course of a week, an AIDS patient might need to see a pulmonary specialist for pneumonia, an oncologist for Kaposi's, an internist for cytomegalovirus and a psychiatrist for stress or dementia.
Cohn and Judson were pushing to set up an infectious-diseases clinic. The hospital was under fire from activists who complained that as the number of AIDS patients multiplied, DGH was treating them on gurneys that lined the hallways. Finally, the two doctors were given the fifth floor of the old hospital building for their clinic. With them went nurses Gorley and Gilden.
AIDS cancer patients still were sent to the oncology division on the other side of the large hospital campus. And Myers, who personally took on all AIDS oncology cases, spent a lot of time on the phone with the doctors at the new ID clinic. With so little known about AIDS and so much distance between the two clinics that handled AIDS symptoms, it was often anybody's guess whether a patient's distress was caused by the disease itself or perhaps by a treatment.
In late 1990 the doctors met and agreed that they needed to combine as many services as possible in a single place. Myers would conduct an oncology clinic there every Monday afternoon, while other specialists would see patients in the same offices on different days.
Then Saddam Hussein invaded Kuwait, and Myers, a colonel in the Army Reserve, was called up. With his blessing, the AIDS oncology clinic opened, with medical fellows who had been working with Myers taking his place.
Instead of being sent to the Middle East, though, Myers was stationed at Fort Leavenworth, where he treated athletic injuries and high blood pressure and did so many Pap smears that he couldn't go into the base grocery store without half the women scattering at his approach.
In a way, it was a relief from the constant, depressing battle with AIDS. But he knew that his war was back home in Denver, where the death tolls were mounting daily.
When Myers returned to DGH six months later, the clinic was in full swing. And as the number of AIDS oncology patients continued to grow, it soon became clear that Myers couldn't see two dozen patients on a single Monday afternoon and give them any kind of care. It was decided that he would hold a second clinic on Thursdays, while more Ryan White funds paid for his replacement in the breast-cancer clinic, Dr. Marie Wood.
It seemed that the more patients he saw, the more he learned about himself as a doctor and as a witness to this tragedy. Among the flood of new AIDS oncology patients was Bob, a successful developer in an exclusive mountain community. He had a beautiful wife and two grown daughters, and he also had HIV--contracted from a homosexual lover.
Bob seemed more troubled that he'd had an affair with a man rather than the fact that he'd cheated on his wife. For Myers, that was drawing too fine a line. Although he couldn't condone promiscuity for medical and moral reasons, he realized it no longer mattered to him whether the behavior was homosexual or heterosexual. He had met too many brave young gays to think of them as dirty and evil. He had watched too many of them die.
He had found that he could dislike some--such as the patient who spit in the face of a medical student--and befriend others. His life was enriched by their talents, their humor and their grace as they worked with him to live a little longer.
Now, for Myers, the hardest part was dealing with the constant reminders of how powerless he was to save them.
The point was driven home when Wes Kennedy died. Wes was a promising young artist when he arrived at Myers's clinic in 1991 with Kaposi's in his throat. The lesions made swallowing and even breathing difficult.
With the help of radiation, then chemotherapy when that failed, Wes battled to continue working. It troubled Myers that Wes's art grew more angry and dark as his disease progressed. But it was powerful and alive.
In the summer of 1993, when it was clear that he would die soon, Wes asked Myers to keep him alive long enough for a retrospective show of his work in September. Myers said he'd try.
But Wes died in August. The next day Myers turned to the obituary section in the newspaper and read that Wes had asked his physician to keep him alive long enough so that he could attend the show, but to no avail.
The words weren't hostile, but they hurt. Myers carefully clipped the obituary and taped it to the wall of his study at home. He put it there to remind himself that he wasn't God and shouldn't delude himself into thinking he could do more against this disease than he was already doing.
He could make his patients more comfortable, help them die with dignity. He could even try to buy them a little more time. But he was still a doctor without a cure. A scientist without answers.
August 25, 1984--Infectious Diseases/AIDS Clinic
Myers stands contemplating a wall in the staff room. On the wall are more than 120 names and dates. Some are accompanied by newspaper clippings; others are surrounded by colorful stickers of flowers, balloons and flags. A number are circled by hearts.
The names represent the patients who have died in the little more than a year since the clinic began recording their passing in this way. The clippings are obituaries, most of which don't list a cause of death--or they disguise the true culprit behind such generic diseases as lung cancer or pneumonia.
Although most of the names belong to men, there are a few females, too: a 44-year-old homemaker who left a husband, two sons and a daughter; a young woman in her twenties whose boyfriend hung with her until the bitter end, signed her name to the wall and disappeared.
