And the Band Played On

by Randy Shilts

  CASTRO DISTRICT, SAN FRANCISCO

  Marc Conant woke up with a start, his forehead dripping in a hot sweat. Again, the incredible feeling of loss and the fear, the gnawing fear, overwhelmed him. Conant’s restless Doberman paced nervously on the back porch while the dermatologist walked around his comfortable home, its lights still off, trying to clear his mind of the dream. It was recurring often now. He would be somewhere, very alone, and he would look at his skin and see the massive purple lesions of Kaposi’s sarcoma spreading over his body. He was beginning to look like them, the patients he was seeing every day now in his practice, the young men so horribly disfigured by the splotches of bluish purple.

  Then he would wake up in his hot sweat, seized by the impulse to run. Only a fool would stay here when you know that everybody is going to die, he thought.

  Like most of the doctors working with GRID around the country, Conant had his blood tested regularly to ensure it held the proper ratios of T-helper and T-suppressor lymphocytes. It was the closest thing to a GRID test around. His lymphocytes were just fine, he knew. He didn’t have gay cancer, but there were so many other things to worry about.

  All day, people had been calling him about the cluster study, and every terror Conant had conceived on that April morning a year before when he first heard about Ken Home now seemed realized. He immediately recognized Patient Zero as the suave Quebecois airline steward who had come into his office the month before. He was the type of man everyone wanted. What everyone had wanted was bringing them death. Quite literally, Conant thought. Conant had heard that the young airline attendant was one of the more popular catches you could make at the Club Baths on Eighth and Howard these days. He might even be there now, Conant thought. People could be out there catching this now.

  There were other worries. The sum total of all Conant’s funding pleas was a $50,000 grant from the American Cancer Society. That was just enough to afford one harried secretary to coordinate the increasing numbers of patients using the KS clinic. The secretary ended up doing social service referrals, grief counseling, and lots of hand-holding, as well. There was nobody else.

  Nine months had passed since the National Cancer Institute conference in Bethesda, and still there had not been a single gesture to intimate that the NCI was prepared to release funds. Refusing to wait for the official request for proposals, Conant had outlined his own research project on KS treatments and submitted it to the NCI. He then dashed off a letter to Assistant Secretary for Health Dr. Ed Brandt, begging him to intercede for accelerated NCI money. He received a polite reply that the United States government was deeply concerned with the problem and that both the CDC and the National Institutes of Health were doing everything possible to stop the epidemic, and thank you for writing.

  The United States, Conant thought, had the know-how and resources to conquer this disease. The greatest scientific technology waited in the world’s best-funded laboratories. People could be warned through a mass media network that could reach into virtually every citizen’s home within a matter of minutes. This wasn’t some Third World country, for Christ’s sake. We could win this fight, but nobody is willing to make the effort or even acknowledge that there is a battle out there to be won.

  Conant settled back into his bed, hoping the nightmare would not return, at least that night. When he was young, Conant had sometimes wondered what it might have been like to be a bright, resourceful Jewish man on the day after Krystalnacht, to see clearly the wholesale death that lay so soon ahead, even if the rest of the world didn’t seem to care. Why didn’t they run away?

  Now, for the first time, Conant understood.

  At the end of May, Marc Conant and Paul Volberding went to Tokyo to present their data on Kaposi’s sarcoma to the World Dermatological Conference. Their Japanese hosts were polite and intrigued by the new phenomenon.

  “Isn’t it a shame you have the problem in San Francisco,” said one prominent Japanese scientist. “It’s because you have homosexuals.” He paused a moment and confided, “Of course, we don’t have homosexuals here.”

  NATIONAL CANCER INSTITUTE, BETHESDA

  Robert Biggar’s paper, hypothesizing an infectious agent as the cause of GRID, had now been rejected by every major scientific journal in the country. It simply went too much against the grain of prevailing theories. Other doctors were shooting up mice with semen to show that sperm actually was causing the immune suppression. Lab assistants scurried to pornographic bookstores to buy bottles of “Rush” and “Bolt” so rats could be overdosed on butyl inhalants in other experiments. Herpes experts seemed positively elated at the renewed attention to cytomegalovirus, or CMV. Other doctors posited that the collapse of GRID patients’ immune systems occurred because they were overloaded with other infections. Many reviews of scientific theories on GRID etiology completely dismissed the single-agent theory as too unlikely.

