by Randy Shilts
It didn’t take long for an eager young resident to come back with the story of a young man who was suffering from a yeast infection in his throat that was so severe he could hardly breathe. Babies born with defects in their immune systems sometimes suffered from this florid candidiasis, as would a cancer patient who had been loaded down with chemotherapy, Gottlieb knew, but he’d never seen such a thing in a thirty-one-year-old who appeared perfectly healthy in other respects.
Gottlieb and his residents examined the young man and collectively scratched their heads.
Two days later, the patient, an artist, complained of shortness of breath. He had also developed a slight cough. On a hunch, Gottlieb twisted some arms to convince pathologists to take a small scraping of the patient’s lung tissue through a nonsurgical maneuver. The results presented young Doctor Gottlieb with the strangest array of symptoms he’d ever heard of—the guy had Pneumocystis carinii pneumonia.
Gottlieb walked a tube of blood down the hall to a lab immunologist who, like himself, was always on the lookout for something that broke the routine. This researcher was specializing in the new science of T-cells, the recently discovered white blood cells that are key components of the immune system. Gottlieb asked for a T-cell count on the patient. There are two kinds of T-lymphocyte cells to look for: T-helper cells that activate the specific disease-fighting cells and give chemical instructions for creating the antibodies that destroy microbial invaders, and the T-suppressor cells that tell the immune system when the threat ended. The colleague ran his tests on the patient’s blood, laboriously hand-counting the subgroups of T-cells. He was floored by the outcome: There weren’t any T-helper cells. Figuring he had made a mistake, he tested the blood again, with the same results.
Hot damn. What kind of disease tracked down and killed such specific blood cells? Gottlieb brainstormed with residents, colleagues, and anyone with a spare hour. Nobody had a clue. Now Gottlieb was excited. He pored over his books and tracked down research on obscure immunological diseases. Nothing explained it. He also examined the minutiae of the artist’s medical charts; he had suffered from a cornucopia of venereal diseases. In a conversation, the patient mentioned that he was gay, but Gottlieb didn’t think any more of that than the fact the guy might drive a Ford.
After weeks of fruitless investigation, Gottlieb was still stumped. Maybe some leukemia would surface later on. In a year or two, he thought, we’ll find out what’s wrong.
November 4
SAN FRANCISCO
“I don’t have to vote,” the housewife said.
Bill Kraus, holding his neatly piled slate cards from the Harvey Milk Gay Democratic Club, tried to control his temper. As far as he was concerned, voting was like breathing: How could you not do it? The woman cut him short.
“Jimmy Carter was just on TV,” she said. “He’s already conceded the election.”
“Just like that Georgian jerk to call it quits before they were even done voting on the West Coast,” Bill groaned after he got back to the headquarters on Castro Street.
The national debacle shaping up was no major surprise. Ronald Reagan was sweeping the country and bringing in the first Republican Senate in nearly thirty years. There wasn’t much satisfaction in the thought that, for the first time, gays indeed had been a serious campaign issue—for the other side. To be sure, the Caner camp ended up making every concession gays wanted. They had to in order to battle independent candidate John Anderson, who was even more forthcoming in his attempt to capture gay votes, which tend to concentrate in the urban centers of states rich in electoral votes. However, in the South, the Republicans had used all this to their advantage.
“The gays in San Francisco elected a mayor,” announced the solemn voice in television ads aimed at southern voters. The visuals shifted from photos of deviate-looking gay rights marchers to a still of President Carter. “Now they’re going to elect a president.”
Religious fundamentalists, who had burst forth in 1977 specifically over the volatile gay issue, had been emboldened by their successful repeals of homosexual rights laws in a dozen cities in the late 1970s, and they organized as never before for the 1980 election. Jerry Falwell and his Moral Majority became household words, and analysts heralded the fundamentalists as the most important new political force to emerge in America in decades. Falwell and his New Right compatriots rarely let a speech go by without some dark reference to the growing clout of homosexuals, often paired with a citation from Revelation, indicating that this already had been prophesied as a precursor to the Last Days.
