And the Band Played On

by Randy Shilts

  Dr. Silverman agreed that his department needed to step up educational activities in the bathhouses, and he praised the bathhouse owners for pledging their cooperation. That should take care of the problem, most of those at the meeting agreed. More pamphlets.

  Privately, Silverman felt that if people like Bill Kraus were so goddamned opposed to the bathhouses, they should take picket signs and stand outside the doors, warning people away. That would draw more media coverage of the issue and give him a demonstration of community support that, in turn, could justify his closing the baths. Without such support, Silverman did not feel that closure would serve a constructive end. Gay leaders lauded Silverman for taking the most appropriate action. The foes of the Milk Club could barely restrain a smirk at Bill Kraus. Everybody figured he was behind this burst of attention on the bathhouses, as he had been last year. Once again, he had lost.

  Controversy also swirled around the bathhouses in New York in February. A New York Native writer had spent a night at various bathhouses to see if they had indeed turned into campuses for AIDS education. He found that nobody used rubbers, few paid even cursory service to safe-sex guidelines, and that most patrons laughed at the writer’s suggestion that sexual activity be restricted to healthy endeavors. Larry Kramer took to pasting AIDS warning stickers on bathhouse doors, a move that only earned him more derision.

  The pages of the Native were crowded with the obituaries of dancers and architects, priests and poets, university professors and civil engineers who had all died young from AIDS. Still, there remained little pressure for any frontal assault on the disease.

  Larry Kramer engaged in a long campaign to regain his seat on the board of directors for Gay Men’s Health Crisis, but he was rejected in an overwhelming board vote in early February. As intemperate as ever, Larry fired off a letter to the board, calling them a “bunch of ninnies, incompetents, cowards.”

  The minutes from Mayor Koch’s InterAgency Task Force on AIDS continued to read like a laundry list of the substantial problems that persisted in New York because of the lack of coordinated care facilities or any social support services. One man was literally pushed out onto the cold street in February after he was denied placement in a city housing facility because he had AIDS. At GMHC, people seeking clinical services had increased from 40 a month in early 1983 to between 80 and 100 each week. The group was turning about half of them away now because of lack of resources. Even as problems mounted, the task force voted in February to stop meeting every two weeks and assemble once a month instead.

  February 7

  PARK CITY, UTAH

  Michael Gottlieb had never seen such an electric level of scientific exchange as what had coalesced at the scientific conference he had organized under the auspices of UCLA. The 150 scientists were most of the top people working in AIDS across the country, either as researchers or clinicians. The tremendous strides the field of immunology had made since Gottlieb announced the first four cases of Pneumocystis in the MMWR just thirty-two months ago was evident. For all the funding problems and rivalries, scientists clearly had responded more swiftly than any others challenged by the AIDS epidemic. After the intervention of Assistant Secretary for Health Ed Brandt, scientific journals recently had agreed to expedite publication of AIDS-related breakthroughs. The release of new federal and state funds had attracted more top minds to the intriguing medical mysteries posed by the epidemic.

  On the conference’s second day, Gottlieb scheduled the climactic panel on lymphotropic retroviruses that would include Drs. Robert Gallo, his close associate Max Essex of Harvard University, and Jean-Claude Chermann of the Pasteur Institute. Gallo privately belittled the French research, but Gottlieb suspected nothing when Dr. William Haseltine, another Harvard researcher with close links to Gallo, asked to speak for ten minutes before Chermann. Gottlieb granted the time, although the scheduling would be tight. There was good snow for skiing that Tuesday afternoon, and one lure for the five-day conference had been the promise that scientific sessions would end by noon so doctors could hit the slopes.

