The American People, Volume 2

by Larry Kramer

  As our current tragedy unfolds, it is evident that we are dealing with a new disease. As I stood outside Walter Reed and squinted at the jackass general in his space cadet suit, with row upon row of ribbons representing his years of excellence as a faithful bureaucrat, the puzzle of these seemingly unrelated occurrences eluded me. Previously healthy homosexuals dying at an early age without evident alcoholism or consistent IV drug use. Death from a parasite that crawls around inside the lungs of rats, guinea pigs, and men. I was hearing on the grapevine that not-dissimilar occurrences were appearing in southwestern Africa.

  I went by the Officers’ Club to cash a check. It had the musty smell of everything to do with today’s Army. Stale food smells and crumbling remains of a time when America cared for its army, before Vietnam. Being an officer in the United States Army is now neither an honor nor a privilege. The enlisted men have about bottomed out and a significant number of volunteers for our armed forces are certifiably mentally retarded. Shoving the cash in my pocket, I paused to look at the photographs in the entrance from a time of greater splendor. There sat Walter Reed himself, staring back with his baleful eyes. “What would you do, young Walter?” I wondered aloud to the amazement of two women officers. Poor Walter, brilliant scientist, perhaps a thief of the discoveries of others, died as a result of attempting to second-guess his own appendix, which ruptured while he temporized and killed him horribly with peritonitis.

  Then an idea hit me. Shades of Walter Reed! I should start a collection! Get docs to establish a central repository of information about this disease of young men. JOD certainly wasn’t providing that service, nor was NEJS. And certainly not at our labs at NITS. We knew fuck-all about this. COD had never even bothered to inform us in the first place. And what better place to affiliate with than the Armed Forces Institute of Pathology, where the records of decades and specimen remains of thousands of young men who died untimely deaths were kept. Surely the Army would want to keep tabs on this new disease. Surely the Navy would be interested too. What a great idea! What we might learn! Mother would appreciate it.

  The pathology of humans is a curious science. Recognizing that diseases are the result of changes in tissues was a major discovery that took most of human history. In the briefest of slivers of geological time, it became apparent that human tissue, as a part of human beings, become diseased from causes. In the 1850s a towering genius named Rudolf Virchow proposed the theory that all cells come from other cells, but more important, that all diseases have causes. This was the limit of medical rationalism. Thanks to autopsy and pathological methods laid out by Virchow and perfected by several generations of morbid anatomists, it became possible for even the least gifted healing artist to dissect out the cause of death from corpses who’d had far more time on the far side of the mortal veil than one would imagine possible.

  The autopsy ritual is an ancient one. As a visiting student traveling about, I had first seen it in the autopsy theater in ancient Krakow unfolding before tiers of onlookers, the pale yellow light streaming down from the skylight, the surgeons intent on the waxy remains of an aged crone, long dead of cancer. The sounds of the Virchow chisel being struck to open the cranium brought back the image of the soft-boiled egg I decapitated in the Hotel Francuski for breakfast. The autopsy room in the famous General Hospital in Malmo, Sweden, where 70 percent of the deaths of the city’s inhabitants are autopsied and the autopsy rooms are as clean and modern as the operating room for the living patients, lives with me as well. My journeys taught me this first principle of the science of pathology: Death has a Cause and the Cause can be found by examining the remains of the person, first by eye, then by knife, finally by probing with the extension of sight, the microscope.

  I am always amazed by autopsies. Amazed at the intricacies of the body, the subtle or grotesque changes that transform and compromise the organs, the surprises brought by careful dissection, the finger probing the windpipe or the unfolding of the gut to reveal the ghastly cancer perforating the tubes. My repugnance at death is overcome by the miracle of the human body and the mystery that causes death.

  After the sexual liberation of the 1960s homosexuals evidently became more open in their promiscuity and it accelerated both in degree and in the nature of the acts. I plow through some of the reports and I learn about homosexuals who have a thousand sexual contacts a year and who have all the “classic” venereal diseases. The details are tragic. Intimacy as the result of compulsion and degradation instead of affection seems to mark many of these homosexual characters. If gay lifestyles really do include all the events I read about in the medical journals, it is no surprise that a new disease has appeared. Immune exhaustion seems far more likely as an explanation of what is causing this UC.

