Five Quarts: A Personal and Natural History of Blood

by Bill Hayes

  Louder voices than mine have taken up the cause. Like many people, gay and straight alike, California State Assembly member Mark Leno finds the ongoing ban “blatantly discriminatory,” and he has fought to change it for more than four years. Assemblyman Leno told me that back in January 2000, when he was a member of the San Francisco Board of Supervisors, he gathered six men like himself—gay and HIV negative—alerted the media, and headed to the local branch of Blood Centers of the Pacific, the same facility I visited. On camera, standing on the blood bank’s steps along with its administrator, Leno called for a change in the policy.

  What do you call a protest without a confrontation? Un-newsworthy? Well, no, for this story held a twist: “Even the administrator herself agreed that it was a foolish policy,” Leno recalled. “She was frustrated, too. The ban shrinks the available donor pool when instead we need to expand it.” In the time since, the problem has only worsened. According to the American Red Cross and America’s Blood Centers, which together represent virtually all U.S. blood banks (including Blood Centers of the Pacific), many facilities across the country routinely have less than a day’s supply on hand and can’t meet hospital demand. While the need for blood steadily increases each year, due in large part to the rise in heart and cancer surgeries, organ transplants, and other complex procedures requiring large transfusions, blood donations are on a steady decline. About 95 percent of qualified blood donors do not give, according to a recent statistic.

  To bolster his argument, Leno and his staff did a rough analysis showing that if just one in twelve HIV-negative gay men in the United States donated regularly, their annual contribution would represent one-third of the blood needed every year by the nation’s hospitals. Joining forces with the Blood Centers of the Pacific and numerous medical experts, Leno helped lobby for a change in the FDA’s policy on gay donors, with the aim of shrinking the over-twenty-year abstinence period down to five years or, better yet, down to one. But the Red Cross fought hard against it. And when it came up for vote in September 2000, the FDA’s advisory panel voted seven to six to uphold the ban indefinitely. The years 2001, 2002, and 2003 passed without official debate on the issue. Over time the abstinence requirement, anchored in 1977, grows more punitive.

  Shortly after the first vote, I spoke with FDA medical officer Andrew Dayton, a nice guy who carefully defended the agency’s position. “We have a strong congressional and public mandate for zero error,” he explained. “If we change the policy and something happens, it’s a very big issue. We have to be ultraconservative.”

  Of course, I absolutely understood that great precautions must be taken with our blood supply, but what made sense in 1985 no longer does, given the triple HIV testing done on donated blood. To my mind, the ban perpetuates an early-AIDS-era myth that the blood of gay men is intrinsically different, dirty, or bad, a fallacy that harks back to the ancient belief that the blood contained the essence of a person. I recalled how this misconception had reared its ugly head early in the history of blood banking, during the early 1940s. Posters plastered across major East Coast cities called upon Americans to do their part for the war effort by donating blood—one powerful image showed a wounded GI using his rifle in an attempt to lift himself, with the headline “Your Blood Can Save Him”—except that there was some invisible fine print: Black blood wasn’t always welcome. In Red Cross blood drives carried out in the eleven months leading up to Pearl Harbor, all African Americans were expressly prohibited, as per a new policy established by the U.S. military. As journalist Douglas Starr explains in his book Blood: An Epic History of Medicine and Commerce (1998), the armed forces were segregated at the time and “its leaders thought it best for morale not to collect African American blood,” the assumption being that white soldiers would object to having “colored” blood put into their veins. The possibility that some black soldiers might not want Caucasian blood did not figure into this decision. As Starr continues, the policy was “liberalized” soon after December 7, 1941, when the Red Cross successfully lobbied the military to accept blood from black citizens, though it would be processed separately and labeled for use only in “Negroes.” Following the war, the institutionalized segregating of blood continued in many American hospitals, particularly in the South, into the late 1960s. Ignored throughout these turbulent times was the perspective of prominent scientists who, one after the other, declared that, in terms of race, blood is blood is blood. The practice was medically baseless.

