Dr. Adam Myers arrived at Denver General Hospital in 1974, following a residency program at the University of Colorado in which he specialized in hematology, the study of blood diseases such as anemia and leukemia. He was soon appointed DGH's director of ambulatory services. But he came by his oncology training almost by accident.
Dr. George Moore arrived at DGH at about the same time as Myers. Although he was one of the top cancer surgeons in the country and had been nominated for a Nobel prize for his work, he was a cutter and needed someone trained in oncology treatments to do follow-up care. Reluctant as Moore might be to admit it, sometimes the fight against cancer required more than a sharp knife and steady hands. Since no one at DGH specialized in oncology, Moore sought out Myers.
There were some similarities in treatments, especially for cancers of the blood. But a lot was new to Myers, who caught up with marathon reading sessions and crash-course seminars.
He was growing in other ways as well. Myers was finding that everything he had learned in medical school about keeping his distance from patients might not be helping them.
By the mid-Seventies, medical science was beginning to make real advances in fighting, even curing, some cancers. It was no longer common practice to keep patients' diagnoses from them. Still, the general rule was for doctors to remain detached, to look at disease through a one-way mirror.
That's why Myers was surprised to find that his patients were often the ones trying to comfort him. He was particularly struck by the heroics of a middle-aged man with colon cancer.
While it is not always a true measure, cancer patients often gauge their health on their ability to maintain or even gain weight, especially if the gain can't be attributed to edema. But this particular patient's response puzzled Myers.
Undressed, the man was all bone, and he seemed to waste even further between visits. And yet his weight somehow remained constant. Myers accidently discovered why one afternoon when he picked up the man's pants. The pockets were filled with rocks.
"I didn't want you to feel bad because I was losing weight," the man explained to his humbled doctor.
But the greatest lesson Myers would learn in his early days as an oncologist he learned from a woman.
She had already undergone a mastectomy to remove a breast when she developed a persistent cough and was referred to his office. X-rays revealed tumor nodules throughout her lungs; the film looked like she had been hit with a load of buckshot.
Myers went after the cancer with heavy doses of chemotherapy. The treatment was agony, and it wasn't always certain which would kill her first, the disease or the cure. But she held on and the cancer retreated. Months later her X-rays were clear except for a little scar tissue. Thanking her doctor, the forty-year-old woman went home to Sterling and her husband and daughters.
Not long afterward Myers bumped into the private-practice surgeon who'd performed the woman's mastectomy. He'd heard of Myers's success treating her and patted him on the back for a job well done. Walking away, Myers felt a little lighter on his feet. Yes, indeed, death had taken a pasting this time. He was still congratulating himself when his pager went off.
It was a long-distance call from Sterling. The woman's husband said she was complaining of terrible headaches and was having trouble controlling her right hand.
Myers arranged for an air ambulance to fly the couple to Denver. When they arrived, the woman was immediately whisked off for a CAT scan of her brain.
A few hours later, Myers sat in his office. Across the desk were the woman and her husband; in front of the doctor were the results of the CAT scan and its inevitable consequences. The woman's brain was filled with cancer. There was no doubt she would die, probably within months.
Myers didn't know what to say. All he knew was that death had won--and as long as he sat behind his desk, he was safe from having to deal with the woman's fears.
The room was quiet, but something in Myers's face and the way he kept his eyes on his desk said all that was necessary. The woman's husband suddenly began crying.
Myers glanced up and forced himself to look at the woman. She had summoned her courage to force a small smile.
Ashamed of trying to buffer himself from the tragedy, Myers stood up and walked around his desk. The woman stood, too, and they met, throwing their arms around each other.
Even then it was the woman who stood back and patted Myers on the chest as though she were comforting one of her own children. "It will be all right," she said. "It will be all right."
She died three months later. Before she went, she thanked Myers again--this time for giving her a few more months to say goodbye to her children and her husband, to fully appreciate all that life had brought her.
She also left an unexpected legacy at Denver General Hospital. From that night forward, Dr. Adam Myers would never again place a desk or any other barrier between himself and a patient.