On television, Falwell quickly claimed credit for the Reagan landslide and announced he would push forward with his pro-family, and anti-gay, legislative agenda. Most analysts, however, pinned the conservative landslide on the sheer unpopularity of incumbent Carter and the fact that people seemed ready for a frugal government that pledged cuts in domestic spending.
Cleve Jones swept into the gay headquarters with his boss, California Assembly Speaker Leo McCarthy, while Bill Kraus, Gwenn Craig, and their cronies were assessing the impact these Baptist loonies would have on the administration. They cheerfully reminded themselves that a Democratic House could probably stall the anti-gay legislation Falwell had ambitiously proposed. Other than that, the Republican regime would largely mean massive cutbacks in domestic programs that had little effects on gays. The gay politicos turned their attention to local election results. Voters had just thrown out the city’s method of electing supervisors by district. Gays had fought hard for district elections in the 1970s, largely because it seemed that no gay candidate could ever be elected citywide; there just wasn’t that kind of power then. Harvey Milk had won his seat as a district supervisor, and Bill Kraus had slaved for months to engineer the election of Milk’s successor, Harry Britt, in the citywide election. As aides phoned in the results from City Hall, the extent of gay entrenchment in San Francisco became obvious. Harry Britt was easily elected supervisor. Bill’s strategy of building coalitions with Chinese, labor, and liberal groups had succeeded beyond his own expectations. Tim Wolf red, a former Britt aide and Milk Club officer, had also won a citywide race to the San Francisco Community College Board of Directors.
Even better, the results demonstrated that the gay neighborhoods, again, were showing the highest voter registration, feeding the highest voter turnouts in the city. Gay precincts were also proving to be the city’s most liberal, churning out ten-to-one majorities for incumbent Democratic Senator Alan Cranston. Returns from big cities across the country also confirmed the wisdom of targeting gay precincts for the old-fashioned door-to-door ward politics Bill Kraus had helped fashion in San Francisco. Some of the largest Carter voting blocs in Manhattan, New Orleans, and Houston were from homosexual neighborhoods. Quick calculations showed that 62 percent of gay voters in the big cities were going for Carter, compared with 27 percent for Reagan and a surprisingly strong 11 percent for Anderson.
Cleve Jones and Bill Kraus couldn’t conceal their relief at the returns. With its religious-right alliances, this would not be an administration friendly to homosexuals, but it didn’t matter. Whatever happened nationally, they told each other, at least gays were dug in across the country in safe urban enclaves. Jerry Falwell wouldn’t have much say in the city councils of areas where gays were concentrated. That was where the decisions that truly affected the day-today life of homosexuals were made.
As the crowd at the headquarters thinned, Bill shuffled through the posters, leaflets, and slate cards that littered the floor and remembered the euphoric night three years before when Harvey Milk was elected. It was a vaguely troubling thought. Back then, it had been so clear what they were fighting for. There were visible foes, like Anita Bryant and John Briggs’s anti-gay schoolteachers referendum. Now, in such a short time, they had already won much of what they wanted, at least in San Francisco. The votes were still there, but the fire had left the politics of Castro Street. What were they fighting for now?
November 15
ST. LUKE’S-ROOSEVELT HOSPITAL, NEW YORK CITY
Enno Poersch put Nick’s hand in his own strong grip, hoping his optimism might course into the vacant man’s eyes.
“This is great,” said Enno. “They finally know what you have. Now they’ll be able to cure you and you’ll be fine.”
Nick was still so exhausted from the surgery he could barely manage a smile. The white gauze still capped most of his head. The exploratory surgery had been most indelicate. The doctors had simply taken off the top of Nick’s skull to try to figure out what had created the three massive lesions. The effort had at last produced a diagnosis. Nick, they said, had toxoplasmosis; yes, it could be treated.
“Everything’s gonna be fine,” Enno said.
