Plague Years

by Ross A. Slotten, MD

  She listed all of my acquaintances she knew who appeared to be single. I thought of one physician friend my parents and I had run into during a neighborhood garden walk. He had a swaggering gait and spoke in a harsh Chicago accent. He stood with legs spread and arms folded—the picture of a macho man. It would have killed him if he thought strangers could tell he was gay. “Is he married?” my mother had asked later, not fooled for a minute.

  I swiveled in the chair to avoid her gaze, a hint of sweat moistening my forehead and my heart racing.

  “What about Doug?” she asked. “Will he ever get married?”

  Once more I was caught off guard and laughed. Among my friends and acquaintances he was one of the few straight ones, although his somewhat effeminate gestures—he had spidery arms and legs and walked, as a friend once observed, as if pulled forward by a string attached to his belly button—and the fact that I’d spent so much time with him in high school made my mother think otherwise. If she’d named anyone else, I would have confessed.

  “I would think so,” I said, thinking of the many sexual conquests he bragged about. “He’s something of a Casanova.”

  “You two have a special relationship,” she said, lowering her glasses to the tip of her nose.

  “We do not!” I protested. “He’s my best high school friend and that’s it.”

  “How often do you see him?” she challenged.

  Before I could answer, she launched into a tirade about his rude behavior when Tom and I celebrated the opening of our practice a year earlier. At the reception he ignored my mother, whom he disliked as much as she disliked him, and he left without saying good-bye. It wasn’t our supposed secret relationship that irked her but his insolence.

  “This is leading nowhere,” my father interrupted. “Let’s change the subject.”

  My father, who’d launched the perilous conversation, saved me in the end. Grateful, I retreated back into my shell. But without saying as much, we had settled for don’t-ask-don’t-tell. They knew that I was gay; I knew they knew; and they knew that I knew they knew. That was the last time we discussed my marriage prospects.

  But this uncomfortable confrontation had nothing to do with marriage. It was an awkward attempt to break through my shell, and I evaded my parents ineptly. Two of my brothers were already married. Whether that deflected my parents’ concern about me I don’t know, because we never talked about it. J. never would marry. As time passed, Gavin was gradually absorbed into my family, and his large family gradually absorbed me. That absorption occurred without drama, at least in our presence. We entertained everyone at Thanksgiving; he was invited to a seder at Passover—the only Jewish holiday we celebrated, albeit a bit irreverently since half the guests weren’t Jewish; I spent Christmas with one of his two sisters and their children. As time passed we were accepted on both sides as a couple, even if nobody discussed what we were—don’t-ask-don’t-tell wasn’t just a Slotten thing. That unwritten policy applied to many gay men and women of my generation.

  And no one in our families ever brought up that other taboo subject—AIDS.

  : 7 :

  The Saga of Stan S. (1986–88)

  I met Stan at a small dinner at Tom’s apartment in November 1983. I don’t remember the conversation because I was too self-conscious about my face, which bore the fading effects of chickenpox. My condition embarrassed me even though Stan was a former dermatologist. But we were at a party, and I was gay and vain.

  A few years earlier, in his mid-thirties, Stan had quit his medical practice to devote himself full time to his floral business. When I was in medical school, I lived close to his shop in Old Town. I’d pass him on the street, but as he set out the bins of flowers and plants, he ignored me. Evidently I wasn’t his type. An attractive man in his early forties, he had a wiry, muscular frame with bowed legs, large balding head, long thin nose that curved toward his mouth, which in profile made his face appear almost flat, neatly trimmed mustache, and introspective green eyes. He strode with purpose and conviction, reminding me of a cowboy who’d just dismounted his horse. Glassy eyed with admiration and jealousy, we young gay doctors marveled that he no longer needed to practice medicine. In an era when many physicians had catapulted into the economic ranks of the top 1%, that was quite an achievement. We weren’t jealous of his wealth; we were jealous of his life. He made just as much money pursuing his dream, which was less stressful than being a doctor. We were less courageous.