  Immunology has been as a fog to me. It all seems so ill defined. The body’s domination of evil entities such as bacteria or foreign proteins should occur with transfers of energy. Immunologists, though, do not have this simplistic view of the matter. They seem to believe that any problem can be solved with an antibody, a “receptor,” and a “model” to study the problem. That they would have us believe we live in such an uncomplicated relationship with all the forces that would or could destroy us in no way has cleared this fog.

  A lot has happened in the field of immunology. A bewildering variety of cell types have been identified in humans as well as in animals. Blood or immune cells can now be fractionated by dozens of exotic methods. Lymphocytes can be grown in the laboratory, and to some extent Martin Arrowsmith’s dream of artificially making antibodies has come true. My intransigence in keeping up with immunology had been leaving me feeling superannuated, or like I was the new kid in the neighborhood. Well, in this case, that’s not a bad thing. There should never be such a thing as certainty. Pathology had taught me that.

  Jerry Omicidio is an immunologist.

  The Old General to whom I presented my Great New Idea had his latest joke ready for me, about the queer congressman who bought the new car: “The first thing he did was blow its horn.” Suddenly I knew what would happen. The Ruester administration would clam up about the problem of the “Gay Plague.” It would be relegated to the dirty jokes told by Americans who would never understand. I knew then that would happen.

  It seems there is a patient at Franeeda Navy who is exceptionally ill. The patient was known to be effeminate and has a peculiar set of symptoms. He is demented with strange mental lapses, has constant diarrhea, and has suddenly gone blind. Blind? The ophthalmologist was brought in for a consult. The guy had wispy little cotton-like stuff in his eyes and was blind as a stump. Yes, he does have some funny bruises on his legs, but they may be due to a vitamin deficiency since the guy has had the shits for months. Yes, it does seem like the guy won’t make it, and no, they didn’t call across the street to NITS for a consultation since we are civilians over here. The guy can’t be queer, though, because he swore that he wasn’t when he enlisted in the United States Navy, and the lawyer with the judge advocate (called in by the Navy attending physician) asked him right out if he’s queer. The patient denies ever being homosexual. This is a secret more likely than most to be carried to the grave. Blind! Oh shit, the queers are going blind and crazy!

  On Monday I call the Navy. The National Naval Medical Center is a national tragedy. The military has two major health centers in Washington, one for the Army at Walter Reed, the other for the Navy at Franeeda. The Navy hospital is supposed to serve the catchment of most of the mid-Atlantic region; in addition, it has the responsibility of providing health care and hospitalization for the president and other functionaries of the U.S. and foreign governments. The Navy is ill suited to care for such eminent and highly visible patients. The hospital has recently been rocked by a major scandal concerning a surgeon who was both physically and professionally incapable of performing the heart surgery he insisted on doing. It has been under the direction of a series of incompetent admirals drawn from the ranks of the Navy’s Medical Service Corps, who have, amo
ng other things, neglected to determine the credentials of physicians practicing in the hospital. A “new” hospital had to be remodeled out of an old annex because it was discovered that the “Tower” on the old hospital was a firetrap. A succession of presidents have been victims of hasty and slipshod health care provided by the Navy here. The lifesaving treatment that Peter Ruester will receive at George Washington University Hospital after the assassination attempt by a demented sexual pervert armed with explosive bullets would have been more problematic if he had been taken to the Navy. He’d probably be (fortunately) dead.

  My friend and a most respected fellow pathologist, Jay Truslove, who is at Navy, was dealing with the case of the blind Navy sailor. The kid had been taken to the intensive care unit and should make it into the autopsy suite within the week. Nobody is certain whether this man has anything in common with the California or New York cases, but he has had a strange history of skin lesions that “look” like Kaposi’s and, because of that stupid British asshole Nelson Golly, were still being called nimroids. In addition to being blind from cytomegalovirus retinitis, he has been out of his head for two months and now has an interstitial pneumonia. Fascinating.