Hugging became as integral to his practice as blood tests. He took the time to talk to his patients about their lives and hopes. What he lost in emotional detachment he gained in friendships and an increased appreciation of the nobility of the human spirit.
And so, whether by fate or design, by the early Eighties Myers was an expert in combatting blood-borne diseases and cancer, uniquely suited to dealing with the human consequences of the most devastating epidemic of the late twentieth century.
Over in DGH's public-health division, epidemiologist Dr. Dave Cohn was already trying to come to grips with a mysterious new fatal syndrome that seemed to be concentrated in the homosexual community. One of the chief symptoms had been labeled the gay cancer--a rare, formerly mild variety called Kaposi's sarcoma.
July 27, 1994--A Restaurant Near DGH
Myers sits at a table tipping back a Bud Lite over dinner. His shoulders slump and there are dark circles under his eyes. In a couple of days he's leaving for a three-day vacation to New Mexico.
"God, I need this trip," he says. "It's been a bad month at the clinic." A bad month indeed. Five more patients have died.
At times like this, Myers grows frustrated with medicine. This century has witnessed the virtual extinction of once "incurable" maladies, particularly infectious diseases such as polio, tuberculosis and smallpox. People tend to forget that, up until World War II, the best antibiotic science offered was sulfa; as a result, millions of people died who today would be saved if each one swallowed a few small pills.
Even the battle against cancer has made stunning advances. A few years ago some forms, such as Hodgkin's, testicular and childhood leukemia, were nearly always fatal; today they can be cured. The progress can be attributed in part to a better understanding of cell cycles and molecular and tumor biology, but also to a barrage of new drugs.
Then again, some cancers--melanoma, lung and breast cancers--are as deadly today as they were fifty years ago. Cancer is not something that can be stamped out like smallpox--at least not until gene therapy, which inserts genes into DNA to switch off abnormal growth, is a reality. That development will be to current oncology treatment what penicillin was to leeches.
Researchers are working on a promising new theory that joins chemotherapy drugs to antibodies that search out particular cancers. But progress is slow, and most people do not understand that medical science has always run on a cycle of great leaps forward followed by periods of inertia.
"Right now, we're crawling on our hands and knees," Myers says. He knows he is doing the best he can. But that doesn't make it any easier to accept the loss of a patient.
To deal with the stress, Myers has developed a habit of closing his office door when he hears that another patient has died. Alone inside, he spends a few moments reflecting on his memories of that person.
He recalls the patient's courage and humor and all the little things that made him human rather than just another statistic. And he avoids, as best he can, the memories of what this miserable disease did.
When he can, he tries to say his goodbyes while the patients are still alive.
Sometimes the farewells are drawn out over a long period of time. Brad and John have cheated death so often it is hard to believe that their luck will ever run out. But so many times Myers has hugged them and watched them leave the clinic, unsure if there will be another visit.
Myers had time to say goodbye to Sam, but it has still been difficult accepting his death.
The chemotherapy had stopped Sam's Kaposi's, but the wasting syndrome got him. He vomited for ten days, then finally stopped taking his medicine. Sam had had enough; he was ready to go.
And he told Myers he was happy to do so. At least he looked human again and could see without having to pry his eyelids apart. He died at home with his lover, Stephen, holding his hand.
Jeff was dead, and Kirk--loud, abrasive, pugnacious Kirk--had also died at home, of respiratory failure. Slowly suffocating, he had refused to come into the clinic and had passed on in his own way.
And longtime patient Russell had checked into the hospital one last time. It was clear that this was the end. Kaposi's had obstructed his bowels so that he had to be fed intravenously. Russell's mother and his lover had made arrangements for him to spend his last days in a hospice.
So Myers had gone to say goodbye before they moved him. Russ was half-conscious and on a morphine drip to keep the pain tolerable; Myers wasn't sure how much he could comprehend. But still he ran his fingers through his patient's hair and told him that he respected his courage and that it was okay to let go.