November 25
SAN FRANCISCO
Ken Home had always wanted to be a dancer, performing a dazzling array of pirouettes, entrechats, and arabesques before a rapt audience that would nod approvingly at his grace and beauty. A glowingly optimistic sort, he loved everything about the theater, with its romance and costumes and fairy-tale happy endings. Maybe he could even be a star, the guy people cheered and wrote about. That’s why he had left his blue-collar family in Oregon and moved to San Francisco in 1965, when he was twenty-one, to study at the San Francisco Ballet School. A nose job had complemented an otherwise delicate face, and his body was hard and muscular from years of training. The sheer contrast between his childhood plainness and his adult beauty made Ken’s introduction to San Francisco gay life rewarding. All these men liked him so much, and he so desperately wanted to be liked. Sometimes, he confided to friends, he felt like a Cinderella who had finally arrived at the ball.
Maybe that’s why it was easier to let go of the dancer’s dream in the late 1960s. Ken told friends a vague story about the ballet director decreeing that all the single men had to get married or engaged to stay in the company, something about hating to be embarrassed by all the dancers’ arrests in gay bar raids. In any event, Ken dropped out of the ballet school, assuring friends he would get back into it once he got his finances straightened out. In 1969, he took a clerical job at the Bay Area Rapid Transit system and found he liked the regular paycheck as well as a work week that was a dream compared to the regimen of 6 A.M. to 9 P.M. he’d followed with the ballet. He had more time to go out at night now. “This isn’t so bad after all,” he told a friend. “I’m having fun.”
Ken soon fell in love with a German sign painter and lost touch with his early San Francisco friends, who recalled a sweet young kid who loved romance. They were surprised five years later to happen into Ken at the Folsom Prison, a leather bar. His hair was cut severely and he sported a close-cropped, narrow beard that followed the line of his jaw like a chin strap on some Nazi helmet. His old friends were floored, not only because he was so thoroughly the prototype of the black leather machismo then sweeping San Francisco, but also because he looked so wasted. His hair had gone gray and his eyes looked glazed. Ken complained about how tough it was in this “city of bottoms” to find a man who would screw him.
His friends decided that Ken had fallen into the trap that had snared so many beautiful gay men. In his twenties, he had searched for a husband instead of a career. When he did not find a husband, he took the next best thing—sex—and soon sex became something of a career. It wasn’t love but at least it felt good; for all his time at the Cinderella ball, the prince had never arrived.
As the focus of sex shifted from passion to technique, Ken learned all the things one could do to wring pleasure from one’s body. The sexual practices would become more esoteric; that was the only way to keep it from getting boring. The warehouse district alleys of both Manhattan and San Francisco had throughout the 1970s grown increasingly crowded with bars for the burgeoning numbers of leathermen like Ken Home. By 1980, it was a regular industry.
Life is a disappointment, Ken was thinking as he walked into San Francisco’s largest medical office building on the morning of November 25, 1980. It was an ironic thought for a man who was taking his first steps toward finally becoming someone that people would write about.
“My life is falling apart,” Ken Home told Dr. James Groundwater.
Groundwater was a dermatologist, involved in a course of work that did not lend itself to such dramatic confessionals. But the forty-three-year-old physician had the fatherly manner of someone to whom you’d spill your guts, and as Ken anxiously took off his shirt, the doctor heard his story.
For two years, he’d been feeling tired and always a little sick to his stomach. There was also this diarrhea, off and on, since 1978. It was horrible. And then, last month, Ken said, came these funny bumps.
Groundwater examined the bluish-purple spots. One was on Ken’s left thigh, the other was near his right nipple.
“What’s happening to me?” Ken pleaded.
He was angry that years of visiting doctors had not made him one bit better, or even told him what was wrong.
Groundwater was surprised at the size of Ken’s lymph nodes. They certainly had something to do with those spots.
Ken continued his story as the doctor examined him: His bosses had been making unrealistic demands, so he went on disability this month. He had also started seeing a shrink; he’d do anything to get his life back together.
Groundwater pondered what could be wrong with the thirty-seven-year-old patient. It could be lymphoma, which would explain the swollen nodes but not the spots. Groundwater drew some blood and cut off a sliver of the lesion for a biopsy. They’d figure this out.