  Biggar’s colleague, Jim Goedert, leaned toward the popper theory when the pair started putting together a large cohort of gay men in New York City and Washington, D.C., for a long-range study. Biggar was frustrated that his hypothesis was being ignored, but he also knew work must proceed. He had seen plagues in Africa, and he knew that the American infatuation for quick and easy theories, like semen or poppers, came only from naivete. No matter how affluent and civilized, humans were humans and susceptible to viruses that could come from nowhere. In fact, it was easier for a virus to come from nowhere these days.

  Once, epidemics needed great movements of people to inspire their spread. The Spanish flu pandemic of 1918, which struck 20 million people, killing 200,000 Americans, directly followed the massive movements of people during World War I. Mixing Americans from diverse regions during the mobilization for World War II created a big viral mixing bowl that blended the poliomyelitis virus into people from every corner of America. The widespread outbreak of polio in the late 1940s and early 1950s was the direct result.

  The popularity of air travel had eliminated the need for such dramatic world events to cast the seeds of apocalypse. It took just one person here or there to carry the right virus to the right population, and disease would strike again. Others might not see it now, but it would become obvious in time. Bob Biggar only hoped that it would not be too late.

  CENTERS FOR DISEASE CONTROL, ATLANTA

  Dr. Harry Haverkos of the KSOI Task Force had come up with the idea of bringing Gaetan Dugas to Atlanta. If nothing else, the flight attendant was certain to be harboring lots of virus in his blood, the CDC figured, and Haverkos had him hooked on to a plasmapharesis machine so the agency could collect a half liter of his plasma for lab research.

  Everybody in Building 6 was talking about Patient Zero and the cluster study, due for publication next month. Bill Darrow and Harold Jaffe wanted to get pictures of as many GRID victims as they could and start showing them to new patients. They were convinced even more connections could be established. Higher CDC officials, sensitive to gay concerns about confidentiality, vetoed the idea.

  Jim Curran passed up the opportunity to meet Gaetan, the Quebecois version of Typhoid Mary. Curran had heard about the flamboyant attendant and frankly found every story about his sexual braggadocio to be offensive. Stereotypical gays irritated Curran in much the same way that he was uncomfortable watching Amos n’ Andy movies.

  Gaetan Dugas later complained to friends that the CDC had treated him like a laboratory rat during his stay in Atlanta, with little groups of doctors going in and out of his hospital room. He’d had this skin cancer for two years now, he said, and he was sick of being a guinea pig for doctors who didn’t have the slightest idea of what they were doing.

  MEMORIAL SLOAN-KETTERING CANCER CENTER, NEW YORK CITY

  Brandy Alexander kept a Rubik’s Cube by his bed in Room 428A at the sprawling cancer center. Sometimes he would take the cube, with all its colors, and turn and twist it every which way with his bony, aching fingers to find the solution. But it never worked; there were no solutions.

>   Before the first spot had appeared, Brandy had been a brassy female impersonator who could knock ’em dead with “Over the Rainbow,” “Maybe This Time,” and “New York, New York.” As the lesions spread, though, his brown curls turned gray and he lost twenty pounds, leaving his bones to jut out of his loose, purple-spotted flesh. Brandy’s once-handsome face was covered with thick scabs wrought by an uncontrolled herpes virus. None of the standard medications stopped the herpes, so his face oozed all over with pussy discharges. Besides the KS and herpes, the thirty-eight-year-old had an array of the usual opportunistic infections, including severe hepatitis and tuberculosis of the bone marrow.