"I'm going to say goodbye now, Russell," Myers said, reaching for a limp hand. "I'll see you again someday. I wish you well."
The words somehow made it through. Russ looked up through half-closed eyes and mouthed the words "Thank you," then squeezed the doctor's hand one last time.
He died the next day at the hospice. On the day of the funeral, Myers called Russell's mother.
They talked a long time about a good man and a good son--a sensitive, caring human being who was always more concerned about how they would handle his death than he was about dying.
"I can't imagine what it must be like to live through the death of a child," Myers said, picturing the faces of his own son and daughter.
There was silence on the other end of the line. Then Russell's mother quietly said, "I can't, either."
At the restaurant two weeks later, Myers tips back a second beer and closes his eyes. When he opens them again, they are wet. He is tired, physically and emotionally drained. He is a doctor without a cure, a scientist without answers.
But when he feels like giving up, he remembers his father, who was never too tired to go "hit 'em out," and the woman cancer patient who thanked him for giving her a little more time.
Placing the empty bottle on the table, he again says quietly, "God, I need this trip."
A New Disease and Saying Goodbye
It wasn't long after the first reports of the gay cancer started filtering in from the East and West coasts that Dr. Dave Cohn began seeing the first cases in Denver.
On a purely scientific basis, the disease--actually a syndrome or collection of diseases--was a rare opportunity for an epidemiologist. Something was suppressing the immune systems of the patients, all members of the gay community or Haitians, allowing opportunistic infections to do the real killing. No one knew what was causing it--but as long as they weren't gay or a recent visitor to Haiti, no one worried about catching it. In fact, since the syndrome was connected with more hedonistic homosexuals, some wondered if it might be a reaction to the use of amyl nitrates, a drug said to increase sexual arousal.
The first patients Myers saw with the syndrome were referred by Cohn, who had noted extreme swelling of their lymph nodes.
The initial diagnosis was lymphoma. But biopsies indicated to Myers that the lymph nodes were simply enlarged and overactive, apparently as a reaction to something that the body was trying vainly to fend off.
Myers found the condition medically curious, but the real struggle with the mysterious ailment was waged over at DGH's office for infectious diseases, where doctors like Cohn and Frank Judson, along with nurses Pat Gorley and Jane Gilden, were being overwhelmed by the number of victims.
Then, in 1981, Cohn sent a patient whose body was covered with what appeared to be purple bruises to Myers's oncology clinic.
The cancer--Kaposi's sarcoma--was so rare that Myers had to look it up. According to the literature, Kaposi's was a mild variety of skin cancer that mostly affected older men of Mediterranean ancestry; patients usually died of old age before the cancer became a real health risk.
What made Cohn's patient unusual wasn't just the rarity of the cancer but the fact that it no longer was confined to the skin. It was everywhere: on his body, in his throat and, most disturbingly, in his lungs, where it threatened to suffocate him. But the Kaposi's was just another player in a variety of diseases from which the man was suffering, and Myers could only support him with painkillers and drugs to help him breathe easier until he died.
Cohn soon sent over another man with Kaposi's in his lungs. This patient, too, was ill from a multitude of infections and died quickly.
As Cohn continued to refer Kaposi's patients--sending them directly to Myers rather than to his colleague in the oncology clinic--Myers began to balk. For one thing, he hardly knew what to do with them. There was so much wrong with these patients that intervention was worthless. Most were too weak to withstand chemotherapy.
But to just stand by as people died so horribly went against everything he had been taught. It was like watching hyenas eat a living animal, tearing away at the flesh, as the victim struggled vainly to escape. He was a doctor, and though he often dealt with terminal cancer patients, as an oncologist at least he stood a chance of curing them.
Even more frightening was the dawning realization in the medical community that this new syndrome was contagious. As reports began pouring out of the Centers for Disease Control that drug users, hemophiliacs and, finally, heterosexuals were also being affected, it could no longer be attributed simply to the gay lifestyle.
Still, no one was sure how it spread. It was likely through contact with body fluids--but did that mean it could be inhaled? Or caught by contact with sweat or saliva? Was it in the blood?