  On Wednesday Truslove calls. The guy died at six in the morning and the autopsy will be at ten or so. He’d like me to help him and suggested, “You should even bring your boss so he can see what he’s going to be up against.” I pour some preservatives for electron microscopy and light microscopy and leave with my box of dissection tools. Jerry comes with me along with his assistant, one Daniel Jerusalem. (The autopsy room at Navy is in somewhat better order than the one at Walter Reed, where there was blood on the doorknob the last time I was in it.) Truslove is ready to start when we get there. The corpse is on the gurney covered by sheets. I quickly change into the disposable paper scrub suit in the locker room. The technician has moved the gurney alongside the autopsy table. The body is still covered.

  When the sheets are drawn back I get my first look at the specter that will haunt me for the rest of my life. My first inside look at UC. Jerry and Daniel are riveted as well. The body is grotesque. He was twenty-eight years old and about five feet ten. He is so wasted he looks like one of the corpses from Belsen or Auschwitz. His cheeks are so sunken that his face looks like a skull. The eyes, still open, stare into a void. The wasted body with the points of the pelvis like crags above the shrunken abdomen looks more horrible than the hundreds of cancer patients I have seen on autopsy tables. His hair has the scruffy look of chronic disease. The genitals lie like an afterthought attached to the distorted pelvis. His circumcised penis has a large purple spot on the glans, and there are other purple blotches on his knees, lower legs, and ankles. There are white flecks at the corners of his mouth, as though he’d been eating chalk as he died.

  Jay seems as fascinated as I. The kid had been a clerk-typist at the Washington Navy Yard. Gossip says that he was a raging faggot who provided blow jobs or his behind to any and all. No doubt he had officially denied being homosexual since it would compromise his care, cause the revoking of his medical benefits, not to mention a dishonorable discharge.

  The autopsy proceeded. I was content to watch as Jay made the Y-shaped cuts across the chest and down to the pubis. I was getting my vials and dissecting dishes ready when “Jesus Christ! Look at this!” broke into my preparation. Jay had opened the chest, and the lungs were sodden masses. The kid, Paul, had been a smoker, so the color was a mottled red and black, but the normally air-filled lungs were rock-hard solid. I took several pieces from both lungs for my dissecting dishes. Some I cut into tiny cubes for electron microscopy. The larger pieces I would look at later with the light microscope at NITS.

  The organs came and went, liver, kidneys, heart, adrenals, pancreas, finally testicles. Testicles are difficult to dissect: when the capsule-like membrane of the testicle is cut, the tubules where the sperm is made unravel like yarn from a skein. By the time we were finished and Paul was ready to go to the undertaker I had assembled some forty vials of tissues in addition to samples for the Navy’s autopsy report identifying some cause of death. From the anatomical part of the autopsy we knew Paul had died from a whole string of diseases. In short, Paul was a train wreck. Every single one of his organs was malformed beyond belief. Even Jerry was shaking his head unbelievingly. After a while he and Daniel took off.

  It was nearly four when we finished. Jesus! What a mess!

  In the locker room Jay and I are alone. He is talking animatedly. I toss my old shoes into the trash and strip off to my skivvies. My locker is next to his and I become aware of a presence in the cramped quarters. He is looking me in the eyes and suddenly an amazing thing happens. He expands! He puffs up and seems to be twice as big as he was a few seconds ago. He stands before me with flashing eyes and flexed chest. I am startled to numbness. I look away to avoid his gaze. I catch a glimpse of his crotch and realize the guy has a hard-on. Jay is coming on to me! Jay is queer! What does he want to do with me here in the locker room of the Navy hospital morgue?

  I panic. I mumble incoherently and grab my clothes from the locker. I dress as fast as I can while avoiding his eyes. Sensing my alarm, he seems to shrug and goes into the cramped toilet-shower next door. The shower starts just as I finish dressing. I step to the door and yell more loudly than necessary, “I’ll call you as soon as I know anything, Jay.” He replies indistinctly and I leave, marveling at the entire experience.

