“I like to use the analogy of the seed and the wind,” he says, “with the seed being HIV, and the wind being what’s changed in terms of social, economic, and personal conditions that have resulted in the conversion of what was probably a local pathogen into a worldwide pandemic. Because if you look at all the routes of transmission of HIV that we understand—blood-borne, sexual, and birth—the thing that has changed and has resulted in the enormous spread of HIV are largely events of the last twenty-five to forty years of human history.
“The most obvious one is the acceleration of international travel and the ability of people, and hence pathogens—like seeds—to travel from one place to another. Did you know, for example, that HIV was introduced in Japan through American-made Factor VIII, which is used for hemophiliacs? Even precious body fluids like blood and blood products travel all over the world now, whereas in the old days it was very local. If you had an uncle in the hospital who needed a transfusion, you called the family, and everybody came in and donated blood.
“And then there was what I can only call a diabolical alignment of forces that occurred just before HIV entered into the population of people who were injecting drugs.”
Jerry describes how a series of public health measures designed to reduce heroin use by making needles and syringes less readily available—paraphernalia laws that resulted in imprisonment if one was caught with needles and syringes—led to the sharing of needles, and to the development of “shooting galleries,” where you paid a dollar or two for a needle and syringe, injected the drug, and returned the paraphernalia, which was used by the next person, and then the next person.
But such sequential anonymous needle sharing was only one of the elements that led to the explosive spread of HIV, and Jerry lists others, among them the bathhouses used by gay men, the rise in anonymous sex that accompanied sexual liberation, and the detribalization and urbanization in developing nations following World War II that broke down traditional structures, and that resulted in social disruption—large populations of men, separate from women, migrating, becoming concentrated in urban areas, and contracting and transmitting disease.
Jerry says again what he has said before: “You can look at every route of transmission and you will see that what explains the transmission of each route has something to do with how we live as human beings more than it does with the biology of the organism.”
It is this understanding of disease that informs the way Jerry has approached his work as an AIDS doctor for the past two decades.* Like my other friends, however, he did not start out intending to become a doctor. At Columbia, he had been an undergraduate history and sociology major, and when he graduated in 1959, he entered Columbia’s graduate program in sociology.
“Somehow or other, I thought of sociology as being social activism— as something that would change society, which is what I wanted to do,” he says. “I spent some time at the Institute for Social Research, with Paul Lazarsfeld and others, and I quickly learned what sociology was, at least the way it was practiced there, and it was mostly statistical—market research and opinion polls and stuff like that, and I knew pretty soon that this wasn’t what I wanted.
“In truth, I was quite a confused and unhappy young man then. But I kept asking myself, ‘What can I do personally?’ So I spoke with some people and came to believe that I could be the kind of sociologist I’d wanted to be, on a one-to-one basis, if I were to become a doctor. And I guess that in some sense this is what my career in medicine has been—that medicine has allowed me to be the person I am. So I chose to go to medical school both as a personal decision, but also as a choice that meant being involved in social activism. I’m not the kind of person who would lead a political movement, especially one that was without a personal basis, so that from the first there was never any question but that I would care for people, and in so doing exercise my politics through medicine.”
Jerry talks with passion about the global politics of AIDS. He is outraged by the greed of drug companies, and by the restrictive policies of our own government and other Western nations regarding the dissemination of drugs, and he has his own ideas about what might be done, on an international level, to address the enormous needs of those suffering from AIDS in the developing world. He has begun writing and speaking about this, believing that while he is doing the work on an individual and personal basis, he should also be trying to figure out ways of affecting the larger forces that affect health care.
“So I guess I’m trying to figure out ways of influencing the larger systems—where power resides. I mean, think of it this way: what does a Jewish doctor who is white and whose parents lived through the Holocaust feel is our ethical responsibility to forty million people dying in Africa? And how do we begin to address that, politically, in the midst of our affluence? Now, I’ll let the politicians figure out the strategies, but I can give them some medical advice, and this is what I’ve begun to try to do.”
After Jerry dropped out of the graduate sociology program at Columbia, he enrolled in Columbia’s School of General Studies, and, while living at home in Brooklyn with his parents, took the pre-med courses he had never taken as an undergraduate. He was accepted into the New York University School of Medicine (Bellevue) and began his studies in the fall of 1960, at the same time that Phil and Rich, who had begun medical school there the year before, were starting on their second year.
Jerry shakes his head, as if bewildered to be looking back so many years. “Oh I was a very confused young man!” he says again, laughing. “So why did I become a doctor?” he asks. “It’s a good question, and I really don’t know the answer. But okay, we had this doctor in our family, Sidney Feldman, and he was our family doctor. He was a wonderful man, and he was a role model in our family of a gentle, caring person. He loved music—classical music…
“Yes.” Jerry pauses. “Yes,” he says again, to himself, and then: “I remember that he once told me that on his way to the hospital every day he used to drive down a certain street in Brooklyn because there was a beautiful maple tree on that street that was spectacular, and that it gave him great pleasure to drive down that street and look at it. So this man was not just a doctor, but he had a sense of beauty, and I was very taken by that. He was a special person in our family.