There are names of black men and white men, brown men and yellow. The majority were in their thirties and forties when they died. There are actors and writers, architects and engineers, home builders, auto dealers, waiters, laborers and chief executive officers of corporations. New names grace the wall all the time: Sam...Russ...Frank...Jeff... Kirk. And soon there will be more.
For those who still live, there is no escaping their destiny. They are reminded of this every morning they wake up and see the lesions on their faces, or every time they take a drink of water and have to wash down a pill. And still, Myers says, shaking his head, they keep their courage and their slight hopes that a cure will be found before it is too late.
The wall is frightening and sad, but in other ways it is comforting as Myers recalls faces and connects them to memories.
There was Michael, who told the story of being so tired on his way to the clinic that he decided to rest by sitting with his back against a building. A man in a business suit threw some coins in his lap. "He thought I was begging," Michael said. He thought it such a fine joke on himself that he repeated it often.
But now his name is on the wall.
Sometimes the heroics approach the unbelievable. On many occasions Myers has watched as a man holds his lover without complaint after a night of cleaning up vomit and diarrhea. Or watched as family members brush off their tears and hold on as their brother or son disappears into AIDS dementia.
It's almost worse for the survivors, especially for those who are HIV-positive. For them, it's a preview of what to expect someday.
Some hang in there. Others choose not to go on at all.
Sam's lover, Stephen, was found dead in Texas. The report they received at the clinic was sketchy, and Myers didn't know the cause of death. But the last time he saw Stephen, he was in good health, with no symptoms of AIDS. He suspects that with Sam gone, Stephen decided not to wait.
Every week there seems to be at least one new name on the wall and another patient for the clinic. The DGH Infectious Diseases/AIDS clinic is known as one of the model clinics in the world for its multidisciplinary care and social services. But the doctors, nurses, receptionists and social workers here all lose their objectivity and suffer as each new name is added.
With a sigh, Myers leaves the wall and goes to an examination room, where a new patient waits.
Fifty-year-old Don has a grizzled beard and wears his weariness like an old thrift store coat. He's accompanied by his companion, Gary.
Don has a non-Hodgkin's lymphoma on his gum. Myers wants to do a spinal tap to see if the cancer has spread to Don's nervous system. At the doctor's direction, Don lays on his side on the examination bed, curled into a tight fetal position to open the spaces between his vertebra.
Drawing a small arrow on Don's back to mark the spot between the vertebrae where he wants to withdraw spinal fluid, Myers injects a local anesthetic. Nurse Georgia Caven holds the patient's hand. "Relax," she says.
Don sighs. "I haven't been relaxed in so long," he says, almost wistfully.
He grunts and winces as Myers inserts the long needle and probes until, finally, liquid drips from the end. Four tubes are quickly filled.
The liquid is clear, a good sign that the cancer hasn't spread, Myers says.
He retracts the needle and tells Gary that Don isn't to do "any dishes or vacuuming for a while." Gary nods as though he'd gladly do all the housework for all eternity if someone would just tell him that Don will be all right.
"You can return to normal," Myers tells his patient as he slaps a Band-Aid over the small hole. "There's your Purple Heart."
"Normal." Bob pronounces the word slowly as though practicing a new language. Then he whispers, "I wish I could."
Nightmares Without Answers
Dr. Charlie Abernathy came to Denver General as head oncological surgeon when Dr. George Moore decided to cut back to part-time. Abernathy was a regent at the University of Colorado and a member of the university teaching staff. Built like a fullback with the smile of Santa Claus, he brought with him an embracing love of life.
Abernathy was a good friend. Busy as he was, he always found time to help out. When Myers mentioned that his son had decided he wanted to be a doctor after spending two years in the Peace Corps, Abernathy asked to meet the boy.
He took young Adam on rounds and questioned him about his choice. When they returned, he told Myers, "He's the sort of person we need in medicine--compassionate and caring, like his father."
Abernathy was an avid outdoorsman, and other than a touch of asthma and a slight elevation in his cholesterol count, there was nothing to warn of impending danger. But in summer 1993, during a trip to California with his wife, he suffered a heart attack and nearly died.
When he returned to Colorado, Myers visited him in the hospital. "Adam," the older man confided, "I got a look at the other side of the wall."
Although he didn't elaborate on what he'd seen, he seemed more at peace. Myers wasn't surprised when his friend announced that he was going to cut back to part-time work and move with his family to Steamboat Springs, to be near the mountains he loved.
In March he suffered another heart attack, this one fatal. Myers was stunned. For weeks afterward, he suffered recurrent nightmares.