  Dr. Gallo started the session with a talk on “the family of HTLV viruses.” Although his talk implied that he had made unspecified research breakthroughs lately, he gave the audience no hint of what other NCI researchers knew—that Gallo was on the verge of announcing his discovery of the cause of AIDS. The crowd already was getting restless when Haseltine rose to speak on arcane matters of gene regulation in the HTLV-I virus. After Haseltine had talked for half an hour, Gottlieb grew worried. He asked a Harvard colleague who was moderating the panel to interrupt Haseltine. The researcher acknowledged the moderator’s signal but turned back to the audience and continued to talk.

  As Haseltine droned on, Chermann paced nervously on the side of the room. He was self-conscious about his English, and now it appeared that he might not get a chance to speak at all. Gottlieb was dumbfounded. Haseltine was not even an invited speaker and he was taking up all the session’s time. What was going on?

  Other scientists familiar with the simmering rivalry between the National Cancer Institute and the Pasteur Institute had no doubt about what was going on. Haseltine was trying to block the French from giving their research, they thought. Finally, however, Haseltine finished, and Chermann got the chance to speak to the impatient crowd.

  Minutes into his presentation, a hush fell over the conference room as Chermann outlined what the year of French research had uncovered. In halting English, he described the LAV virus, explained its selective taste for T-4 cells, and laid out the impressive evidence from widespread blood testing linking LAV to AIDS. The audience was expecting some interesting findings about LAV, but few were prepared to hear the welcome news implicit in Chermann’s message. The mystery disease was no longer a mystery.

  Bob Gallo visibly blanched.

  “Look, Bob Gallo is speechless,” said one New York scientist in a stage whisper. “He’s just figured out that the other guy is going to get to go to Sweden to get the Nobel Prize.”

  In the question-and-answer session, Gallo questioned Chermann aggressively, making it clear to everyone that he disbelieved the work of the French scientist. Couldn’t this LAV have been the result of some contaminant? he asked. He also proposed that the French should not call their virus LAV, but HTLV-III. Chermann held his ground, noting that the virus bore no similarities to the HTLV viruses Gallo had discovered. Gallo’s request was indeed impudent, since it is traditional that the researchers who discover an organism have first prerogative in naming it. Despite Gallo’s efforts, the elite scientists attending the Park City conference left saying the French had discovered the cause of AIDS. A year ago.

  February 10

  DAVIES MEDICAL CENTER, SAN FRANCISCO

  On the day that Jean-Claude Chermann informed America’s top AIDS researchers of the cause of Acquired Immune Deficiency Syndrome, a biopsy of tissue from Gary Walsh’s lung showed that the Pneumocystis protozoa were proliferating. In the days that followed, Gary’s temperature routinely peaked at 104 and 105 degrees. All week, he had shown severe reactions to Bactrim, a drug normally used to treat the pneumonia. His doctor put him on pentamidine and now Gary was sleeping between sixteen and twenty hours a day. The longest he could stay awake was forty-five minutes.

  On his way to the biopsy, Gary talked to Lu Chaikin and Matt Krieger about his memorial service. On Friday, he reminded his nurse that he did not want code-blue status. Matt overheard the conversation.

  “I can’t take it anymore,” Gary explained when they were alone. “I’m tired of one infection after another. I just don’t know if I want to live like this.”

  Three days later, Gary’s doctor informed him that the pentamidine wasn’t working. His lungs were still filling up with Pneumocystis protozoa. The doctor mentioned a new experimental drug he might want to try.

  “And if I chose not to, or if it doesn’t work?” Gary asked.

  “Then we send you home or keep you here and put you on a morphine drip t
o make you as comfortable as possible,” his doctor said.

  Gary decided to try the experimental drug.

  February 15

  CENTERS FOR DISEASE CONTROL, ATLANTA

  Jean-Claude Chermann was persuaded to speak in the CDC auditorium while he was in Atlanta to give Don Francis samples of LAV. Most of the researchers in the AIDS Activities Office wedged into the chamber. By the end of the afternoon, the agency’s headquarters was buzzing with the near-unanimous assessment that the French had indeed discovered the cause of AIDS.