“Our family started out on the Lower East Side.* My father was very smart, and went to Cooper Union for a year, but he dropped out, and the story we heard was that he dropped out because he had to support the family. But in retrospect, I wonder. Because I know my father was severely depressed, and was hospitalized at Hillside Hospital—but not in Queens where it was when your brother Robert was first hospitalized.
“The original Hillside is in Hastings, at the top of a place called Hillside Park, and my father was hospitalized there for a year, a ten-minute walk from where Gail and I wound up living, in fact, when I was at Montefiore. It was a family secret we don’t know much about. Then, after he came out of the hospital, he became a window cleaner, and he worked as a window cleaner for the rest of his life. So he was limited not by his intellect, you see, but by his depression. And he used to say, ‘Every window is a pane to me,’ and he was a very gentle, loving man. But my mother was afraid of him, and she used to say, ‘Don’t say anything that will upset your father,’ because I think she lived in fear of upsetting him in a way that might bring back the depression.
“My mother worked as a bookkeeper until she married my father. They were both socialists, and I went to a school run by a labor Zionist organization where I learned Yiddish. We were involved with the Henry Street Settlement House on the Lower East Side—I took piano lessons there—and we went to summer camps, Kindervelt and Kindering, and I worked in both places as a waiter. All the waiters and busboys were children of parents who belonged to this socialist organization, and there were Puerto Rican kids and Polish kids and black kids in the summer camps. We were all in it together, and I loved it, I really loved it, and I guess I was introduced early on to
socialist ideals—to tolerance, and to racial tolerance especially.
“My father had a friend named Smitty, a black man who was the janitor for an Ebinger’s bakery on my father’s route, and when my father was on vacation, Smitty would wash the windows for him, and my father would reciprocate and do favors for Smitty. Smitty was the only person I ever remember, outside of family, who came to our home for dinner, and he came with his wife. This was in the 1940s. He was a lovely man, and he was my father’s best friend, and he lived in a black neighborhood in St. Albans.”
Jerry and I reminisce about our childhoods (“Sometimes,” he says at one point, “I think a lot of what I do and the way I react in certain situations comes down to the fact that I’m still just trying to please my unpleasable mother and get my depressed father’s attention”; I smile, tell him about Robert reminding me, recently, of the time our mother said, “Am I the only man around here?”)—about teachers and friends from Erasmus, about the Dodgers, about the street games we played as kids: punchball, stickball, boxball, box baseball, kickball, Chinese handball, Ringalevio, Johnny-on-the-pony, hit-the-penny, heels.
He talks, with enthusiasm, about some of the new programs he has recently initiated at Yale, through which he is trying to find effective ways to teach clinicians not just to provide care, but to prevent disease and the spread of disease. We don’t know how to do this in the clinical setting, he explains, and he has set up several pilot programs that work with primary-care physicians, teaching them how to integrate HIV prevention into clinical practice. It is hard to believe, he says, that this has not been done in an organized way before.
I attend one of these training sessions with Jerry—fifteen doctors sitting around and talking about how, step by step, to talk with patients so as to encourage adherence. Afterward, driving back to Jerry’s home, we talk more about his new programs, and about health-care policy in general—about his belief in the absolute need to invest more resources in prevention and public health measures than in biotechnology, in basic medicine rather than in heroic medicine, and in care rather than cure—and though I agree with him, I say something about being grateful, too, for the existence of biotechnology and heroic medicine, which, after all, saved my life. Though I know, I add at once, that most people do not get the kind of care I did.
“Right,” Jerry says. “You got the best, and the system didn’t screw up for you. And you had access to very good care, and not everybody does. You can’t expect everyone to have equal care all the time, of course, but people should have access.”
I don’t say anything for a while.
“Sure,” he says. He takes his eyes off the road for a second, smiles, then reaches across and puts his hand on my shoulder. “Sure, Neugie. Everyone’s entitled to the kind of care you received.”
12
A Safe Place
ALTHOUGH ARTHUR COMPLAINS CONSTANTLY about living in New York City (“Mountains and streams mean more to me than bridges and buildings,” he says), he is the only one of my four friends who is still there. Arthur often seems to me, in fact—as in his grumbling about New York—a quintessential New Yorker: eccentric, outspoken, and, with strangers as with friends, exceptionally direct, gregarious, and generous. He kibbitzes with virtually everyone he meets—the doormen and elevator operators in his building, waiters and delivery people; and when we go for walks—with his trim salt-and-pepper beard, a black beret aslant on his head, bright red sweatpants, and earphones clamped tight to the sides of his head—he looks like a wandering poet recently escaped from a Woody Allen movie. He says exactly what he thinks most of the time, mixing outrageously blunt comments, Brooklyn slang, and Yiddish expressions with sophisticated and learned speculations—and despite his leave-me-alone demeanor, he does not hesitate to act decisively in crises, large and small.
When, on one of our walks, a car skids to a stop in the middle of Eighth Avenue, near Columbus Circle, bringing five lanes of traffic to a horn-blaring halt, Arthur, without hesitating, walks straight into traffic, talks to the two women in the stalled car, its hazard lights now blinking, and begins to help. When a truck, coming around the corner, bears down on us—I’ve followed Arthur intothe street—Arthur turns and, like a traffic cop, puts up a hand to stop the truck. To me, in a smiling aside, even as he turns back to the two women: “I don’t want anyone killing my friend Neugie before he finishes his book.”
