David was the last of us to contract chicken pox, but he got it the
worst. My older sister picked it up at
school, passed it on to me and finally, probably about the time I had scratched
off the last of the crusts from my skin, he came down with it. He must have been less than one, since I, two
years older, have no recollection of this.
I just know that for years my parents would recall how sick he got and
how worried they were. He had been born
prematurely and from day one, my parents worried about him. Just a skinny little thing, covered with pox,
my dad would recall from time to time with a grim shake of his head. In my early childhood, I didn’t have a clear
notion of what chicken pox was. I
imagined for a time it was some sort of culinary dish like chicken cacciatore
or chicken a la king. This kind of
misunderstanding was typical for me, a middle child benefiting from what I
later liked to call benign neglect as I was buffered on one side by a
preternaturally verbal older sister and on the other by my sickly younger
brother who together managed to soak up most of the parental attention. I was
free to concoct my own versions of things in dreamy solitude. Worried attention, on the other hand, had a
rather toxic affect upon my younger brother, I think, who grew up to be a
robust, talented, but extraordinarily anxious young man.
We shared a bedroom throughout a good
deal of our childhood and for the most part it was a harmonious situation,
though of course we did have our occasional squabbles. He had what was probably some sort of vocal
tic that would manifest just as he was settling into bed. As I read on the adjoining bed, short little
grunts and sighs would emanate from his side.
I learned to merely grit my teeth since complaining to him, just made it
worse and my parents, I was sure, would take his side. Later he decided that the light of my lamp
bothered him and I would retreat to another room. He would emerge after some minutes claiming
that a faint light under the door was preventing him from sleeping and I would withdraw
to a far end of the house. For a scrawny
little thing, he wielded a lot of power.
As I grew older, I developed protective mien toward my brother. In college, we talked often on the
phone. Usually, I could gauge his mood
in the first millisecond or so.
Frequently, he would start with sort a brief vocalization, sort of a
throat clearing then a long pause and then slowly at first he would pour out
the various things that were on his mind.
I would listen, make an occasional encouraging comment and finally I
would hang up the phone feeling totally spent.
In one of those conversations, he confided to me his growing conviction
that he was gay. I immediately assured
him that I was fine with it, but at the same time, I was yet again gritting my
teeth, wondering how my poor scrawny younger brother, covered with pox, could
deal with the world as a gay man. For
some time, I carried this revelation in solitude. Gradually, the circle of those in the know
grew and some years later we were able to enjoy a friendly if not entirely
relaxed Christmas at Dad’s (my mother had had since passed away) with David and
his black male lover.
In 1982, I began my internship in
pediatrics at Bellevue Hospital. The
work was grueling, but fascinating. My
brother, in the meantime, had gone to the Studio School not too far away laying
the foundation for a painting career.
Will he ever choose something easy, I wondered at the time. He supported himself by working as a
typesetter at the Nation magazine and painted tirelessly in a loft that he had
bought in a pregentrified of area of Brooklyn and which he shared with his
boyfriend. I remember being amused that
my artist brother owned property before I did, the doctor. His work habits were fueled by an intense
nervous energy. He carried a sketch pad
with him everywhere. We would on
occasion travel out to the country together to visit our father and I would
laze around while he would spend virtually the whole weekend tramping around
with his easel.
David sometimes invited my wife and me to elaborate dinner parties in
his loft. He would hover over the stove
carrying on multiple conversations with his guests, usually artists and writers,
while frenetically tasting, adding ingredients. His salads, in particular, were the product of
endless additions of minute amount of spices and herbs. I marveled at all the talents that were
emerging and began to feel a tad envious as I compared my conventional life
style to my brother’s bohemian bonhomie.
In 1981, the CDC reported a cluster of 5 homosexual men with
pneumocystis carini pneumonia. Initially
the disease was known as GRID or Gay Related Immune Deficiency. As it became increasingly recognized that
more than 50% of cases were not gay related, it was changed to Acquired Immune
Deficiency Syndrome. At Bellevue, we
began in the fall of 1982, to see young children with unusual infections. I remember one infant in particular who was
my patient. Despite all our efforts, she
got sicker and sicker. Drawing blood or
replacing an IV in her became a dreaded task for all involved and I remember
struggling sometimes up to an hour, ungloved in what was typical during that halcyon
era and afterwards scrubbing off all the blood from my bare hands. Only in retrospect, did we recognize that she
represented one of the first cases of pediatric AIDS, usually contracted at
birth. Two years later, a pediatric AIDS
clinics was set up at Bellevue.
That era in some ways resembled America pre 9/11. Though the AIDS crisis intruded upon our
consciousness far more slowly than the terrorists attack upon the World Trade
Center, there are, I think, some real similarities: the sense of an
undetectable enemy, a similar kind of fear. AIDS changed our feeling of safety
and brought an abrupt halt to the notion of sex without consequences which had
blossomed on the college campuses of the 60’s and 70’s after the advent of oral
contraception. Potential lovers were scrutinized suspiciously
in the same way that air travelers uneasily eye fellow passengers of Middle
Eastern appearance. Unlike
chicken pox, which mounts a frontal assault upon our respiratory tree and then
quickly fans out through the blood stream establishing gaudy beachheads in the
skin and mucous membranes, the AIDS virus is the ultimate bioterrorist,
sneaking into our bodies undetected, biding its time in patient preparation for
its assault on the immune system. In the
case of chicken pox, the body’s immune system steadily fights off the infection
and the pox marks which initially look like dew drops on a rose petal as they are
poetically described in medical textbooks, become cloudy, and then burst
leaving a crusted bump. The patient practically always recovers fully,
but yet there is one similarity to the AIDs virus: the varicella virus does not
completely leave. It nestles in the
ganglion roots of the spinal nerves establishing a redoubt where it remains
dormant, kept in check by a vigilant immune system.
