Plague Years

by Ross A. Slotten, MD

  In the weeks preceding our vacation, I buried myself in as much literature as I could find on Botswana. This was my fourth trip to Africa. Books about the continent lined my shelves like cairns marking my past visits—three times to the national parks of Kenya and Tanzania—or sentinels guiding me toward future destinations. Now I’d visit the south. All these books shared one thing for me: in darker moments, they were refuges insulating me from the barrage of demands, anxieties, frustrations and self-doubts that threatened to overwhelm me. Sometimes, in an obsessive fit, I’d pick up the Lonely Planet Guide to Africa and read the section on Botswana over and over again.

  Books weren’t my only emotional outlet. When distraught, I often went straight to the piano, an upright my parents had bought me when I was a child. After I returned to Chicago from California, this beloved instrument followed me from apartment to townhouse to single-family home as I moved around the city. Often I spent an hour or more lost in a world of beautiful sound, pounding the keys and running the arpeggios of a Chopin nocturne or Schubert impromptu as I vented feelings of despair about the cruel fate of my patients, my own mortality, or, in the case of my former lover Art, the abrupt end of a tumultuous relationship. At such moments I felt like a lab rat that pushed a lever repeatedly to get its fix of cocaine.

  Although I could have gone anywhere in the world—a Mexican beach or an island in the Caribbean might have made more sense—Africa beckoned me once again. The lure had less to do with the pristine wildernesses and wildlife inhabiting them than with something more primal. Because humans evolved in Africa, Aaron Latham wrote in The Frozen Leopard, Africa was in our genes. Peter Matthiessen, in The Tree Where Man Was Born, put it more poetically: “Perhaps it is the consciousness that here in Africa, south of the Sahara, our kind was born.”

  In a different life I might have been an archaeologist or fossil hunter, unearthing our origins like the Leakeys. Each discovery of one of our ancestors piqued my interest and provoked speculation about our place on the planet and in the universe. Even an atheist like me, dealing with issues related to death and dying every day, contemplated such metaphysical questions.

  How I became a doctor is still mystifying to me. Before college I’d had no firsthand experience of what it was like to be a doctor. No members of my immediate family were physicians. My father’s father had sold cigarettes for a living during the Depression; my mother’s father had been a tailor. No one except my father had finished college, and none were professionals. In high school I founded the Aesculapian Club (Aesculapius was the Greek god of medicine; his serpent-entwined staff remains a symbol of medicine today), partly at the instigation of Doug, who always wanted to be a doctor, and other friends in high school. A local orthopedic surgeon mentored us and rounded up colleagues to speak to us about their experiences. One of my heroes at the time was Dr. William Nolen, who wrote a best seller, The Making of a Surgeon. I had the opportunity to interview him at my high school during a book tour in Chicago. Otherwise, what I gleaned about medicine had been from television shows like Dr. Kildare, Marcus Welby, M.D. and Medical Center. These popular shows, with their handsome stars, idealized the role of the doctor in a secular age when science promised answers to all of life’s questions. Through their brilliance and uncommon wisdom, those TV doctors saved lives and solved people’s problems. Dressed in their surgical scrubs or long lab coats, they embodied the notion that medicine is a noble calling. I didn’t want to own a grocery store like my father (nor did he expect me to). I wanted to save lives and solve people’s problems like Dr. Nolen and my television heroes. I had no idea that I’d chosen to pursue one of the most difficult professions imaginable. Saving lives and solving medical problems would be infinitely more complex than anything I ever dreamed of at the age of seventeen.

  From Chicago we flew to London and then to Johannesburg. Our route took us over the great sights of Africa: The Sahara Desert, the Nile, Mt. Kilimanjaro, the Rift Valley, the Congo River and Victoria Falls—all shrouded in darkness or hidden under heavy cloud cover. What other continent boasted so many iconic landmarks, I wondered. I became nostalgic about previous African trips and fantasized about future ones. There were so many possibilities. If only we could take a break from life and get this wanderlust out of our systems! Two years would be enough, just two years, I pleaded with my superego, which wasn’t amused. No! chided the stern inner voice with the intonation of my mother, and out poured a litany of rationalizations that included ridiculous words like responsibility and money. I retreated timidly to another plane of thought.