In the dream, the two doctors would be working in the oncology clinic when suddenly Myers would notice that Abernathy was gone. He searched and searched, then started to panic. "This isn't like Charlie," he would say over and over. "Where is he?"
When he woke up, Myers missed his friend more than ever.
Then another physician friend, a doctor known for his gentle way with patients and love for his occupation, was diagnosed with a particularly malignant cancer.
The night after discussing the diagnosis with him, Myers had another dream: He and his friend were working in the intensive-care unit at University Hospital when suddenly his friend began acting confused and disoriented. With horror, Myers realized that these were symptoms of the cancer attacking his friend's brain--and he was at a loss to know how to treat it.
Myers woke up in a cold sweat with the words "no answers" echoing in his head. He was overwhelmed with despair. He had no answers.
September 1, 1994--Infectious Diseases/AIDS Clinic
The clinic is quiet. Outside the day is cool and gray, the first warning of the approaching autumn--a dangerous time for patients for whom a runny nose may presage death.
In the Library, Roger is hardly recognizable as the young man who first arrived at the clinic in May. If he looked ten years younger than his actual age at that time, now he looks twenty years older.
His face is swollen to volleyball dimensions by edema. A bright reddish-purple circle hovers under his right eye; his skin is as white as typing paper and nearly as translucent. He's wearing a pink scarf with a teddy-bears-and-hearts design over his head to hide his hair loss.
Roger's in a talkative mood and tells anyone who will listen that his religious beliefs "are a bit of a Mulligan stew."
"Some days it seems better to pray to God," he explains. "Other days it's the Great Spirit or the Powers That Be or even shamanistic animal spirits."
Right now he's praying because his father is dying of prostate cancer. They weren't very close, he says, but he's troubled that now they will never resolve their differences.
He's also worried about Tim, whom he married a year ago. Tim had accepted Roger as HIV-positive and stuck by him through each opportunistic infection--the pneumonia, the Kaposi's, the cytomegalovirus. But the strain was beginning to show. "Last night was a real crisis," Roger says.
"I tried, but I couldn't handle it all myself and had to yell for help. Tim was there in a flash. He changed the sheets, bathed me, got me my medicine and stayed up all night with no sleep. He says he's okay, but I know it's wearing thin."
Myers has entered the Library and listens to Roger's story. He's heard so many like it that the love between these guys no longer surprises him.
"My sister brought me to the clinic this morning," Roger continues. "She started crying because I told her, `It's close now.'"
The young man looks out the window at the gray sky. "At least Tim and I made it a year."
October 24, 1994--Infectious Diseases/AIDS Clinic
Woofer sits alone in the Library. It's late, and most of the other patients have received their treatment and gone home. Myers and the nurses are in the staff room reviewing the day's cases.
Woofer is bored. They already got after him for yelling for help just to see who would come running. Now he fiddles with the pump on his intravenous tube, trying to speed up the new treatment he's hooked to that takes over three hours to administer.
He didn't get any better with ABV. And after an initial response to Daunosome, he failed that treatment, too. Today Myers put him on taxol.
"It's my last hope, I guess," says Woofer, who shifts his head constantly to compensate for the blindness in his left eye and the tunnel vision in his right. "My dad's visiting," he continues. "He's such a character--I guess I get it from him.
"This morning he jumps out of the shower singing, `I'll be seeing you, in all the old familiar places.' We laughed and hugged and then we cried.
"He's eighty years old and starting to have a lot of health problems. We joke that we're racing each other to heaven, and whoever gets there first has to have a party all set up for when the other one gets there."
Woofer pauses and closes his eyes--long enough that it seems he has fallen asleep. Then, suddenly, he looks up.
"You know, there are motorcycles in heaven," he says. "But the bikes in heaven have wings. They have wings so that you can jump from cloud to cloud."
He closes his eyes again. "I'm going to like that...jumping from cloud to cloud on a Harley with wings."
October 24, 1994--The End
Dr. Adam Matthew Myers Jr. lives in a modest Denver bungalow surrounded by memories.
A black cat, named after a patient who died of AIDS, lounges on the dining-room table. On the wall above is a photograph titled "Wes Kennedy's Hands," a self-portrait depicting the artist covering his face with his long, talented fingers. Wes's obituary still clings to the wall in the study.
In the living room is a framed clay relief of an Indian pueblo given to Myers by Charlie Abernathy. Above the fireplace, the Colorado landscape is a gift from a lung-cancer patient who lived another year under Myers's care before dying.
Upstairs in his bedroom is a drawing of an eagle with glasses, given to him by a Hodgkin's patient. Myers doesn't know if that patient is still alive--not all of his patients want to be reminded of that period in their lives when the bogeyman came calling.
