Tell Me I'm Okay

by David Bradford

  ‘But, I’m sure they weren’t there before I had sex.’

  ‘That’s only because you never looked closely before. They were there all the time, for sure.’

  ‘Well, I don’t like them. Can you get rid of them?’

  ‘No, not without causing scars. Besides, we don’t need to. They’re part of you, just a variation on normal.’

  ‘All guys don’t have them though, do they?’

  ‘No, that’s true, but they are very common. They stand out more in guys like you, from a Mediterranean background.’

  ‘So, I’m stuck with them, then?’

  ‘Look, no-one will ever notice – only you, because you’re conscious of them.’

  ‘You sure? It’s not like syphilis or something?’

  ‘I’m sure. I wonder Mario, would you like to help me.’

  ‘How, Doc?’

  ‘How would you feel about me taking a photo of those PPPs?’

  ‘What would you want to do that for?’

  ‘Well, lots of doctors are clueless about these things, and lots of young men like you get worried unnecessarily. I often give lectures to doctors, and a picture of your papules would be great in showing them how different they are from warts. Yours are a particularly good example.’

  ‘Particularly good, hey Doc?’

  ‘Yes, definitely.’

  ‘OK, I’ll do it for you.’

  I’ve showed my slide of Mario’s PPPs in countless lectures over the years. Mario’s future sex life was never inhibited by his PPPs. He visited me regularly for check-ups and we became friends. He was always keen to know how his picture was received at GP lectures. When I moved to Cairns, he rang me at regular intervals to check that I was still using his slide; he even dropped in to see me there once when he was on holiday in Far North Queensland.

  Herpes

  Before HIV came along, genital herpes was the biggest clinical problem we faced. The infection wasn’t life-threatening, but ‘herpes was forever’.23 Frequent, recurrent attacks of herpes could be troublesome, and a first attack was often painful and disabling.

  One morning, I had just finished seeing a patient and was about to call in the next, when our new doctor, Nilofar Rizvi, put her head around the door. ‘Sorry to interrupt David, but I thought I should tell you that I’m about to call an ambulance to take a young woman to hospital.’

  ‘Oh dear, what’s wrong, Nilofar,’ I asked

  ‘The poor lass is only seventeen and has the worst attack of primary genital herpes I’ve ever seen. She’s feverish, in lots of pain and she can’t pee. She needs sedation and strong analgesics. I’ve phoned the Casualty Department at the Royal Women’s Hospital. Her mother’s here; she’ll go with her.’

  I had fought a protracted battle with the HCV to obtain funding for a full-time female doctor position. Up to that time, we had managed with part-time doctors for the women’s clinic. Nilofar had been a senior registrar in gynaecology and obstetrics at a teaching hospital, but had two small boys, so had been looking for a nine-to-five position in a similar field. Fortuitously, she had approached me at the same time the HCV had provided funding. There had been no other applicants, and I’d been grateful for Nilofar’s interest. She was a gentle soul. In the two weeks she’d been with us, I had developed great confidence in her kindly handling of patients and in her knowledge of women’s health.

  ‘Have you taken a swab for viral culture?’

  ‘Yes, but I haven’t any doubt about the diagnosis.’

  ‘I certainly don’t mean to doubt your diagnosis; it’s just that it’s nice for patients to know if it’s Type 1 or Type 2.24 Type 1 doesn’t tend to cause troublesome recurrent attacks in the genital region like Type 2 often does.’

  ‘I didn’t know that, but I’m sure this was Type 2. The patient’s too distressed to give a good sexual history, but she says her boyfriend is waiting in the male clinic. Her name’s Lenore and his name’s Tony; maybe you ought to see him.’

  ‘I’ll do that. Thanks for arranging the hospital admission, Nilofar.’ At that time, we knew about acyclovir, a potent antiviral drug, not curative, but effective against the herpes virus when in an active phase. The drug was not yet available in Australia, so we had no specific treatment. In women, a severe primary attack of genital herpes often necessitated a hospital admission.

  I took a look into the male waiting room. I spotted a nervous youngster in the crowd who looked as though he wasn’t long out of school. I called, ‘Tony!’ As expected, the young man jumped up, looking terrified, much like a startled rabbit. When I took him into the consulting room he was literally trembling.