  From Johannesburg we flew to Botswana and boarded a four-seated bush plane piloted by an ebullient white man named Charlie who looked too young to fly. “Buckle up,” Charlie reminded us, but when I told him that my seatbelt was broken, he shrugged and said, “Oh well, that’s Africa, you know.” Charlie guided the plane effortlessly, as if driving a car over invisible roads and unfazed by the atmospheric equivalents of potholes and surface irregularities. I watched for the lone raptor that might inadvertently collide with us, mucking up the propeller in a whir of blood and feathers, stalling us and hurtling us to our deaths. But the sky was empty except for clouds that unrolled swiftly above us.

  “Elephant!” Charlie suddenly cried. “Do you see them?”

  He tilted the plane sharply to give us a view. Gavin slid toward me, and I gripped my seat with fingers curled into talons. Several gray lobules with flaps splashed through water, lumbering silently along. OK, OK, I thought, just fly the damned plane, but I feigned excitement and praised his game-sighting skills. After twenty minutes the landing strip came into view, a swath of green amid brush and woodlands. We circled sharply and descended. After landing, my entire body vibrated and my blocked ears felt like the inside of a seashell.

  Our first camp was rustic, like a frontier outpost. An older white man, plump and smiling, welcomed us. His spindly legs poked through khaki shorts, and he wore a khaki shirt with epauletlike straps. His hair was short and wavy, and his complexion was ruddy. He seemed like someone who could wield wit as quickly as a fearsome temper. Clive made an amiable quip about our being “bloody Americans.” His wife Barbara, with dirty fingernails, extended a hand for us to shake. She too was in her mid-fifties. Big-boned, tall, and no longer slender, she had an attractive square face and lively green eyes accentuated by crows’ feet. Her skin, a toasty brown, was leathery from too much sun.

  Clive and Barbara, who’d fled Zimbabwe after the end of British colonial rule, weren’t fans of the government of Botswana, or any African government for that matter, although Botswana was the only true and stable democracy on the continent. Products of the imperial past, they dismissed Africans as incapable of self-governance. Their aim was to stir up enthusiasm for wildlife preservation, though they were pessimistic about Botswana’s future.

  We walked with them through the compound and strolled along the edge of the plains. The camp, an oasis of safety and comfort, was on our left; on our right, Africa, where only the fittest survived. The sun at its zenith, hot and blinding, pressed down on us, obliterating our shadows. An antelope foraged, but most animals had retreated into the shade. This was Africa, touched only lightly by humankind.

  “Too many people in Africa, I’m afraid,” Barbara said unexpectedly while gazing at the limitless horizon, shading her brow. “But now there’s AIDS. Perhaps that will save Africa. It might be a godsend.”

  I froze in my steps, knees locked and teeth clenched, as I looked at the landscape but saw only terrible images in my brain, skeletal bodies prostrate on mats or bare earth in some remote African village. AIDS doesn’t resemble starvation, where imploring eyes beg for food; AIDS eyes are too sick to implore.

  Whose Africa was AIDS saving, I wondered: that of the white colonialists who’d been turned into nomads or that of the Africans themselves? The continent had been invaded, colonized, and divvied up into artificial countries, creating the chaotic conditions from which AIDS emerged and thrived. That wa
s too fraught an issue to discuss with people I hardly knew and at whose mercy I’d be for the next few days, but perhaps this was merely a way to start a conversation. It must have been obvious to them that Gavin and I were partners. How silly of us to pretend otherwise—or maybe not. Such is the treacherous life of the gay traveler, guessing at motives, seeing shadows that don’t exist, or missing messages that truly intend harm.

  “AIDS is a problem in the West,” I finally managed to say. “But it’s even more devastating in the third world, where dissemination of information is next to impossible and where behavior will only be changed after it’s too late.”

  “Condoms don’t work around here,” she asserted. “The men absolutely refuse to wear them. And the women are powerless to say no. I’ve heard that nearly half the Zimbabwean army is infected with the AIDS virus.”