  Brandy Alexander was typical of these patients, his doctors told Don Francis before he entered the room. Although Don Francis had come to Sloan-Kettering with Jim Curran on other business, he felt embarrassed that he’d been working on this disease for nearly a year and still had not met a patient. The physicians led him to Brandy Alexander, who exuded a gracious charm. He lifted his hand to Francis, as though he wanted the young blond scientist to kiss it. Francis immediately saw the large splotches of purple on the man’s arm.

  It wasn’t even his favorite color, Brandy confided. He didn’t have any bags to match.

  Alone, in the room, Brandy talked honestly with Francis about his life. Brandy could tell Francis wasn’t particularly shocked at anything he heard.

  “The sex got to be unstoppable,” he said, his eyes wandering around their hollow, gaunt sockets, trying to see the answer. “1 don’t know whether it was to be close to another person because I didn’t want to be alone. I don’t know if I just got bored with normal sex, so I’d try something new. Something more exciting. Fisting. Another rung.”

  The monologue was taking Brandy to a conclusion that irked the scientific side of Don Francis’s mind. Brandy was trying to find a reason he was lying in pain in that bed in Room 428A about to die. The old moral teachings, Francis thought, die hard.

  “I think this is a communicable disease and you got it,” said Francis, matter-of-factly. “You’re not being punished. A virus has made you sick.”

  Back with the Sloan-Kettering doctors, Don Francis got down to the purpose of his mission. Sloan-Kettering had one of the handful of retrovirus laboratories in the country. Even the CDC didn’t have a retrovirus lab, and it would be months before they could get one together. They weren’t set up to investigate long-latent viral diseases in Atlanta, Francis said, just the quick hits that burst forth and need a fast solution. They were floundering on GRID and needed help.

  Sloan-Kettering needed to get to work on GRID, Francis prodded. There wasn’t time to delay.

  The doctors listened patiently and agreed this was an important problem. They’d think about it and get back to him. Of course, Francis knew then that they would never call back.

  The dream came to Don Francis often during those long, frustrating nights in the gathering darkness of 1982. Just beyond his reach, a faint orange light was suspended, shimmering with promise. It was The Answer, the solution to the puzzle. He reached for it, stretching so he could draw the light toward him. But it drifted farther and farther out of reach. The answer was always there before him, tantalizingly close, and still beyond his grasp.

  Don’s wife usually awoke him at that point. His mournful groaning would disturb the kids.

  16

  TOO MUCH BLOOD

  June 11, 1982

  CENTERS FOR DISEASE CONTROL, ATLANTA

  Sandy Ford called Dr. Bruce Evatt, the CDC hemophilia expert, as soon as the order came in. Sandy, who had first alerted the CDC to the GRID epidemic last year, had even worse news to break to Evatt.

  It had happened, Ford told him. An order for pentamidine had come in from Denver. The Pneumocystis victim, the doctors had said, was a hemophiliac.

  That night, Evatt’s associate in the Division of Host Factors, Dr. Dale Lawrence, took a flight to Stapleton International Airport in Denver.

  June 14

  DENVER

  With his white shirts, plaid ties, black oxfords, and thinning dark hair that fell over earnest dark eyes, Dr. Dale Lawrence looked like everybody’s favorite biology teacher in high school. He sounded like a serious instructor too, soft-spoken even as he strained to put his words together just right so everything he said would be easy to understand. He had to ask all these questions, he told the stunned wife of the hemophiliac patient, because so much was at stake.

  Although Lawrence had worked for a year with the CDC’s Division of Host Factors on issues of genetics and susceptibility to GRID, he had been to enough Task Force meetings to know what needed to be asked. He had to positively eliminate the chance that the man might have been involved in gay experiences or, perhaps, some kind of drug use or medication that could have engendered his immune deficiency. Lawrence’s intense investigation the earlier few days had eliminated everything else. Just that morning, he had gone to the local blood center. Blood bank officials were very skittish about his arrival; Lawrence knew why. Just one or two documented hemophiliac GRID cases would severely shake the foundations of the blood banking industry.