Thanksgiving Day, November 27
ORANGE COUNTY, CALIFORNIA
Canadian winters were so tedious that Gaetan Dugas was overjoyed at the invitation to spend Thanksgiving weekend in southern California. The new object of Gaetan’s affections, a hairdresser, was equally thrilled at the catch. Normally, the hairdresser was content to cruise the Boom-Boom Room in Laguna Beach. His trip to the 8709 Club in West Hollywood had been only his second or third time at a bathhouse, and he’d hooked this gorgeous airline steward who was coming back for seconds, maybe even thirds. What a wonderful weekend they’d have. The baths weren’t so bad after all, he thought.
Gaetan briefly examined himself in the mirror. Yes, a few more spots had had the temerity to appear on his face. The doctors said there was no treatment, but that didn’t matter. He felt fine, and pushing back his sandy hair just so, he smiled at the thought: “I’m still the prettiest one.”
December 5
SAN FRANCISCO
Desperation haunted Ken Home’s sunken eyes as he slowly pulled off his shirt to show Dr. Groundwater the two new purple spots on his chest. No, not another biopsy, he told the doctor fiercely. He wanted some answers.
The blood test assay that had come in from the lab was also disconcerting. Something was wrong with Ken’s white blood cells. Even more startling was the lack of reaction to a series of routine skin tests Groundwater had given the BART station manager during his last exam. The tests, little pricks with needles infected with benign germs, normally swell up to hard red bumps. This means the immune system is manufacturing the antibodies to fight the germs. No bumps on Ken. The immune system had just ignored the needle pricks.
Ken repeated his complaints of nausea, fatigue, and diarrhea, leaving the dermatologist mystified. The man sounded sick, very sick, but from a lab point of view, there wasn’t really that much wrong with him. Blood tests are off all the time, and sometimes the skin tests don’t take—but such immune fluctuations don’t leave you so incapacitated. All Groundwater could do was order more tests. He persuaded Ken to let him do a biopsy of a lymph node, which would show whether there was some kind of lymph cancer. The doctor also drew extra blood and sent it to the lab with special instructions to scan the serum for every exotic viral disease they could imagine.
There is an answer to this, Groundwater thought. There always is.
December 9
LOS ANGELES
“What ar
e we doing to ourselves?”
It was the question that Dr. Joel Weisman felt compelled to ask himself as he checked out the nervous, thirty-year-old advertising manager. The guy was sick. He had a painful eczema, persistent diarrhea, and endless fevers. Even worse, he’d been sick for six weeks now and was seeing Dr. Weisman on a referral from his normal internist. After ordering up tests, Weisman wrote his tentative diagnosis on the patient’s chart: “Patient has problems that appear to be secondary to immune deficiency.”
Mysteriously ill people aren’t all that rare in a medical practice, Weisman knew, but this was not isolated. In October, another young gay man had gone to Weisman’s associate with a strikingly similar disarray in his immune system. The constellation of diseases was startling. White fungi grew around the man’s fingernails, fluffy candidiasis was sprouting all over his palate, and he too was suffering from rashes, prolonged fevers, swollen lymph glands, and low white blood counts. Hospitalization brought a brief respite from the skin problems, but by early December, the patient’s nightsweats were soaking through the sheets of his bed and the rashes had returned. Weisman’s partner first thought the man’s blood had been bombarded with both bacterial and viral infections, but by December he also diagnosed “immune deficiency.”
On top of these two cases, another twenty men had appeared at Weisman’s office that year with strange abnormalities of their lymph nodes. That’s how the ailments of these two more seriously ill patients had started. Weisman had half-expected something more serious when he started seeing the lymphadenopathy, or abnormal enlargement of the lymph glands. New studies were showing that 93 percent of gay men were infected with cytomegalovirus, a herpes virus that had been linked to cancer. The gay sexual revolution had also made the Epstein-Barr virus, a microbe also linked to cancers, pandemic among homosexual men. There were only so many viruses a body could battle before something went horribly awry. Now Weisman worried that he was seeing what could happen in the frightened eyes of the advertising manager who had been far too young and healthy last year to be so sick today.