  Barbara was right about the high infection rate and the reasons for AIDS’s explosive spread throughout the continent. At a future international conference on AIDS I would hear one scientist proclaim that Robert Mugabe’s failure to address the public health catastrophe in Zimbabwe should be treated as genocide or a war crime. Forget the fact that he ruined his country economically, the scientist said; Mugabe would be remembered as a leader who turned his back on his people and let hundreds of thousands of them die of AIDS.

  As we returned to the large communal tent, I could have launched into a discussion about my work with AIDS patients from the very beginning of the epidemic, but I wasn’t emotionally prepared. On so many levels the subject pained me, and I wanted to avoid it, if only for two weeks. But eight thousand miles from Chicago and my patients, AIDS shadowed me. I could never really escape it. It wasn’t just the conversation with the managers of a safari camp.

  Two years earlier, while in the Seattle airport waiting to fly to Thailand and then India, we noticed a thin older woman performing calisthenics on the floor of the passenger lounge, in front of two hundred people. Ten days later, in Rajasthan in northern India, this woman and her husband not only were on the same train we took but occupied a room in the same car. She wasn’t crazy; she was a restless soul. Her son, who’d traveled extensively in India, had died of AIDS a year earlier. She and her husband were retracing the steps of his spiritual journey before his death and scattering his ashes. How extraordinary, I thought. I viewed our convergence with this couple as merely a coincidence; other people, including Gavin, saw something more cosmic or teleological.

  Now, on this same trip to Botswana, we learned of the death of Freddie Mercury, the British rock star—whom, as a classical music snob, I’d never heard of. But at that moment it didn’t matter. Here was someone famous who had died of AIDS. Although Mercury was an Indian Parsi, Africa embraced him because he’d been born in Zanzibar. Like so many gay celebrities at the time, Mercury was described as bisexual, which somehow made his death from AIDS more palatable to the public, or at least to his publicist. The revelation grabbed the world’s attention. I marveled at his bravery. He could have instructed those closest to him to lie about his diagnosis. Instead his posthumous admission increased sympathy for those afflicted by HIV.

  And then, on our way back to camp from a safari one late afternoon, a small bird called a carmine bee-eater hounded our Land Rover. For several miles it swooped, swerved, and wove from one side of the car to the other. At first I was terrified—Alfred Hitchcock’s horror film The Birds conjured images of pecked-out eyes and seagulls running amok—but our guide explained that vehicles stirred up grasshoppers and other insects in the brush. Bee-eaters usually fly in flocks; this one hunted alone, hovering persistently close to us.

  “Can you believe Neal’s been dead four months?” Gavin asked, tears welling up. Neal, my former college roommate and confidant, had died in July in Honolulu. Gavin, his thinning blond hair whipped into a frenzy by the wind, turned his attention once again to the bird. The canvas roof of the vehicle had been detached and the windows were rolled down on all sides, giving us a panoramic view of the scrubby landscape as if we were in a boat and not an automobile.

  “No, I can’t,” I said. “Sometimes I don’t believe he’s really dead. I just think he’s gone off somewhere and not called us, that we’ll talk to him again someday.”

  “Maybe he’s not dead,” Gavin said, motioning toward the bird with a flick of his head. I looked back and smiled uncomfortably at the undulating form that glinted vermilion in the sunlight. Gavin could sometimes joke at an inopportune time. But he had a superstitious side that strained my credulity and sometimes exasperated me. Lately he was beginning to believe in celestial signs and the power of crystals, which was more than I could bear.

  “Come on,” I said. “That’s ridiculous.”

  “No it isn’t,” he said forcefully. “I sometimes believe in these things.”

  “I know you do, but I don’t. I don’t understand how you can.”

  “It might do you some good if you started believing in them,” he said in a huff.

  Had we not been in a Land Rover piloted by a stranger, we might have had a real blow-up. As with so many arguments, it was the subtext that mattered. Gavin never thought that I’d believe Neal’s soul inhabited a bee-eater. It was my dismissiveness that irked him. That tendency—the elevation of my convictions over his—irritated him as much as his less rational side irritated me. But despite our disagreement, we were both spooked. Retreating into our internal worlds, we reflected on the bird’s significance in silence until we reached camp.

