The New York Review of Books - USA (2020-09-24)

28 The New York Review

Plague Years:
A Doctor’s Journey
Through the AIDS Crisis
by Ross A. Slotten.
University of Chicago Press,
214 pp., $20.

In the summer of 1982, as a young on-
cologist at the University of California
at Los Angeles, I developed a hack-
ing cough, fever, and loss of appetite.
After a few weeks the symptoms did
not abate, and I contacted my internist,
who ordered a chest X- ray and blood
tests. The X- ray showed a patchy pneu-
monia, and the blood tests an inflamed
liver. I underwent more extensive test-
ing, but no diagnosis could be made. I
feared that I had AIDS.
The disorder had been reported
to the CDC a year earlier by a UCLA
colleague, Dr. Michael Gottlieb. He
described five previously healthy ho-
mosexual men who had contracted
pneumocystis pneumonia. (The pneu-
mocystis carinii microbe was known to
afflict severely malnourished children
and immune- compromised patients,
such as those recovering from organ
transplants.) Not long after Gott lieb’s
communication, a dermatologist at
New York University named Alvin
Friedman- Kien reported to the CDC
an “outbreak” among gay men in New
York City and California of Kaposi’s
sarcoma, a skin tumor that had been
observed endemically in Central Af-
rica and sporadically among elderly
Ashkenazi Jewish and Mediterranean
males. Clinicians began to diagnose
more and more gay men with aggres-
sive lymphoma—scores, then hundreds
of once healthy, mostly young patients
with cancers or infections and severely
impaired immune defenses.
Because I specialized in oncology
and had conducted research on viruses
targeting immune cells, I began to care
for AIDS patients. No one knew then
what caused these patients’ immune
deficiency. Although the disorder ap-
peared to be transmitted sexually, the
routes of contagion were not fully de-
fined. I did not believe myself to be at
risk other than in my role as a physician
at the bedside, but there I had ample
exposure to patients who coughed,
sweated, and even bled; early on, we
took scant precautions. I was terrified
that I would be the first doctor to con-
tract AIDS in the course of routine care.
My terror was based on what I had
seen the disorder do to these young
men. With impaired immune defenses,
virtually every organ system in the
body was attacked and devastated by
opportunistic microbes. Patients suffo-
cated from pneumocystis pneumonia.

They experienced explosive seizures

from fungal infections of the brain, un-

controllable diarrhea from parasitic in-

fections of the bowels, and unrelenting

fevers from tuberculosis- like organisms

typically carried by birds. Those with

Kaposi’s sarcoma developed bulbous

red- and- purple tumors that distorted

their faces, choked their throats, and

swelled their limbs. Lymphoma often

grew throughout the central nervous

system, causing paralysis. AIDS was a

horror.

After several weeks of further testing,

a diagnosis was finally made: I had con-

tracted a microbe called mycoplasma

that causes pneumonia and, rarely,

hepatitis. I was treated with antibiotics

and my condition slowly improved. But

as I returned to work caring for numer-

ous men, and soon some women, with

AIDS, the terror that I myself had the

disorder remained. I had nightmares

that mycoplasma was a misdiagnosis,

that I was writhing in agony in a bed on

our AIDS ward, next to the patients I

had seen on rounds.

In 1983 the cause of AIDS was iden-

tified as a retrovirus ultimately called

HIV, and soon thereafter tests were de-

veloped to accurately diagnose those

infected. I spent an anxious few days

waiting for my result, trying to block

from my mind the possibility that I car-

ried the virus and that my life would

end in a spiral of suffering. The HIV

test was negative. It took some time to

fully relinquish the haunting fear.

We are now in the midst of the Covid

pandemic, and Dr. Ross Slotten’s

memoir of caring for AIDS patients in

Chicago in the 1980s and 1990s, The

Plague Years, could not be more timely.

Slotten himself feared that he would

succumb to the condition; as a gay man

whose first long- term lover fell ill with

the disorder and could well have trans-

mitted it to him, he had a clear risk of

contracting HIV. In his book he artic-

ulates the struggle that all caregivers

experience to sustain emotional equi-

librium while discharging their duties,

all the more so today, with health care

workers putting themselves at risk of

COV- 2. In Boston alone there are more

than one thousand such workers—not

only doctors, but nurses and EMTs, as

well as transport, cleaning, and admin-

istrative staff—who have contracted

COV- 2.

Slotten studied classics at Stanford as

an undergraduate, and then medicine

at Northwestern, aiming to serve the

elderly, homeless, and indigent:

In 1984 I opened a practice with

Tom K., who’d completed his train-

ing in family medicine at St. Joe’s

three years before I did. Our office

was in a nondescript building... on

the north side of Chicago, on the

margins of two historic neighbor-

hoods: Old Town, once the haunt

of artists, writers, intellectuals,

and other eccentrics; and Cabrini

Green, one of the most notorious

housing projects in the nation,

overrun by gangs but also home to

hardworking people who had trou-

ble finding affordable housing be-

cause of their race and low income.

With the advent of AIDS, he and Tom

K., also a gay man, quickly became

leading figures in combatting the epi-

demic in Chicago, learning as they went

along: pneumocystis pneumonia was

optimally treated with trimethoprim-

sulfa, esophageal candidiasis with ke-

toconazole, and Kaposi’s sarcoma with

interferon- a or low doses of vinblastine,

a chemotherapy drug derived from the

periwinkle plant.

San Francisco and New York City

have long been cast as the epicenters

of the AIDS epidemic, but Slotten pro-

vides a history of another major urban

center coming to grips with an illness

that was unexpected and misunder-

stood. He vividly explores the pow-

erful pull of denial that enabled the

virus to spread within Chicago’s gay

was actually $200,000, four times the
median US household wealth that
year), she mentions that they already
had substantial assets from their fa-
ther’s estate, including shares in a com-
pany called Midland Associates and in
“other Trump entities.” Indeed, Mary
suggests that it was concern about pro-

tecting these shares that prompted her

and her brother to sue—and while they

were at it, to ask for more. She later

learned that Midland Associates was

set up by her grandfather in the 1960s

as a “quasi-legal, if not outright fraudu-

lent” way to transfer wealth to his chil-

dren. After disclosing this, she turns to

complaining about her “self-made” fa-

ther’s lack of access to the money: “His

boats and planes were gone; his Mus-

tang and Jaguar were gone.”

The sources of the Trump fortune

and the methods of preserving it—the

fact that Fred made a career of pillag-

ing the public coffers, and that he and

his children developed sneaky, possi-

bly illegal schemes to avoid contrib-

uting to those coffers—are not points

of serious reflection in the book. Mary

may have been a relative loser in the

narrow contest of inheritance, but, in

the family way, she has always been a

winner. Q

Lessons from the Worst Years of AIDS

Jerome Groopman

Genyphyr Novak /Alamy

An ACT UP activist being arrested during an AIDS demonstration outside the headquarters

of the American Medical Association, Chicago, April 1990