  World War II blood-drive poster (Courtesy of the American Red Cross Museum. All rights reserved in all countries.)

  I launched none of this heavy history at Andrew Dayton during my talk with him because, I must admit, I was hoping that he might have a surprise for me, some stunning revelation to turn my frustration with the gay ban 180 degrees. Well, he did turn it a few degrees. If the FDA policy were changed, Dayton told me, the biggest danger would not be gay donors per se but, instead, the workers handling the blood. The problem would be human beings making human mistakes—the employees who accidentally release HIV-infected blood instead of disposing of it. This already happens, he acknowledged. About ten units of tainted blood products are mistakenly okayed for release in the United States every year, causing two or three HIV infections. “The problem is not the large blood banks,” Dayton said, “but smaller blood collection facilities, typically in hospitals, which don’t have the staff or automated equipment. They do it manually and have the highest risk of error.”

  When I asked what the FDA is doing to reduce such errors, Dayton admitted, “It’s not quite clear what direction to take.” He was unequivocal, however, on one point: “It’s important to keep high-risk donors from even giving a unit of blood.”

  The ban on gay donors conceivably could change, he conceded, if specific research were done. “What we’re lacking is seroprevalence rates, the frequency of HIV infections in men who haven’t had sex with another man for one year versus five years versus twenty-three.” He added, “I think that if we got results that said rates are virtually the same as the general population, then that would put an end to the question.” While the FDA has encouraged the Centers for Disease Control and the National Institutes of Health to organize such studies, Dayton noted, none is currently planned, nor is there funding to support them. Even if data were presented and the policy changed, the best-case scenario, he posited, would likely be a five-year deferral for gay men following their last sexual encounter, still far beyond what’s required for other groups. In my case, I would never qualify as a blood donor so long as I’m with Steve—and definitely not so long as he has AIDS. And neither of those will change. In the FDA’s eyes, Steve’s and my realities are the same: My blood’s as bad as his.

  When he and I first got together, friends were dying of Kaposi’s sarcoma, Pneumocystis carinii pneumonia, and toxoplasmosis, all of which can now be prevented or treated. And while protease inhibitors certainly extend lives, they contribute to new health problems—heart disease, lipodystrophy, and kidney or liver dysfunction. Overtaxed organs may finally just give out. Should Steve ever get that sick, I would give my life for him, by which, in practical terms, I mean I’d donate spare parts of my living body—a kidney or half a liver, whatever he needed. And I could—there is no restriction against healthy, HIV-negative, gay men donating organs for transplant. The final irony is, were I to die today, I could literally give Steve my heart, yet when it comes to blood—such a simple, plentiful gift—I am not allowed.

  TWELVE

  Blood Lust

  BLOOD LIVES IN NEAR-TOTAL DARKNESS. WITHIN THE body it travels along the many thousands of miles of vessels under the deep shade of bone, flesh, and skin. Except during its jaunt across the eyes. These red threads in the whites of the eyes aren’t veins but arteries, it dawns on me early one morning. So obvious once you think about it, the color’s the giveaway, the blood so bright because its cells have just taken a deep breath. In the same way that the eyes gradually adjust when you enter a dar
k room, the closer I study my reflection, the more blood I begin to see just under the skin’s surface.

  The hot water in the bathroom sink has once again fogged the mirror, and I give it another swipe of the hand. In the swath of me, I see the venous blood that purples the circles beneath my eyes, the blue earthworms of my temples. If I shut one tired eye—and oh, how the second wants to follow—I see the web of tiny capillaries on the outside of the lid. It’s as though I’ve showered in luminol, that blood-revealing solution used by crime scene investigators.