All that anyone knew for certain was that, so far, it was always fatal.
Because they knew so little, members of the medical community began treating the syndrome as a highly contagious disease of unknown origin and capability--which meant that patients were shut up in isolation rooms and attended by physicians and nurses wearing gloves, gowns, masks and sometimes even environmental-disaster suits.
Some doctors refused to handle such cases at all. A few private-practice oncologists tried explaining their reluctance as looking out for the benefit of their other patients. The people with the purple markings on their faces were scaring them.
Fortunately, there were private physicians like Dr. Eddie Pajon, an oncologist at Aurora Presbyterian who accepted these patients early on, even working for free when necessary.
Myers also felt the fear. He tried wearing rubber gloves when he examined patients, but when he saw the despair in their eyes he stopped. Gloves, a desk...they were all barriers. He decided to use gloves only as he would in his standard practice, such as examining someone's mouth.
Still, there was something more than the uncertain dangers that made him uncomfortable with these patients, and he knew it. They were nearly all homosexuals...and he'd had an aversion to homosexuals since those two unfortunate encounters in his past.
Myers didn't place any credence in the theory that the disease was God's way of punishing homosexuals. This disease was too loathsome to hang on the God he believed in.
But at the same time, he didn't think that homosexuality was normal, or even healthy. He had heard about the gay bathhouse scene and had listened as men bragged about having had hundreds of sex partners. It was little wonder that this disease--whatever caused it--had spread so quickly.
Now Cohn kept referring all these guys specifically to him, and he didn't want to become known as the "gay doctor."
"Send them to the clinic," he told Cohn one afternoon. "But don't send them to me." He might as well have been talking to a rock. Cohn kept sending the men directly to Myers.
As fate would have it, Myers had another cancer case to worry about: his father. In 1984 Adam Sr. had been diagnosed for a second time with prostate cancer. His parents had enjoyed ten years on the south Jersey shore after the first diagnosis. This time, though, there would be no reprieve. The cancer was too far along.
Myers kept up with his father's battle through long-distance telephone calls, making sure he was getting the best medical care. Finally, in November, it was clear that it was time to go say goodbye.
When he walked into his father's hospital room, he was surprised by the sudden look of fear on the old man's face. Then he realized his father knew that his arrival meant the end was near.
They didn't waste any time lying to each other. Instead, they talked about the old days...the Yankees games they went to...hitting 'em out at the neighborhood park...playing catch until it was too dark to see the ball.
The younger Adam choked up when he recalled asking his father to put on his old cleats, only to have them fall apart in his hands. But that was okay, his father said. You can't go back, you can only go forward.
After a bit, they both grew quiet. "How about a back rub?" Myers asked.
His father nodded. "That'd be nice, Adam," he said and turned over.
Myers began rubbing, his heart breaking over how little muscle remained on the bones. He kept kneading and caressing. He knew that once he stopped, he might never get to touch his father again. He didn't want to let go.
But at last he stopped. Stooping, he kissed his father and they said goodbye, knowing it was for the last time.
Myers flew back to Denver and to his patients. Their peculiar affliction had just acquired an official name: acquired immune deficiency syndrome, or AIDS.
When he looked at the patients, he saw his father and the look of fear that came with the realization that death was near. He listened to their stories of how society treated them--how they'd lost their homes and jobs and families when they became sick. He recalled how he'd felt when the rich woman had attacked Dr. Simels as a "goddamn Jew" and the indifference shown by the neurosurgeon when he was a young intern in Philadelphia. He felt ashamed that he had allowed his own prejudices to interfere with how he acted toward these patients as a physician.
And just as he had reached out to touch and comfort his father, he began to reach out to these men and discovered that a simple touch had a way of comforting both physician and patient.
A few weeks later, he was sleeping when the telephone rang at two in the morning. It was his sister. "Dad's dead," she said. "I just wanted you to know that he went peacefully, and he wasn't afraid."
Myers hung up with a promise to call back later in the day. Then he rolled over and cried himself to sleep.
end of part 1
