THENEWYORKER,JULY27, 2020 45
I have gotten sicker, I keep adding tur-
quoise, so now I am basically a walking
Sioux. But I am still here.’’
By any measure, that’s a surprise, be-
cause about two and a half years ago
Kramer started to die—not from AIDS
but from end-stage liver disease caused
by a long and debilitating bout of hep-
atitis B. Hepatitis, like H.I.V., is a viral
infection that is often transmitted
through the exchange of bodily fluids.
Not long before I arrived in Connecti-
cut, doctors had told Kramer that his
liver could not function for more than
six months; the level of hepatitis B in
his blood, which for infected but health-
ier people is measured in the thousands,
was close to the billions. But, after some
months on an experimental drug called
adefovir, which blocks the replication
of the hepatitis virus in the body, Kramer
had improved greatly. When I was with
him, he was waiting—a beeper clipped
to his overalls, fistfuls of pills by his
bedside, and a charter plane on call—
to be summoned to the University of
Pittsburgh Medical Center for a liver
transplant, a very risky operation that
Dr. John Fung, the chief of transplant
surgery there, had agreed to perform.
Once Kramer got the call, he would
have two hours to appear in the oper-
ating room. (After one false alarm, and
the travel uncertainties caused by Sep-tember 11th, Kramer moved to Pitts-
burgh, and rented an apartment five
minutes from the hospital.)U
ntil recently, H.I.V. infection would
have ruled out any hope of receiving
a liver transplant; the waiting lists are long
and the hope of success limited. Yet Fung,
the forty-five-year-old surgeon who re-
placed the legendary Thomas Starzl as
the chief of Pittsburgh’s highly aggres-
sive transplant unit, persisted. Nearly two
dozen H.I.V.-positive patients had had
the operation by the end of last year.
Three have died; the rest are in various
stages of recovery. Nonetheless, Kramer
would be by far the oldest such patient to
attempt the complicated surgery. There
were also some touchy ethical issues to
consider. Each year, more than twenty
thousand people in America die while
on waiting lists for organ transplants.
Many people wondered why a relatively
elderly person with H.I.V. disease was
the right kind of candidate. (“There are
a lot of crappy choices you have to make
in life,’’ Arthur Caplan, the director of
the Center for Bioethics at the Univer-
sity of Pennsylvania, told me. “Celebrity
livers are among the worst. I am not say-
ing he couldn’t benefit; I just think other
people could benefit more.”)
When I met with Fung in Pitts-
burgh, he dismissed such concerns. “This
isn’t about celebrity; I didn’t even know
who Larry Kramer was when he walked
in here,” he told me. “Kramer has been
on a waiting list for about a year.’’ Fung
is a boyish, bespectacled man who spends
almost every waking hour in the oper-
ating theatre. “People with H.I.V. dis-
ease can live for many years after this
surgery. That’s my bottom line. To tell
somebody he cannot be treated because
he has a certain virus is not how Amer-
ican medicine works.”
Two years ago, doctors told Kramer
that he was too fragile to survive even
anesthesia, let alone surgery. His weight
had fallen from more than a hundred
and sixty pounds to less than a hun-
dred and thirty. His stomach was often
grotesquely distended from fluid that
had accumulated there. Judy Falloon,
who works with Fauci at the N.I.H.,
recommended gambling on adefovir as
a last chance to bring his virus under
control. (At higher doses, it had proved
toxic for many AIDS patients.) KramerWhat I want to say is
poverty’s not quaint when it’s your house you can’t escape from.
Decay’s not beautiful to the decayed.
What’s beauty?
Lipstick on a penis.
A kiss on a running sore.
A reptile stiletto that could puncture a heart.
A brick through the windshield that means I love you.
A hurt that bangs on the door.
Look, I hate to break this to you, but this isn’t Venice or Buenos Aires.
This is San Antonio.
That mirror isn’t a yard sale.
It’s a fire. And these are remnants
of what could be carried out and saved.
The pearls? I bought them at the Winn’s.
My mink? Genuine acrylic.
Thank God this isn’t Berlin.
Another drink?
Bartender, another bottle, but—
¡Ay caray! and oh dear!
The pretty blond boy is no longer serving us.
To the death camps! To the death camps!
How rude! How vulgar!
Drink up, honey. I’ve got money.
Doesn’t he know who we are?
Que vivan los de abajo de los de abajo,
los de rienda suelta, the witches, the women,
the dangerous, the queer.
Que vivan las perras.
“Que me sirvan otro trago... ”
I know a bar where they’ll buy us drinks
if I wear my skirt on my head and you come in wearing nothing
but my black brassiere.—Sandra Cisneros