  Shaving, I try too hard not to cut myself, and I do. Though minor, it’s enough to make me flash on a scene that’s stuck in my head since my last reread of Bram Stoker’s Dracula: It’s a little past sunrise, a few days into Jonathan Harker’s visit to the count’s Transylvania castle, and the young man is shaving in his room. He fairly jumps out of his skin as a cold hand settles on his shoulder and Dracula utters, “Good morning,” though nowhere in the mirror can the count be seen. Jonathan’s nicked himself and the sight of blood running down his chin seems to quicken Dracula’s. Only the crucifix hanging at his throat keeps the count from pouncing. “Take care,” Dracula purrs before retreating. “Take care how you cut yourself. It is more dangerous than you think in this country.”

  Thinking about this exquisitely creepy scene makes me realize how differently it would play if it were set in the vampire world created by contemporary novelist Anne Rice. It wouldn’t take place during the daytime, for one thing, because Rice’s vampires can be injured or destroyed by sunlight. The crucifix, on the other hand, would cause no harm. Nor would the vampire be invisible in the mirror. In fact, since possessing great beauty is a prerequisite of being “turned”—so that the insult to God might be greater, as one vampire explains—Rice’s creations might even consider it cruel if denied their reflections for eternity. Also, unlike in Dracula, such a scene would never unfold from the mortal’s point of view. The reader would be placed inside the vampire’s head as he stalks the young man, lusting for his blood while also hating himself for the lust. Finally, while an Anne Rice vampire wouldn’t possess the power to slip through a keyhole, which is how Dracula magically snuck into Jonathan’s room, one could easily insinuate himself into a prospective victim’s bedroom in the more traditional way—through the art of seduction.

  As Rice’s first vampire book opens, for instance, a mortal enters a vampire’s room, rather than the reverse. The young man has been enticed there for something illicit, thrilling: a story. The vampire promises it will be a good one. By all rights, the young man should be terrified. After all, he is alone in a room with an intense stranger he just met in a bar, a predator driven to drink human blood. But instead, the boy is utterly intrigued by this elegant, articulate character, the vampire Louis.

  When I moved to San Francisco in 1985, the year the second book in the series came out, the fact that I hadn’t yet read the first earned me a joking reprimand from my new roommate, Rich: “Bad, bad homosexual!” as if I were a puppy who’d not been housebroken. He gave me a copy of Rice’s Interview with the Vampire along with another essential work I’d yet to read, Armistead Maupin’s Tales of the City, deeming this one of his cultural duties as a gay man who’d lived in the Castro for more than a decade. The two books were night-and-day versions of life in San Francisco. Tales was a delightful breeze, set in the 1970s, pre-AIDS, while the lush, dense, and tragic Interview, though it had been published in 1976, seemed to have been written expressly for San Francisco of the mid-1980s.

  The story of Interview, with its brilliantly simple setup, struck a chord with me at age twenty-four. It read like a cautionary tale about dating during an epidemic. In Louis you meet a supernally attractive, urbane man who says he just wants you to know him. He wants to know you. He invites you back to his place. You go, though you know this guy is dangerous. But he is so irresistible. You spend the night together, locked in a profound intimacy. Oh, the things you talk about. Well, he does most of the talking, but that’s okay. You get to stare into those amazing eyes, all the while knowing that if you’re not careful, if you let your guard down, he can infect you with what infects him.

  I could appreciate Daniel the interviewer’s risk-taking for the sake of an extraordinary story. But I also understood Louis’s motivation. Though the safety of all vampires lies in each one’s silence, for now he doesn’t care. A power beyond him has turned him into something he loathes, a monster, and he knows he can never change. He consents to the interview for a deeply human reason, to purge himself of his secrets. For myself, as a young man who had just horrified his parents by telling them I was gay and moving to San Francisco—“You might as well commit suicide” was my father’s bon voyage—I saw in Interview something instantly familiar. It was a vampire’s coming-out story.