As it turned out, David was aware of the cluster of cases in Los Angeles
before I was. I prided myself that I
kept up with the medical literature, but I missed that report. The gay community, on the other hand was
already humming about it. He called me
that fall, his voice cracking, and there was that long pause that I hadn’t
heard for years. He was frantically
worried that he had contracted the gay disease. Over the next few months, it
was like old times: late night calls and nervous ruminations. Looking
back on it today, I cringe as I recall my repeated reassurances. Don’t worry, I counseled, my assured tone
fueled by my confidence in the power of my medical knowledge: a confidence that,
as is commonly the case among doctors, reached its apogee towards the end of my
internship. Only later, did I come to
appreciate the pipeline of information from the gay community that David was
privy too, which proved to be a much more reliable source about the nascent
AIDS epidemic. Gradually, he calmed down, and by the Spring of 1983, he rarely
brought it up and was deeply consumed for preparations for his first solo art
exhibition. On the wards at Bellevue,
our conversations turned increasingly to speculation on what was causing this
mysterious disease. As David calmed
down, I began, in secret, to worry.
It was a good two years later that David called me to tell me that he
was laid up. He had an attack of
shingles. He related this to me calmly,
mildly complaining that the pain was interfering with his painting
schedule. I feigned an equal casualness
as I strained to keep my own voice from cracking. After hanging up, I stood there and my wife
entered the room astonished by the tears streaming down my face. Varicella, benign varicella, had reared its
ugly head after 30 years of slumber in the dorsal roots of David’s thoracic
spinal nerves producing a band of blistery eruption which snaked round from one
side of his back to near his navel.
Shingles, results from a reactivation of the varicella virus in the
spinal nerve. While merely a temporary,
albeit painful, affliction for the elderly, for the young gay male, it is a
harbinger of much worse things to come, because it is a sign that the body’s
immune system is starting to wane. Since
there was no blood test for diagnosing AIDS at that time, this was the first
incontrovertible sign that he had a problem with his immune system. Once I learned he had shingles, the last
vestiges of denial fell away and I knew.
Some months later I dropped by on one of my regular visits to his loft
and found him stretched out on his bed, breathing a bit heavily and with what
seemed to be a slight bluish cast to his face.
He waved me closer with a smile before going into a paroxysm of
coughing. Just a bad cold, he told me
and I managed to convince myself that he was not breathing rapidly and that the
lighting was a bit funny. The next day,
I came again and this time I brushed away his protestations that this was a
cold and convinced him to go to his doctor.
His doctor took one look at him and dialed the hospital. While waiting for the hospital to pick up, he
turned to look at me and I thought I saw a recriminating look on his face. Why had I not been more alert to the clear
signs of respiratory distress that any intern could see? By that evening, he was in the intensive care
unit at Columbia Medical Center on a ventilator. He showed remarkable strength and dignity
while flat on his back with a hose sized tube ensconced in his trachea. He wrote frequent notes on a little pad with
the same frenetic energy that so characterized him. He wrote “I’m optimistic”
among other things and was careful to equally divide his attentions among the
circle of friends and relatives around his bed.
I remembered his almost disabling
anxiety when he thought he might have AIDS and marveled at how well he coped
with actually having it.
Most people survive their first episode of pneumocystis, but David did
not. I asked his doctor about this, and
he did not have a definite answer. Years
later, I learned that subtle genetic differences probably account for the
variable outcomes. We had a memorial at
a gallery in Soho. We stood, surrounded
by his paintings and many of us in turn stood up to talk. As I approached the front to take my turn, I
thought how strange for me, a doctor, to be giving a talk in a Soho art
gallery. There was one other doctor in the crowd, his doctor, a specialist in
infectious diseases from Columbia. Several years later I read an article about
the AIDS epidemic in the New York Times Magazine and saw that David’s doctor
was prominently mentioned as a pioneer in the early treatment AIDS. Towards the end of the article I learned to
my astonishment that he himself had recently succumbed to the horror of the
disease that he had been close witness too as a treating physician.
******
In 1989, my then two year old daughter,
Jessica, came down with chicken pox passed down from her older sister. It was a fairly typical case and on Sunday
morning of Memorial Day weekend, the lesions looked like they were mostly
crusted over. Late that afternoon, her
fever returned, but now was much higher than it had been at the height of her
illness. Within a few hours I noticed a
faint rash, appearing like mild case of sunburn. I snuck into my study and quietly looked up
toxic shock syndrome. I closed the book,
convinced that I had succumbed to that age old malady of med students of seeing
in themselves whatever disease they happened to be studying and I calmed myself
down. It was my wife, using a mother’s
instincts, who truly recognized the severity of what was transpiring. I placed a midnight call to one of my
partners and together we drove to the medical center. It turned out she did have toxic shock
syndrome, which is a rare complication of chicken pox. She was in the hospital for a week or so, but
completely recovered.
David’s paintings are hung throughout our house interspersed with
Jessica’s, who has become an accomplished painter. I watch her move quickly, about the kitchen
and I catch a glimpse of small round scar between her eyes, the only remnant of
her bout with chicken box. She leans
over a salad she is preparing, making familiar minute adjustments. She fixes me, with a look. “Dad, what’s a matter, you’ve never seen
anybody make salad before?”
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