  ‘Sit down, Tony. Don’t be afraid. I’m not going to bite you!’

  ‘No, Doctor. Thank you.’

  ‘I think I know why you’re here. Is your girlfriend’s name, Lenore?’ ‘Yes, yes, Doctor. Is she all right?’

  ‘The lady doctor has just seen her and she’s arranging for her to have a few days in hospital, so they can make her more comfortable. But she will be all right.’

  ‘Hospital! Her old man will kill me, Doc!’

  He put his head in his hands and started to cry. I put my hand on his shoulder and waited for him to recover.

  ‘Now, Tony, be a good lad and tell me the story.’

  ‘Well, Lenore has been my girlfriend for a year. I really love her, and she loves me. Just lately … Well, lately, we have begun to do a few things … fool around. But, honestly, we’ve never gone like, all the way. Truly!’

  ‘I believe you, mate. But tell me, what have you done?’

  ‘Well … she’s let me feel her up. You know, her breasts and, well a bit of fingering. You understand?’

  ‘Yes.’

  ‘A week ago, we were on our own, at my place. And, she sucked me, and then I went down on her, and I actually made her come. But like I said, that’s all we did. No real sex, honestly, Doc.’

  I waited, without comment. He continued, with an occasional sniffle. ‘And then, a couple of days ago she phoned me and told me she was really sore down there. And now it’s got worse and she had to tell her mum. Her mum brought her along here, and made me come too.’

  ‘Well, that was very sensible of her mother. Tell me Tony, have you noticed anything wrong?

  ‘No, not a thing, Doctor. I’m fine.’

  ‘And, have you ever had sex with anyone else?’

  ‘Never, Doctor. I swear!’

  ‘And, do you get cold sores on your lips?’

  ‘Yes, Doctor, I’ve had cold sore attacks all my life. But, I’m sure I haven’t had cold sores for at least a year, not since the last bad cold I got.’

  ‘Well, Tony, you and Lenore are just unlucky. Even though you couldn’t see or feel any cold sores last week, when you went down on her, you must have been producing just enough cold sore virus on your lips to infect her on the genitals.’

  ‘So girls can get cold sores on their fannies? Sorry, genitals, Doctor?’

  ‘Yes, that’s what genital herpes is – cold sores on the genitals.’

  I spent the next ten minutes educating Tony about herpes. Apparently, up to now, he had got on well with Lenore’s parents, so I advised him to go and have a talk with her father. I said that he should tell him exactly what he had told me, and then explain what I had told him about cold sores. I offered to see Lenore’s mother or father myself to back Tony up if necessary. Tony left a little happier but no doubt fearing the potential wrath of Lenore’s father.

  The results of Lenore’s viral culture confirmed the diagnosis of Herpes Type 1, consistent with Tony’s story. Fortunately, after three weeks, Lenore recovered fully. To the best of my knowledge she had no recurrences of genital herpes. A significant number of people with Type 2 genital herpes were not so fortunate. Troublesome recurrent attacks are a common cause of people attending sexual health clinics. In the early eighties, until acyclovir was approved for use in Australia, there was little we could do to reduce the frequency or severity of attack
s. In 1981, a local herpes support group formed in Melbourne. I was happy to let them use the MCDC one evening for their first public meeting and to take part myself in a discussion there on herpes management.

  In my early days at the MCDC, it was the patients who made my work the joy it was. The turnover of patients was brisk, and the clinic was always short-staffed; it wasn’t unusual for me to see twenty-five or thirty patients in the space of a morning or afternoon. Looking back, although there were many colourful characters, it’s difficult to remember details.

  But some patients, like the twins Marco and Franco, made a mark on my memory. By the standard stereotype, the twins ought to have been gay, they were such fashionable dressers. I imagine many people thought they were gay. They rocked up to clinic one afternoon and demanded a consultation together. I readily agreed. On that first visit, and for many visits afterwards, they were so physically identical I couldn’t tell them apart. Everything about them was the same: they shared a house together, worked together, went to the gym together, and went out together. On the weekends they partied together and ‘picked up’ girls together. From their uninhibited accounts, they were tremendously successful at ‘picking up’ – no wonder! – they were both extraordinarily good-looking, well-built and charming. They were shameless boys; they told me they often shared their girlfriends, pre-arranging the time they would get up for a toilet visit during the night, then each one would return to the other’s bed-room. The girls never suspected. Inevitably, they even shared their STIs. That first afternoon, they both had non-specific urethritis (NSU).