  A neighbor had found Neal dead in his apartment and notified his parents, who flew from California to gather up his belongings and arrange for a funeral. His mother called me. It had taken her forever to find my number, she said; the apartment was a mess, with papers, clothes, and scraps of food scattered everywhere. Although Neal dressed meticulously, even ironing his T-shirts, he had no patience for housework. The call caught me by surprise. His mother, whom I’d met only once long before this, asked me about the circumstances of his death, speaking more like an investigator than a distraught mother. I had no idea, I said, feeling like an accomplice to a crime. He’d tried to hide his illness from all of us, including me, his closest friend. The previous year he hadn’t returned my telephone calls for weeks, until he revealed that he’d been hospitalized for “pancreatitis”—although he declined to describe his symptoms—and had been discharged on nutrition administered through a large vein in his upper chest. He refused to let me come help take care of him and wouldn’t discuss his condition, but the underlying diagnosis was obvious to me. He’d led a promiscuous sex life and had worried about AIDS from the onset of the epidemic.

  Neal’s loss was so great that it didn’t register with me at first. He was one of a handful of people with whom I could be completely honest about my life. Such friendships are rare, take years to build, and usually begin before you’re paired with a life partner, who may either accept or feel threatened by the relationship. You grow up together, like siblings, and support each other in the formative years when the future excites and frightens you with its possibilities and tough choices. Every medical school Neal applied to had clamored for him. Unable to tear himself away from California, he turned down Harvard and other Ivy Leagues for the University of California at San Francisco.

  Even though we lived thousands of miles apart, we remained close. Gavin and I visited him on several occasions. Showing us sides of Honolulu far from Diamond Head and the white-sand beaches overdeveloped with glitzy hotels and overcrowded with big-bellied tourists, he introduced us to the friendly gay bars and hole-in-the-wall restaurants that served the local fare, a delectable amalgamation of Polynesian, Asian, and European cuisines. The intersection of civilizations fascinated him, for he himself was an intersection of cultures—white, black, and Native American. That fascination rubbed off on me and spurred me to travel the world. He loved the local lingo, in which children were referred to as keikis (pronounced cake-eez) and half-whites hapa-haoles. He stayed with us in Chicago once
or twice too. The lakefront, with its cement beaches and blissful sunbathers, amused him; and he was unexpectedly chilled to the bone during a jog through Lincoln Park when the temperature dropped thirty degrees in the space of an hour.

  But it was the miracle of the telephone that kept our relationship alive. We coached each other through the tedium of the first two years of medical school, when the coursework seemed at times to have little relevance to the careers we envisioned. And while in practice, we exchanged stories about our patients or peers and consulted each other if stumped by a difficult case, though he grew silent and pensive when I described a patient struggling with AIDS, as I often did.

  Despite his gregariousness, Neal was a loner. He preferred to remain single and rarely slept with the same man twice; had few friends in Hawaii, where he worked as a psychiatrist at a state hospital, after leaving the death-haunted streets of San Francisco; and moved far from his dearest friends and family. He lived like a refugee, as he put it, ready to move at a moment’s notice, with no ties to any person or place. Home wasn’t the oasis for him that it was for me, a refuge from a stressful job and a world that hated gay men for their lifestyle, as if lechery defined us and the latest fashions enraptured us. He collected no art, furnished his apartment with cheap furniture, and dressed simply in T-shirts, jeans, or shorts. Even a plant seemed burdensome to him. I thought this lack of attachment to material things was rooted in his vagabond childhood, when he and his family moved every few years to a different continent because his father served in the US Air Force—but on reflection, I realized that he expected to die young. What excites most of us and gives us a reason for existence seemed pointless to Neal.

  The thought of Neal in his final weeks, trapped at home, perhaps unable to eat and possibly in pain, unsettled me. How terrible to die alone, to be discovered days or weeks later only because of the stench. I wished he had reached out to me. In addition to grieving his disappearance from my life, I felt hurt, even angry with him. Out of shame, pride, fear, or stubbornness, or perhaps a combination, he had walled himself off from me, even at the end when the wall no longer mattered. I wondered if he had overdosed on narcotics, but I think he would have left a note, if not to me, at least to his parents and two younger brothers. The circumstances of his death would have to remain a mystery.