Insisting on confidentiality could also affect the possibility of getting treatment. People with HIV could be sure that they would not be treated anonymously with antiviral drugs currently being developed. The researchers would have to be able track the drugs' effectiveness and make sure that patients were following the treatment program. He felt that medical confidentiality would be maintained as it was for other patient-doctor relationships.
Gourley urged that gay men "boldly assault the barricades of HIV discrimination by being open and public with their positive antibody status."
After two and a half years of dealing with government bureaucracy, Gourley was ready to leave the safe-sex program. He told Cohn that he wanted to get back into real nursing, where he could work with patients.
He could leave the political issues to others, such as ACT UP (the AIDS Coalition to Unleash Power), which had been formed in the mid-'80s by playwright Larry Kramer, who had been dissatisfied with what he felt was a lack of assertiveness by others in the Gay Men's Health Crisis organization. Kramer had organized ACT UP to agitate for more government resources for AIDS research and the care of people with AIDS. In 1989, 4,500 members of ACT UP and abortion-rights activists held an angry demonstration at St. Patrick's Cathedral in New York City, disrupting mass by throwing condoms in the air, lying down in the aisles and chaining themselves to pews to protest the church's opposition to safe sex and abortion.
But for Gourley, acquaintances and friends were dying or disappearing. Several of his lovers from the '70s were getting sick. Black activist Tim Offutt, who'd worn the buckskin outfit and banged his drum with so much energy nine years earlier, was horribly ill when he left for Chicago to be closer to his family. Gourley heard that he'd been involved in AIDS activism up there, but then there was no word, and he feared the worst.
Phil Schroeder, the friend who'd driven around and around the community center trying to work up the nerve to "come out," was ill. As was Don Gorman in San Francisco, his healthy living and meditation notwithstanding.
And now David Woodyard. David had a heart attack, but they didn't know if it was AIDS-related. There'd also been a series of battles with bacterial infections. He was better at the moment, but there was a feeling of the inevitable.
Gourley wanted to do what he could for his loved ones. Cohn practically begged him not to leave and had an offer in mind. He and Judson were in the process of trying to get a larger clinic to deal with the onslaught of AIDS patients, and Cohn thought Gourley was the logical choice to be the head nurse.
It was clear that the epidemic could not be dealt with as other epidemics had been. Polio and tuberculosis, for example, affected people in specific ways that could be addressed by a primary physician or specialist. AIDS 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 AIDS-related dementia.
The new clinic was set up on the fifth floor of the old hospital building. Cohn felt that hiring Gourley was once again a no-brainer: He was an excellent nurse who was probably as well-educated about AIDS as any of the doctors. He was already HIV-positive, so he wasn't afraid of drawing blood or setting up intravenous drug feeders. And he was gay, so he was familiar with what the majority of the clinic's patients were dealing with socially as well as medically.
The clinic was the only one of its kind in the area. A patient's primary care contact was a nurse, of which there might be a half-dozen on a given day, with only one doctor in attendance. Cohn managed most of the infectious-disease cases -- such as for PCP and thrush. Dr. Adam Myers, the chief of oncology at DGH who had been treating AIDS patients since 1981, conducted an oncology clinic twice a week for patients with Kaposi's and lymphoma. The doctors might see patients only a couple of times a week, while the nurses were there day after day and saw it all ("Buying Time," November 9, 1994).
Ninety percent of the patients were gay, most of them white, most in their thirties to early forties. The patients reminded Gourley of those he'd seen as an attendant on 4West. Their lives were in shambles. Often the disease had cost them their jobs, their homes and, in some cases, their friends and families. The world looked on them as pariahs, as people who had brought this plague on themselves.