  After the first visit, they were regular attenders and always sought me out. The clinic staff were intrigued by the twins and used to rib me. ‘We see your two special boyfriends were back to see you today, David!’

  I got to know Marco and Franco well over the years. They never acquired anything worse than NSU, so perhaps the stories of all their female conquests were exaggerated, or, less likely, my continual preaching to them about condom use paid off. Eventually, I could pick correctly who was Marco, who Franco. Underneath all the swagger, they were basically nice boys, but Franco was tough; there was something softer and gentler about Marco.

  When I moved from the MCDC to a general practice in Carlton, the twins followed me. When AIDS came along, I was pleased they both found themselves regular girlfriends and settled down. Their cavalier attitudes to women had improved markedly over the years. Poor Marco was very cut up when his first real love left him – for a muscle-bound circus acrobat. I was happy to lend a sympathetic ear and to offer consolation. ‘If she preferred a circus acrobat to you Marco, she obviously has no taste in men. You’re better off without her.’

  I greatly missed the twins when I left Melbourne for Cairns.

  I had not forgotten the pledge to my Victorian Medical Board interviewer, the old Professor of Medicine. I was still keen to assist in improving the standard of STI care in Victoria, and throughout Australia. There was a small group of like-minded doctors in other Australian States. One day in June 1981, I had attended a public health meeting in Melbourne, a section of which was devoted to STIs. The meeting had been convened by the Commonwealth Health Department and the feeling of the meeting was that the time had come for a national STI body to be formed. Accordingly, a few of us met that evening and inaugurated the National Venereology Council of Australia (NVCA), in order to raise public awareness and to improve the standard of medical care for the treatment of STIs throughout Australia. The Council would exist, we decided, ‘for the understanding and control of the sexually transmissible diseases’. One practical decision we reached was to hold a scientific meeting on STIs once a year in one of the capital cities.

  The formation of the NVCA was a small beginning. None of us at that first meeting could have imagined that out of the Council would eventually emerge the Australasian Chapter of Sexual Health Medicine within the Royal Australasian College of Physicians. However, the existence of the Council soon attracted the interest of a handful of younger doctors. The most notable of these was Basil Donovan from Sydney. I had heard of Basil by reputation. ‘He’s a bit of a young tear-away!’ I’d been told by an older venereologist from Sydney.

  Basil became an active member of the NVCA and regularly attended the annual scientific meetings. He was a little late for the meeting in Brisbane in 1984 because he had come off his motor-bike somewhere on the New England Highway, but was fortunately unscathed! Basil was the first clinician in Australia to put STIs on the map. In 1984, he published two scientific papers in the Medical Journal of Australia: ‘Gonorrhoea in a Sydney House of Prostitution’25 and ‘Medico-Social Aspects of a House of Prostitution’.26 As a medical officer at Sydney’s public Clinic for STIs, Basil had attended a brothel once or twice a week over the course of a year, to provide screening and medical services for the women there. He did this at the invitation of the brothel owner, who was perturbed that many of his clients were catching gonorrhoea and complaining about it. Not content with merely providing medical services, Basil had used the time for practical on-the-spot research.

  Basil has never looked back since that time. He is now a full Professor and over the years has contributed an enormous amount of valuable research in the area of STIs. In March 1999, there was a short article about Basil in the Lifeline series in the medical journal Lancet:27

  From brothel doctor to academic sexual health physician, Basil Donovan’s career spans the emergence of a uniquely Australasian style of sexual-health practice that is clinically broad, inter-disciplinary, population-based, and adaptable.

  Indirectly, the NVCA benefitted from Basil’s two seminal MJA papers. Never again would any Professor of Medicine be able to decry the quality of scientific research undertaken in the field of STIs in Australia.