  Lawrence carefully drew out grids of all the different batches of the Factor VIII clotting factor that had been injected into dozens of other hemophiliacs served by the same Hemophilia Treatment Center in the Denver area. Maybe there was just one bad lot that was making people sick, and the Pneumocystis diagnosis was a wicked coincidence. Looking back at three previous years, however, he could find no single such lot.

  Instead, Lawrence went back to the wife of the man wheezing on the ventilator at the University of Colorado Medical Center. The couple’s troubled life story was laid out. The man, a janitor, had struggled against his disease for a lifetime, already living decades beyond what doctors had predicted when he was born. The uncontrolled bleeding in his joints had left him partially crippled, but he toiled to eke out a living for his wife and children just the same. Factor VIII, of course, had been a godsend, but now he was in there dying. Wasn’t there anything anybody could do?

  At the end of the conversation, Lawrence felt he had eliminated other possible routes of infection. Lawrence’s boss, Bruce Evatt, was convinced that GRID was being spread through Factor VIII even before Lawrence returned with the final results of his investigation. Evatt had suspected it for months, after the first Florida man had died of Pneumocystis. The Colorado case was the clincher. Because bacteria, protozoa, and one-celled microbes were easily weeded out of the Factor VIII during its preparation process, this meant that GRID was caused by a virus, the only organism small enough to pass through the filters.

  Both Lawrence and Evatt knew there would be more GRID cases among the hemophiliacs soon and blood transfusion cases would follow. Because of their exposure to vast numbers of donors, the hemophiliacs simply had the misfortune to get it first, like the gay men playing on the freeway in the late 1970s.

  That Afternoon

  CASTRO STREET, SAN FRANCISCO

  While Dale Lawrence was wrapping up his Denver interviews on the nation’s first documented hemophilia GRID case, Cleve Jones eagerly made his way to the doorway of the Castro Street building that he had leased as the headquarters for the Kaposi’s Sarcoma Education and Research Foundation. Marc Conant and a couple of doctor friends had put up the money for the rent. This was the first office of any agency established specifically for the epidemic of immune suppression, and it started with one beat-up typewriter donated by a local gay bartender, office supplies pilfered from volunteers’ various employers, and one telephone that started ringing within an hour of its installation. And it never stopped ringing.

  Years of leading demonstrations and hanging out on Castro Street gave Cleve a vast reservoir of fellow rabble-rousers, old tricks, and prospective boyfriends from whom to cull volunteers. There was a deadly enemy out there. The fucking thing didn’t even have a name.

  “I don’t know what to say,” said friends Cleve recruited to answer the new gay cancer hotlin
e.

  Cleve sighed, “Nobody does.”

  FEDERAL BUILDING, SAN FRANCISCO

  Bill Kraus had respected San Francisco’s Congressman Phillip Burton ever since Harvey Milk pointed out the bulky legislator at a political rally and called him “II Patrón” of the city’s liberal Democratic establishment. The congressman had created the awesome liberal clique that had dominated local politics for two decades through the weight of his wily, hardball tactics and his pioneering coalition of black, labor, and gay votes. Burton had engineered the ascension of the late George Moscone to mayor and had been a key ally to the flamboyant Assembly Speaker Willie Brown, generally regarded as California’s second most powerful state politician after the governor. Burton’s younger brother John represented another San Francisco congressional district. Phil Burton himself was one of the most powerful members of the House of Representatives, having missed being elected House Majority Leader in 1976 by one vote.

  However, Phil Burton’s obsession with playing Washington politics had weakened his San Francisco base, and never was he more vulnerable than when he sought his tenth term in 1982. The Republicans had nominated State Senator Milton Marks, the only GOP politician ever to make much of a name for himself in recent local political history. His successive wins in difficult elections, everyone knew, were because he had courted and charmed the gay community for years. Although the liberal Marks was a thorn in the side of the state’s increasingly conservative Republican party, his election gave the GOP a chance to oust that troublesome Burton, so major donations from Republican political action committees flowed to Marks’s coffers.

  When Burton called Bill Kraus for a meeting, he was worried. Burton needed a liaison to the gay community. He wanted to win the election and get back to Washington.