Myers is at once haunted by and indebted to memories. Back when his father was ill, he stopped to visit Dr. Simels and thank him for his guidance. He reported that he had learned to hold his head up and watch where he was going in the world. The retired veterinarian had hugged him like a son and said, "You're welcome."
His mother never has understood why he's not in private practice, making more money, but she's still proud of "my son the doctor." She worries about him contracting AIDS. He tells her that he'll be okay and thanks her for pushing him toward medicine, sparing her the profession's sorrows.
As he sits in front of the fireplace in the living room, Myers toys with the ring on his right hand. It's Brad's ring. Brad is dead.
The gardener had made it home from the hospital the month before and had even come into the clinic to visit and talk about the possibility of taxol treatment. He was disappointed that the snow that week had knocked down all the vines he'd tended so carefully through the summer.
"But I got to see snow," he said. "I wanted to see it snow again."
They'd made arrangements for Myers to come by his house the following Wednesday afternoon. Brad wanted to talk about some secret.
Myers thought it probably had to do with Brad's desire "not to be a burden on anyone" should AIDS leave him bedridden or in an extended coma. The doctor knew he couldn't counsel Brad to take his own life: If he couldn't cure his patients, neither would he help them cut their time short.
But he never had to deal with the issue. That Wednesday morning Brad checked back into the hospital. He was failing rapidly.
On Saturday, Myers stopped in for a final visit. The ward was subdued; the nurses knew Brad, and he was well liked. But they also knew that this was the last time he would be with them.
As Myers arrived, Brad's father was leaving to get his wife from the motel so that she could say goodbye to her son.
Myers knocked and entered. He found Brad sitting in a chair, leaning forward to catch a breath. He wore an oxygen mask that muffled his apologies for his appearance.
He had fought a courageous battle and was as tough as any man Myers had ever met. But it was evident that Brad wouldn't survive much longer.
The doctor helped him back to bed and propped him up. They spent the next hour together, with Myers doing most of the talking while Brad nodded and occasionally added emphasis to some memory.
Myers spoke about gardening and summer squash. Brad's pumpkin had withered on the vine the month before; now the doctor talked about how jack-o-lanterns just ended up being swiped by trick-or-treaters anyway.
Finally, Myers said, "Brad, I think you're dying." The two looked at each other without saying anything more.
As they sat silently, Brad slowly gave in to the morphine drip and his killer. Realizing the moment of death was near, Myers left to look for Brad's parents. He was in the hallway when a nurse rushed up.
"Brad just said, `Go get Adam, I'm ready to die,'" she said.
Myers walked quickly back to the room. Brad's eyes were closed.
"Brad?" he said, touching his arm. "You might be asleep when your parents get here. Is there anything you would like me to tell them?"
With an effort, Brad pulled back from wherever he was heading. In a voice hardly above a whisper, he said, "I love them."
By the time his parents arrived, Brad was in a coma. Myers passed on their son's last sentiments and left them to make their own goodbyes.
At his home, as the flames dance in the fireplace, Myers wonders aloud what it was that his friend Charlie Abernathy saw on the other side of the wall. Whatever it was, he's convinced that someday that's where he'll find Charlie and Brad and Sam and the others who have gone on and those who will follow.
Until then, his duty is to the living. People with AIDS are living longer than they were ten years ago, but his successes are still measured in days and months. In keeping people like John alive so that he can go home to Kansas this Christmas and spend what time he has left with his family. To delay Woofer's ride in the clouds.
His enemy remains fierce and intractable. The emotional toll is high.
A week after Brad died, Myers's physician friend, who had been in remission, was readmitted to the hospital. The cancer had returned and invaded his brain.
It was a devastating blow. Myers had hoped that this time he might win. But the bogeyman was near at hand. No matter how fast he ran, his friend would, barring a miracle, die soon.
Myers felt like a failure. But then his friend's wife pointed out that without his help, her husband would have died that summer. Instead, he had enjoyed a few more months, and they'd had time to reflect on the truly important things, like their children and rich memories of life together. They got to say goodbye while the sun was shining and there was still hope.
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When he met later with his friend, the man matter-of-factly discussed what was coming. He didn't want any intervention other than to address the pain, and he thanked Myers for his care.
As he finished, his eyes were glistening, but he smiled and said, "Now, I just want to make the best use of the time I have. Other than that, I'm ready."
And so Myers, a doctor without a cure, at least has an answer. When all is said and done, it simply comes down to buying a little more time. To cheating death long enough to harvest gardens, to see another snowfall, to play one more game of catch with a child.
To laugh in the dark. To love a little longer. To live while we may.
end of part 2