  Harold Jaffe, who now was chief of epidemiology for the AIDS branch, also came away from the speech convinced that the French had isolated the AIDS agent. He immediately plotted the work that could now be done. With an antibody test that could detect asymptomatic carriers in the early stages of infection, scientists at last could begin to chart the natural history of the disease, an aspect of AIDS that remained largely unexplored. Was AIDS-Related Complex a different manifestation of infection by the AIDS virus or merely a prodrome to the more deadly opportunistic infections? To what extent had the virus penetrated the population? How serious was the prevalence of AIDS infection in the Third World, particularly the already troubled nations of Central Africa?

  WARD 86, SAN FRANCISCO GENERAL HOSPITAL

  By late February, the doctors in the AIDS Clinic had decided to support closure of the bathhouses. Although they preferred not to get involved in political issues, they could no longer pretend to be cool and objective about bathhouses. Day after day, Dr. Don Abrams, clinic assistant director, took the sexual histories of men who appeared at the clinic with their first lesion or that terrifying shortness of breath. Day after day, the young men told him about their bathhouse experiences. Many were not very sexually active, living out of the gay fast track in suburban homes. But, when the itch hit, they’d go to the baths. The baths simply were more convenient than the bars.

  AIDS Clinic epidemiologist Andrew Moss frequently said that the only bathhouse warning poster that would offer patrons truly informed consent would be one featuring full-color photos of a person in advanced stages of the disease. In a February 21 letter to Merv Silverman, Moss urged the health director to promote more aggressive public information and to continue public discussions on the future of the bathhouses. “As you know, all evidence points to a resumption of the previous level of sexual activity once the media attention went away,” he wrote. “Thus I do not feel it is appropriate simply to wait and see what happens.”

  As the bathhouse question simmered, Don Abrams and Paul Volberding decided to invite bathhouse owners to the AIDS Clinic to talk about AIDS. Volberding assumed that the bathhouses remained open in large part because their owners did not understand how serious AIDS was. Once they understood, certainly they would move to close the facilities themselves, Volberding reasoned.

  The bathhouse owners who attended were hostile. Some had come only because they felt pressured to attend, because San Francisco General Hospital was an arm of the SF Public Health Department. Other proprietors couldn’t be bothered and simply sent their attorneys. One bathhouse owner became queasy when he saw the slide projector that Volberding had brought for the talk. He didn’t want to see any pictures of AIDS victims, he said. Abrams and Volberding had planned to show just such photos but changed their minds.

  After Abrams and Volberding spoke, one of the owners of the largest bath-houses took them aside and tried to reason with them. “We’re both in it for the same thing,” he said. “Money. We make money at one end when they come to the baths. You make money from them on the other end when they come here.”

  Paul Volberding was speechless. This guy wasn’t talking civil liberties; he was talking greed. Volberding felt hopelessly naive. The bathhouses weren’t open because the owners didn’t understand they were spreading death. They understood that. The bathhouses were open because they were still making money.

  42

  THE FEAST OF THE HEARTS, PART II

  February 17, 1984

  ROOM 213, WARD 2-NORTH, DAVIES MEDICAL CENTER, SAN FRANCISCO

  “I’ve decided to stop all therapy,” Gary Walsh told Matt Krieger and Lu Chaikin. “My body is too worn out. The side effects of the drugs are too much. I give up.”

  Matt and Lu understood. The time of anger, denial, bargaining, and depression were long past; now there was only acceptance.

  “I understand your decision,” Matt said, “and I respect it.” Matt was being utterly sincere. Still, he felt like he was in a play, performing on stage. The words and thoughts were so out of proportion with anything he had confronted in his life before.

  February 18

  MATT KRIEGER’S JOURNAL

  Random notes.

  “I wonder if I’ve made the right decision. The others fought to the very end. I’m taking the easy way out.”

  “Gary, your decision was very brave and courageous. You’re not taking the easy way out. You’re living your life now in the beautiful way you always have. You’re facing death fully conscious. It’s an incredibly brave thing to do. It’s not easy.”