  Setting up the specimens for processing takes until after nine. Still shaken, I walk home in the dark.

  Two days later I get a call from the Old General at Walter Reed. He is an Army general of little distinction other than getting a medical degree from a Corn Belt land-grant college while in an ROTC program. The Army has been good to him, giving him a job, an identity, and now, as a final reward, the directorship that will allow him to retire to the private sector and be paid five times what he’s worth, consulting to impressed clients. Sadly, malpractice lawyers have not discovered the vulnerability of aging, so this bozo will get away with the myth of his competency.

  He wastes no time. He plunges right in.

  “Hell no, Dr. Doctor, hell no! We don’t want people … no, we don’t want the Congress to think we got queers in the military! I don’t want to see yours or anyone else’s report of what’s happening.”

  And that was the end of that.

  Except that the person who puts the kibosh on any part of my Great Idea, I am to discover, is Jerry Omicidio. Why in the world would he care?

  Garrie Nasturtium of Ruester’s staff actually looks me up and pulls me aside. “Are you crazy? You expect taxpayer money to pay for a study of faggots? You’re as bad as that nun pestering Dye about placentas.”

  And I say, “Garrie, all these centuries of fellows fucking each other, and no one’s so much as looked up a rectum or followed a seminal vesicle. In the end it’s going to cost much less, starting now, and not waiting for what’s undoubtedly going to happen. There are important mechanisms, engines, which are working overtime to do something that’s killing so many.”

  Then I threw in this kicker. “This applies to women as well. What happens inside her organs or indeed her vagina and rectum when this shit gets into them? No one’s ever gone in to look there, either.” Garrie almost choked to death.

  Dr. Jerrold Omicidio, my titular boss, was not pleased to hear about this conversation either.

  INT. FRED’S BEDROOM. NIGHT.

  Fred and Felix have been making love.

  FELIX: If I had it, would you leave me?

  FRED: You already asked me that. No, I would not leave you.

  FELIX: How can you be so certain?

  FRED: I just know. My mother was a social worker. I’m not programmed any other way.

  FELIX: I have something to tell you.

  FRED: You’re finally pregnant.

  FELIX: Well, I was married once.

  FRED: You never told me that.

  FELIX: I thought I was programmed t
o be straight. She said I’d been unfair to her, which I had been. I have a son. She won’t let me see him.

  FRED: You can’t see your own son? But didn’t you fight? That means you’re ashamed. So he will be, too.

  FELIX: That’s why I didn’t tell you! Who says I didn’t fight? Fred—what happens to people who can’t be as strong as you want them to be?

  FRED: Felix, weakness scares the shit out of me. My father was weak and I’m afraid I’ll be like him. His life didn’t stand for anything and then it was over. So I fight. Constantly. And if I can do it, I can’t understand why everybody else can’t do it, too. Okay?

  FELIX: Okay.

  Felix gets up and goes out of the room.

  FRED: Where are you going?

  Fred looks in various parts of the apartment.

  FRED (contd): Hey, you okay? I didn’t mean anything … Felix? I’m really scared of lots of things. Really. Heights! I never told you. I’m terrified of heights. I can’t go above the third floor or I get really scared …

  INT. FRED’S BATHROOM.

  He finds Felix sitting on the floor naked, in a pool of his shit and piss and vomit, his clothes having been ripped off and tossed to the side. He looks terrified. Fred immediately grabs towels and pulls him up from the floor and they hold each other tightly. Then Felix shows him the purple lesion on his foot.

  INT. EMMA BROOKNER’S OFFICE. DAY.

  Emma is confronting Fred. Felix can be seen in the adjoining room standing naked.

  EMMA: You’ve taken a lover!

  FRED: What are we supposed to do—be with nobody ever?! Well, it’s not as easy as you might think! Oh, Emma, I’m sorry.

  EMMA: Don’t be. Polio was a virus, too. I caught it three months before the Salk vaccine was announced. Nobody gets polio anymore. (Looking toward Felix:) I’ll put him on some chemo. A couple of chemos. My own recipe. We’ll hit it hard.