  During the next two years Gavin and I spent an increasing amount of time eating out with Stan in the neighborhood. Our banter ranged from medicine to politics, his latest boyfriend and, of course, AIDS. By 1985 he’d left his first store after a dispute with his business partner and opened up a new one on the Gold Coast, not far from where Art had lived. Stan didn’t think of himself as a florist but as an entrepreneur who sold flowers. A florist, he said mockingly, is a fussbudget with lisping speech and a mincing gait whom people ridiculed behind his back. He took great pains to buck that stereotype. I laughed at the image because I knew what he meant. I viewed myself as a physician who happened to be gay, not as a gay physician. In a climate of bigotry, it was an important distinction for me to make. At the time I believed that my profession and identity were mutually exclusive, the former taking precedence over the latter.

  Like any great businessperson, Stan had a keen eye for what sells. He made sure that the quality of his product and lavishness of display outclassed those of all those fussy florists he dissed. It worked. The political and social elite of Chicago flocked to his store. And if they demanded, as they often did, discounts and special services, he was not intimidated. As far as he was concerned, A.L. and E.K. could (I paraphrase him here more politely) shop somewhere else if they wanted a discount—but there was no better place for flowers. Each month the dollars piled up like an ever more fruitful harvest; much of the cash he stashed away in cabinets and cubbyholes in his apartment, out of sight of nosy tax collectors. When he showed me his secret hoard, I was shocked by his brazenness. I would never have cheated the IRS, even if I grumbled about taxes—but that’s why I’m a doctor and not a businessman.

  Stan was also a perfectionist, a trait I admired. Like a scientist or economist, he kept a daily calendar recording temperature, weather conditions, and money collected, and he compared year to year, month to month, and week to week, acquiring a feel for the market. A wilted flower or ragged display raised his ire so as to send his employees scurrying for cover. But he was generous and kind, paying his staff good wages and treating them as if they were members of his family, and they were fiercely loyal to him. Moreover, he pitched in, ringing up customers, putting together bouquets like an artist working from a palette, and hauling plants off delivery trucks with the ease of a stevedore.

  Stan once invited me to Kennicott’s, a market where he bought most of his flowers. He liked to go early, before other vendors had picked over the newly delivered stock from across the country and Europe. We drove to a grimy, industrial part of Chicago I’d never seen before. No doubt my father had come to a similar neighborhood to select his grocery’s produce and procure the freshest meats. Stan rejected anything less than perfect—and purveyors at Kennicott’s, in fear and out of great respect, kowtowed to him—which impressed me because so many flowers at other stores seemed flawed: a brown petal, a torn leaf, or buds that never bloomed. Taking only seconds to examine each specimen, he tossed aside flowers that I would have bought without a thought and pointed out their imperfections like a botanist. I had no idea how complicated it was to make a flower shop first rate. The experience affected my attitude toward my own practice. I too longed to be the best at what I did.

  Stan cultivated many friends and acquaintances within the city, nationally, and across the seas. Some were professional, such as his friendship with dermatologists at Northwestern, where he had trained. Some were business, as with the Kennicott brothers or art dealers he met at auction houses when he began to dabble in American I
mpressionist art, paying for paintings with wads of ten- and twenty-dollar bills exfiltrated from his apartment. Others were sexual. His sexual appetite was clearly voracious, and he had had hundreds of liaisons over the years. Occasionally he had relationships, but these had rarely lasted long. He guarded his privacy with even greater rigor than I did and had difficulty with intimacy and affection.

  When Gavin and I befriended him in 1983, Stan had hooked up with Rob, a handsome man fresh out of college with sandy hair, sparkling green eyes, a dimple on his chin, a muscular build, and (most important to Stan) the demeanor of a frat boy whom few would have suspected of being gay, for Stan was still in the closet with everyone except his closest friends. By that time Stan was terrified of AIDS; casual sex with numerous partners had become too risky. His only reason for sticking with the relationship, he claimed, was fear, not love. Before Rob he’d never had a steady lover. After two years they were fighting, though whenever we got together at our apartment, eating and talking at the blocklike dining table with its artful checkerboard pattern, there wasn’t the slightest hint of disaffection. They laughed, grabbed each other’s hand, and bumped shoulders like any couple who adored each other. Gavin and I laughed, grabbed each other’s hand, and bumped shoulders in loving sympathy.