  Early on in the book, Louis tells Daniel of the anxious final moments of his first night as a vampire. As dawn approached with its killing rays, he’d accompanied Lestat, the vampire who’d “made” him, to a room in New Orleans. Accommodations were spare, so the two men would have to bed together. “I begged Lestat to let me stay in the closet,” Louis recalls, but the elder bloodsucker just laughed, exclaiming, “Don’t you know what you are?” Lestat slid into the narrow coffin first, then pulled Louis down on top of him and shut the lid. The two would sleep face-to-face. The following evening Louis would awaken and take his final step in crossing over. He’d hunt for the first time and drink the blood of another man.

  THE DESIRE OF THE UNDEAD TO SUCK AND SWALLOW MOUTHFULS of liquid life has more to do with hunger than with thirst. The blood drive is the sex drive in the world of vampires. In ours, conversely, sex is driven by and dependent upon the blood, which works its own dramatic transformation on us humans. The change begins well before the clothes come off.

  Naturally, the impetus for arousal varies from person to person, but regardless of the accelerant—a look, a smell, a touch—the biology is consistent. As ardor takes hold and heartbeats quicken, the brain green-lights the circulatory system to rush blood to certain sexually pleasing places as well as others less obvious. Capillaries in your earlobes and those lining the interior of your nostrils, for instance, will fill with freshly oxygenated blood, causing the skin to plump and become extra sensitive. Likewise, the tiny vessels in the lips and tongue fatten and warm, literally raising the temperature of your kisses.

  Though it sure may feel like it, blood doesn’t increase in volume during arousal but gets redirected. In women, blood turns the pelvic area into a tropical zone, the labia and clitoris swelling, sensitivity building. The breasts, too, become fuller, the nipples stiffening from the blood-soaked spongy tissue within. Male nipples perform similarly, though, being of smaller stature generally, at a more modest scale. Of course, a grander transformation occurs in the groin, where arteries dilate to allow increased blood flow to the penis. Here, forming the length of the shaft, are three clustered cylinders that dangle like a soggy noodle when the penis is flaccid. (The urethra runs through the bottommost of these.) As these spongy tubes soak up blood, however, the organ bulges in all dimensions—on average, about two extra inches in length, more than half an inch in girth—raising the pressure within until it stands erect.

  That it is called an erection merits a wee digression: How very male and grandiose the word sounds to my ear, bringing to mind such awe-inspiring feats of engineering as hoisting an ancient obelisk or raising a modern skyscraper. In point of fact, achieving an erection requires less blood to the penis than one might imagine, though don’t tell this to your typical size-sensitive male. About two ounces—or, one-eightieth of a 150-pound man’s total blood volume—is all it takes to make him hard.

  Leonardo da Vinci

  From the classical age to the Renaissance, it was believed that an erection was due to a breath-like substance brewed in the liver, Natural Spirits, which inflated the penis as, to use a modern analogy, air does a tire. The brilliant Leonardo da Vinci, a visionary in conceiving of su
ch marvels as flying machines and diving gear, was also prescient in identifying the inner workings of male genitalia. More than a hundred years before blood’s role in erection was first correctly described in Western medical literature, Leonardo accurately summed it up in one of his illustrated notebooks. In 1477 he’d attended the public hanging of a criminal in Florence and, like others in the crowd, couldn’t help noticing that an erection was a consequence of this form of execution. During the subsequent dissection of the man’s body, Leonardo saw that it was in fact blood that had filled the organ, a result of the violent, downward jolt. (Incidentally, the phrase well hung, slang for “having large genitals,” does not derive from such observations. Rather, it dates back to an early-seventeenth-century description of a man’s jumbo ears, of all things, a usage that soon broadened to encompass any oversized body part. In any event, grammatically speaking, a noose and a fall lead to being well hanged, not well hung.) Following the dissection, Leonardo wrote, “If an adversary says wind caused this enlargement and hardness, as in a ball with which one plays, I say such wind gives neither weight nor density. Besides,” he added, referring now to the head of the phallus, “one sees that an erect penis has a red glans, which is the sign of the inflow of blood; and when it is not erect, this glans has a whitish surface.”