  For a couple of years, despite the frustrations and the glacial pace at which the HCV responded to my demands for new staff positions and for redeployment of some of the troublemakers, it was a carefree and fulfilling time. I was happy professionally, happy making contacts with like-minded colleagues (like Basil Donovan) in venereology in other states, happy in my relationship with Michael, happy making new friends in the city’s gay community and among the city’s gay doctors, and happier within myself than I had been for most of my life. I had boundless energy. I lectured to medical students, post-graduates, nurses and general practitioners. I did teaching trips all over Victoria. I wrote my first book, VD in Australia, which was published towards the end of 1981. Medicine had become a fulfilling occupation for me. But my new, almost trouble-free, professional life was to prove short-lived.

  * * *

  20A chancre is an ulcer or sore caused by syphilis. It represents the primary (earliest) stage of syphilitic infection.

  21A proctoscope is an instrument used for examining the anal canal and rectum.

  22Medical Journal of Australia 1983; 2:561–564.

  23Popular nineteen-eighties joke: ‘What’s the difference between herpes and love?’ ‘Herpes is forever.’

  24Herpes simplex virus Type 1 is the usual cause of cold sores on the lips; Herpes simplex virus Type 2 is the usual cause of genital and anal herpes. However, both Types can cause infections in their less usual places.

  25Medical Journal of Australia 1984; 140:268–271.

  26Medical Journal of Australia 1984; 140:272–275.

  27Lancet 1999; 353:1110.

  My graduation photo – MB BS, Sydney University, January 1965.

  A Vietnam photo taken by one of the gunners and given to me later. It was taken on a Fire Support Base at the end of a military operation – Operation Duntroon. We were patiently waiting for a helicopter to take us back to base at Nui Dat.

  A picture of me outside the Regimental Aid Post (RAP) at 4 Field Regiment, Nui Dat, about August 1967, taken by Gunner Tony Scroope, my batman at the time.

  Front page of the New York Native from March 1983 with Larry Kramer’s famous article.

  Public Meeting about AIDS for
the gay community in Melbourne Dental Hospital Auditorium July 1983. On stage, doctors and one psychologist, from left to right: Dr David Bradford and Dr Ian Chenoweth, the late Bruce McNicol (psychologist), Dr Rex Melville, the late Dr Peter Meese, the late Dr Vaughan Lenny, and Dr Ian Fraser. Reproduced with permission of the Australian Lesbian and Gay Archives, with special thanks to Nick Henderson.

  The ‘Doll’s House’, Cairns Sexual Health Clinic, on the campus of Cairns Base Hospital, was in operation from 2001 to 2010, when it was demolished to make way for a major hospital redevelopment. The Clinic then moved to a purpose built community health site in North Cairns. My own photo.

  As Director of the Melbourne Communicable Diseases Centre (MCDC), 364 Little Lonsdale Street, Melbourne, in my office there mid-1985.

  An unbecoming front cover. Image courtesy The Medical Journal of Australia. ‘The Black plague of the eighties …’. Med J Aust 1983; 1(12): Cover Picture. © Copyright 1983 The Medical Journal of Australia, reproduced with permission. The “skull and cloak” illustration is taken from an article in The Weekend Australian, March 5–6, 1983 and is reproduced with the permission of News Corp.

  Part Two

  AIDS

  Chapter Eight

  The Wave on the Horizon

  Bert, a friend of mine, worked for a couple of years as general manager on a resort island in Thailand. He once sent me a photo which looks like a holiday snapshot. The scene is deceptively tranquil. There’s calm blue water, bright sunshine, a palm tree and a number of people in holiday attire standing in line along a beach, looking out to sea.

  In retrospect, it’s a scary picture, because in the distance, there on the horizon, you can just make out a wave. It is still far enough away to look benign, but that wave was the 2004 Boxing Day tsunami. Some of the people in the photo died that day. Bert himself underwent a serious battering from the tsunami, being washed backwards and forwards across the island by giant waves for three hours. Somehow, he survived. From 1983, my patients and I were battered by the AIDS tsunami. Most of my patients died, but despite being in a high risk group myself, I survived.