  But in reality they never really got along, and their parting in 1987 was bitter. Unfortunately they lived next door to each other, a circumstance that drove Stan crazy. A creak at Rob’s door sent Stan to the peephole to spy. When he heard laughter and music through the walls, he suspected that Rob was trying to make him jealous. But why was Stan jealous, I wondered. Telling us that he had never enjoyed sleeping next to Rob after sex, he provided details about his dissatisfaction that were comical but made us blush. Cuddling bored him; awakening with a lover brought him no solace or comfort. Stan didn’t have an ounce of romance, which had frustrated Rob. Although he filled his store with roses for Valentine’s Day, Stan scoffed at presenting flowers to a lover for any occasion. Sex for him was like eating, a necessity of life. Once he cleared his plate, he was sated. In many ways Stan was more of a guy than a gay.

  Stan’s paranoia about AIDS grew slowly. In the spring of 1985, while we were guests at his tastefully decorated vacation home in Key West, he had an upper respiratory infection that became a chronic cough. He complained of being short of breath. I hadn’t brought my stethoscope and couldn’t listen to his chest, but it was evident that he was just congested. Already I’d seen a good number of young men who were short of breath, wasting away, and desperately ill. Stan, who appeared robust and kept pace with us as we attended afternoon tea dances, cruised the bars, and dined out without any difficulty, didn’t resemble them. Eventually his shortness of breath resolved, but he feared that any ailment heralded AIDS. He was one of the unfortunate guests in my apartment the day Art died in July of that year. A more frightened group of men could not have been assembled on a more inauspicious day.

  One by one, his past loves, friends, and acquaintances succumbed to AIDS. Scott, who owned a B&B in Key West, died ignominiously in a hospital, Stan said. Scott had developed dementia and incontinence, but his doctor never stopped testing and treating him, adding meaningless days to a tragically shortened life. When Stan visited Scott for the last time, Scott no longer recognized him, which crushed him. Stan wasn’t one to cry, but there were tears of anger in his eyes when he described Scott strapped to a bed in an adult diaper. I didn’t fault the doctor. To give up all hope in a young man seemed almost criminal in those early days of the epidemic. Sometimes we couldn’t believe what we were seeing: a man with a bright future cut down like a soldier by a bullet, as if his life had no purpose. At least a soldier could conceivably die for some greater cause.

  Another friend who died of AIDS was Christian, a Parisian. Stan had introduced us during a trip to Paris in June 1986. Handsome and loquacious, with a winning personality, Christian charmed us immediately. He dressed so well—shirts and pants that perfectly conformed to his slim body and stylish shoes—that we looked like country bumpkins in comparison. It was clear that he and Stan had once been more than friends.

  Gavin and I had traveled to Paris that summer to attend the second International Conference on AIDS, though it was a convenient excuse for visiting the most beautiful city in the world. Stan, who shunned all medical conferences now that he was no longer a practicing physician, didn’t attend but caught up with Christian and other acquaintances he hadn’t seen in a few years. The conference, which lasted three days and brought together twenty-eight hundred scientists and clinicians from all parts of the globe, generated few headlines because there wasn’t much to report. The biggest news was the revelation that the major mode of transmission of HIV in Haiti was heterosexual, proving that everyone, not just gay men, was at risk. The greatest disappointment was the pessimism that an effective vaccine could be developed in the foreseeable future. HIV didn’t behave like influenza, mumps, measles, smallpox, polio, or many other viruses that could be rendered harmless with antibodies; it defied neutralization. In April 1984 Margaret Heckler, the US secretary of health and human services, had announced the discovery of the cause of AIDS and raised hopes by predicting that there would be a vaccine against it within two years. She was wrong.

  I was still thrilled to be at the conference. At family practice conventions I was the outsider, the lone gay family doc wandering upstream past schools of straight people, genuine family physicians, practitioners who treated traditional families: newborn babies, rambunctious kids, sulking teenagers, newlyweds, pregnant women, struggling parents, and doting or dotty grandparents. My families were unconventional: two men or two women trying to make a life together in a hostile heterosexual world; or two gay men, one or both dying of AIDS; or the single gay guy looking for love, trying to dodge the plague.