  “Really?”

  “The morphine takes all the pain away. I feel good. It’s hard to stay with my decision when I feel this good. I have to remind myself of the pain without morphine.”

  Setting up a visiting time with Joe Brewer, he says, “That hour’s taken.” We all laugh.

  He [Gary] tells [his nephew] Rick that Monday night will be too late. I’m dying. Come tomorrow.

  He sweats so heavily, it’s like someone spilled a gallon of water on his bed. He woke from three naps this way.

  He’s very much at peace. He’s not in pain. He drifts in and out of sleep. Sometimes he’s fully awake, alert, funny, wise, childish.

  Sometimes, he’s delirious, eyes half open, mumbling incoherent thoughts.

  Good humor, interest in others is remarkably intact.

  One of the nurses told Lu, “We don’t feel like we’re here for Gary. We feel like Gary is here for us.”

  Another nurse told me, “It is a treat to take care of him. He says the most profound things every time you go in there. You want to touch him and you wonder, ‘Is he a saint?’”

  I asked him if he wanted me to sleep in the other bed overnight. He said that if he’s going to go through this bravely, he has to spend the night alone.

  “I’m scared,” he said. “I’m scared of death. What if this is all. What if there’s a hell. You think of the terrible things you’ve done in your life now.”

  “What do you think it’s like where you’re going?” I asked.

  “I don’t know. I really don’t know. When I was further away from it, I felt like I knew better. But I don’t know.”

  Lu and I were with him all day. It wasn’t unpleasant. It was like all our times together. Rich. With laughter. Wit. And love.

  I know that I don’t really comprehend that he is dying, nor the impact of that. I sleep at his apartment with a feeling like he’s just in the hospital again and will be home soon.

  There is a dull, throbbing pain in my stomach and my heart.

  February 19

  Matt Krieger met Rick Walsh and his wife Angie at the hospital elevator. Rick’s dad, who was Gary’s older brother, had come too. Gary and his brother had not been close in recent years, but as soon as he walked in the room and saw Gary on the bed, he blurted out, “I love you.”

  “This is it,” Gary said. “It’s probably the last time we’ll ever see each other. It’s coming and I wanted to talk to you before I left. I love you and I’m going to miss you.”

  After the visit, outside Gary’s room, Rick fell into Matt’s arms and started crying. He saw his father was crying too; he had never seen his dad cry before.

  As Angie watched the family reunion, she was struck by how much Rick and Gary resembled each other. They were almost identical. Rick Walsh couldn’t get over how much Gary’s best friend Lu Chaikin resembled Gary’s mother. They were almost identical, he thought.r />
  That Night

  Lu Chaikin had always loved Gary, even when he was willful, self-centered, and sometimes defensive, because she saw the essence of Gary Walsh, and she saw that it was good. This essence explained why Gary had devoted his career to helping others accept and integrate themselves, and why his political ideology had never strayed far from the Flower Child credo that the world’s problems could be solved if people just cared for each other as much as they cared for themselves. In the year since his AIDS diagnosis, Lu had watched adversity transform her friend. The pretensions of personality had dropped away, layer by layer, until that altruistic essence was all that remained. Gary had forgotten the hurts of his Catholic childhood and the abuses he had suffered as a gay man. He now offered his friends unconditional love. People came away from conversations with Gary like pilgrims leaving a holy shrine. Lu wasn’t sure whether Gary knew the effect he was having on others. She wasn’t sure whether he understood that, finally, he had become totally himself and that he was very beautiful.

  After all the relatives and friends had left, Lu went back into Gary’s room and tried to express again what she had tried to tell Gary before. Gary smiled his mischievous grin and interrupted her.

  “I got it, I finally got it,” he said. “I am love and light, and I transform people by just being who I am.”

  Gary recited the words carefully, like a schoolchild who had struggled hard to master a difficult lesson. Lu broke down and started weeping.