Arthur and his wife Paulette, senior partner in a New York City law firm, live in a two-bedroom apartment on Fifth Avenue, directly across from Central Park. The apartment is handsomely furnished—uncluttered, open, and airy, with bright light pouring in through high windows, and Arthur and I are sitting in his book-lined study, and talking about friendship. Arthur still maintains friendships with at least a half-dozen guys he has known since about the third grade of elementary school, and, like me, he remains close with many others with whom we went to Erasmus and Columbia.
“Maybe it’s because I need these friendships,” he says, “but who knows why I do? I’ll tell you this, though—it gives me great pleasure. The pleasure you get from reading books, I get from watching you, seeing how you evolved, seeing who you’ve become, seeing what you’re hoping to be. I get the same pleasure from Phil and from Jerry, and from all the guys I know. Because I love people—I love being with them and I always have. I’m fascinated by people, and getting to know people always satisfied a tremendous curiosity and craving. Even in high school, when I didn’t know I was honing any professional career, I enjoyed playing with and marrying myself to the different kinds of involvements I had with different people.
“So when I went into private practice and was doing fifty to sixty hours a week of individual therapy, I was a very happy guy. I’d be seeing, on any day, six or seven different types of people—maybe there were two or three overlaps, maybe three Jewish lawyers—and I was different with each person. I was talking about different things. I was learning about the ways different minds work, and I was engaged in trying to help people deal. I’d go in at eight, I’d leave at seven or seven-thirty at night, and it went like lightning. It was a gift, a no-brainer—like Willie Mays playing center field. I did what I loved, and I made a living doing what I would have done for pleasure.”
Sitting in his study—he has shown me, earlier, his shelves of books about Buddhism, and by and about the Dalai Lama (“These belief systems contain a much healthier approach to life, for me, than the systems I was raised in, and I resonate to them.”)—Arthur is less the outspoken, kibbitzing New Yorker, and more the relaxed, easygoing guy I’ve known for nearly half a century—more the man I imagine he is when he is working one-on-one with his patients, the guy I loved to take long walks with when we were teenagers, and to talk with about whatever came to mind: our friends and our family, our doubts and our dreams and our insecurities and our hopes.
He is, as ever, brilliant and canny (he graduated cum laude and Phi Beta Kappa from Columbia; was voted Most Likely to Succeed when we graduated, nearly thirteen hundred of us, from Erasmus), yet he is also thoughtful, direct, warm, and down-to-earth in his observations. When I ask a question, he rarely answers immediately, but will close his eyes, lean backward, and then, once he starts talking, pause frequently before he chooses words or phrases.
On this afternoon, however, he is the one who asks the questions.
“Okay,” he says. “So tell me something, Neugie. Where does medicine come in? Where does friendship fit in with medicine in this book of yours, and what do they have to do with our growing up in Brooklyn—with what we’ve been talking about?”
Although I have not begun the actual writing of the book, I say (it is early summer of 2000, a week after my return from Norway), what I have begun to see—to speculate about and believe, if provisionally—seems fairly basic, and it’s this: that the things people want from their doctors, and that they are, in recent years, getting less of, have much in common with what they want from friendship.
“Ah, you are a smart
fellow, Neugie,” he says. Then: “Why are you smart?” he asks. “Because I agree with you!”
We laugh, after which Arthur talks about his work as a psychologist, and although I am hearing his words, my mind is floating free, and I am thinking that this—being here with him and talking in the way we do—is one of the great and unexpected dividends from my surgery. The comfort and sheer pleasure these conversations bring, and the ways the five of us have become closer with one another—this has been an unexpected and precious gift.
Rich and Phil went to elementary school, high school, and medical school together, but lost touch through the years. Now, though, when Rich visits his children and their families in Denver, he spends time with Phil; and Phil is planning a trip to New York in September, when he, Jerry, Arthur, and I will hang out together. I say something about this—about how much more we’ve all been in touch with one another since my surgery, and about how much I’ve been enjoying our talks.
“It’s our thing,” Arthur says quickly. “Sure. I call it psychological davaning. It’s what we do, but this kind of Talmudic self-absorbed, self-reflective, looking-at-yourself-as-an-object, commenting-on-yourself stuff—this wasn’t, for example, Ronald Reagan’s thing. I was just reading a biography of this man—president twice, governor of California, head of a lot of organizations, well respected, yet I don’t think he did as much of this in a lifetime as we do in a day. And you know what? There are lots of very smart people who don’t davan the way we do, and his way of living is a reasonable way to live, and there’s only a certain percentage of us who will do what we do and get something from it and grow from it. I talk about what’s inside me. You talk about what’s inside you. These are my ideas. These are yours. This kind of self-revelation and self-reflection is different from going fishing together, but I’ll tell you this—it’s much more fun for me to do this than to go fishing, or even to a Knicks game.
Open Heart Page 23