  Now I was part of a larger community of like-minded people who were medical pioneers and shared a common mission, battling what would soon become one of the great epidemics of modern times. We weren’t in the spotlight yet, and expectations were low. That would change the following year, when the conference was held in Washington, DC. At the opening session, protestors would symbolically turn their backs on Vice President George H. W. Bush, who represented the Reagan administration. With what appeared to be regal indifference, Ronald Reagan rarely mentioned AIDS in addresses to the general public—a silence that diminished its urgency and seriousness. From that point on, the International Conferences on AIDS became magnets for activists and reporters who broadcast their increasingly angry protests as the death toll skyrocketed and politicians either turned a blind eye or denied the global catastrophe altogether. Thrust into that maelstrom, I knew once again that I’d found my calling.

  A year after our Paris trip, Stan came to the office for his annual checkup. Since he felt well and had no physical complaints, I expected to find nothing abnormal. But when I looked inside his mouth I was startled to see white patches, a sign of a seriously impaired immune system. I said nothing and continued, listening to his heart and lungs before pressing on his abdomen as I engaged him in casual conversation. Although I maintained as placid an expression as I could, my mind was in tumult. I must have masked my feelings well, because he sat unperturbed and asked no questions. But I was uncertain how to proceed.

  The world of AIDS medicine had been changing. In March 1987 the FDA approved AZT for the treatment of people with the worst form of the disease. That approval generated near hysteria in the gay community and among their doctors. It was the first bit of good news on AIDS. Although not touted as a cure, AZT promised to add precious months or years to a person’s life. Patients now flocked to my office for testing. But that’s not why Stan was here. Despite his great fear of AIDS and his near certainty that he’d been infected, he refused to know his HIV status. The onus of bringing up the subject fell on me.

  I could have been blunt: Stan, you have thrush, which means you probably have AIDS, and I want to prescribe AZT, but I can’t unless I
know for sure that you’re HIV positive. But Stan wasn’t the type of person who responded to orders, even from a well-meaning friend. And only on rare occasions was I blunt—for example, if a patient with appendicitis refused surgery or one having a heart attack refused hospitalization. But with less certain outcomes I settled for a softer approach. I nonchalantly offered to test him since I was ordering routine bloodwork anyway. If by some terrible chance he were positive, I said, we at least had AZT now.

  “Absolutely not!” he said. “If I ever get AIDS, I’m jumping out the window. I could never live like that.”

  I was taken aback. If I tried to persuade him to take the test, I’d have to explain why. If I explained why, he might literally jump out a window. Choosing to avoid an unpleasant confrontation with uncertain consequences, I reluctantly let the matter drop. Somewhat to my relief, this difficult conversation would have to wait until another day.

  A month later, at the end of August, Stan called me in a panic after noticing the yeast infection himself. I asked him to come to the office immediately. As he sat on the exam table like a nervous little boy, feet dangling without touching the footrest and hands rustling the paper with anxiety, I studied his throat carefully without showing signs of foreknowledge. When I withdrew the balsawood tongue depressor and placed the light source back on the wall, I hesitated. Despite having mulled over a thousand times what I’d say to him when the day of reckoning inevitably arrived, I was unprepared.

  There’s a good reason doctors are advised not to treat people they love: they can’t be objective. But AIDS wasn’t cancer or heart disease; it was a disease unique in history, for most of those who contracted it in the United States and Western Europe in the 1980s were gay men. In the West, AIDS and being gay were almost synonymous; cancer and heart disease were seen as having far less to do with one’s identity. As a result, the majority of caretakers of their fallen friends were gay men or lesbians. Although I could have referred Stan to a handful of other colleagues who now dealt with AIDS patients, Stan and I were enmeshed. Referring him elsewhere would have been tantamount to abandonment just when he needed me most. I felt duty bound to stick by him, no matter how awkward or heart wrenching.