Shadows and Light: A Story for World AIDS Day

In the summer of 1981 I was just beginning my pediatrics residency at Lenox Hill Hospital on Manhattan’s Upper East Side. I had done a rotating internship the year before at Nassau Hospital in Mineola, Long Island, just about 10 miles from where I grew up in a town called… Hicksville. Yeah, I know. Look, I didn’t name it, okay?

Living in New York City had been a dream of mine since I was a kid growing up in those postwar, tract house suburbs, especially once I was old enough to take the Long Island Rail Road into the City by myself to see the parks and museums and skyscrapers and Broadway shows. And best of all, I would finally be moving in with Bob Corsico — my boyfriend, my partner, my… lover (Hey, it was the 80s).

Funny thing. Even though Bob and I met, became friends, and fell in love in Omaha, Nebraska, while we were both students at Creighton University, he grew up in Syosset, Long Island, just about 2 miles from where I grew up in Hicksville.

It’s like we were always meant to be together. Like… Kismet.

After we graduated from our respective schools — Bob from college, me from med school — we headed east together. That first year I lived in Mineola in hospital housing while Bob got a job in the City and commuted from his parents’ house each morning on the train. And now we would actually be living the dream together, in New York City.

For those of you who were not adults in the 1980s — or even on the planet — moving in together for two gay men was a really big deal in those days. It was as close as you could get to being married. And it was still kind of dangerous. Why, just three years earlier, Anita Bryant’s Save Our Children campaign had overturned a gay rights ordinance in Miami, Florida, by stoking fears about homosexuals and children. So it was not something you did lightly, especially when one of you was going to start training to be a doctor who takes care of kids.

But love will have its way.

Now, Lenox Hill Hospital is the descendant of the German Dispensary, founded in 1857 to serve New York’s growing German community on Manhattan’s East Side. So it was essentially a community hospital, and its pediatric training program was pretty small, with only four residents in each of the three years. As a result, we were frequently sent to other, larger institutions to get specialty training that wasn’t available at Lenox Hill.

That’s why, in August of that year I found myself at Memorial Sloan-Kettering, then as now, one of the premier cancer hospitals in the country to do my pediatric Hematology-Oncology rotation. I was taking care of kids from all over the world with cancer and leukemia, many of them there because their diseases were so exotic that they simply couldn’t be treated in their home cities. Memorial was the place where the mysterious cases were sent, and for many, even kids, it was the hospital of last resort.

Each morning our team — the attending physician, the residents, the peds interns like me, as well as the medical students — would go down to the radiology department to discuss any X-rays that had been done on our patients in the previous 24 hours. We had just finished when the radiologist said, “Wait a minute. I know you guys are peds, but I want to show you this one film. It’s really interesting.” He sifted through a pile of X-rays on the desk in front of us, held up a film, and slapped it up on the backlit viewbox. “Take a look at this. What do you think?”

We all stood in silence for a moment as we regarded this strange film. In my head I went through the checklist I had memorized as a third-year medical student about how to read an chest X-ray: Based on the size of the chest and soft tissue it looked like a thin adult, probably male since no breast shadows were evident. Good quality film, no rotation. Heart: normal size and shape. Lungs… Something about the lungs. For the most part they were the expected pitch-black fields indicating that the X-rays had gone clear through the mostly-air of the lungs to expose the film behind, blocked at regular intervals by the gentle white arcs of the ribs bordering and encircling the chest. But in the blackness where there should be nothing — more white, something, some things, floating in space blocking the X-rays, things that looked like… huge cotton balls. “Fluffy infiltrates” is a term radiologists use for lesions such as these. I thought I could rattle off a few things that might do this, but it would help to know more about the patient. I knew my place so the resident was the one who asked the question.

“What’s the history?”

“27-year-old, previously healthy white male,” the radiologist answered, and I thought: That makes no sense. These sorts of infiltrates would usually be seen in fungal infections in really old people.

“He’s been coughing for a couple of months,” the radiologist continued. “Anyone want to guess what this is?” The attending mentioned fungal pneumonia. Cool, I thought. Nailed that one!

“Nope,” the radiologist answered, clearly pleased at having stumped a clinician. “Anyone else?” Silence. After a moment he said, with a sly smile, “Pneumocystis carinii pneumonia.”

His audience didn’t disappoint. This revelation actually brought a gasp from the attending. For myself, I thought: That’s impossible. Pneumocystis carinii was thought to be a protozoan and a very rare cause of disease, especially in healthy humans. My only past experience with it had been the year before on an Internal Medicine rotation at Nassau Hospital when I had taken care of an extremely ill woman in her late 80s who was diagnosed with Pneumocystis just before her death. For Pneumocystis to be present in someone in his 20s was, well, inconceivable. My thoughts were being echoed by the attending.

“How do you know that’s it?” he asked.

“Pulmonary did a biopsy. But shouldn’t your next question be, what’s a pneumonia doing at Memorial?” We looked at each other. Yes, it should. Why indeed would someone with an infectious pneumonia be admitted to a cancer hospital?

Scanning the crowd, the radiologist finally said, “Because the patient was originally referred here for Kaposi’s sarcoma.” Again, his audience was thunderstruck. Kaposi’s is a form of skin cancer that usually looks like a bluish-purple bruise. In fact, people who have it will often ignore it until they notice it hadn’t gone away after weeks or months and finally decide to have it checked out. That’s when they get the bad news. But again, it was only seen in very old, really frail people. What was going on with this 27-year-old?

“Here’s the thing,” the radiologist continued. “This guy gets referred here for Kaposi’s by his private doc, and then they find out he’s been coughing and losing weight so they get this chest X-ray and call in pulmonary. So then the they’re are stumped, and they start talking to other docs around town. Turns out this guy’s not the only one with this stuff going on. There’ve been, like, 5, 6 cases in New York pretty much like this. And you know what they all have in common? They’re all homosexual.”

I don’t remember if I broke into a sweat. I’m pretty sure that my face flushed, and I know that my heart started pounding like one of the jackhammers out on York Avenue. I looked at the film again, for something, what?

“Wait a minute,” the attending said. “I think I read something about this in Morbidity and Mortality Weekly Report. Clusters of homosexual men coming down with these weird diseases. Here, San Francisco, Atlanta…”

“This is one of them,” the radiologist said triumphantly, as if he were displaying a rare white tiger.

Fluffy infiltrates, Kaposi’s sarcoma, Pneumocystis carinii. Words I’d heard. Some things I’d even seen, but in the pit of my stomach I knew that I would hear these words and see these things over and over and over again, in hospitals, in clinics, in bars… in friends. Something bad was happening. This X-ray, this guy I’d never met: He could be me. Someday, I wondered, would I be him?

I don’t remember much more of the discussion that followed as the team talked about what they did and didn’t know, what they’d heard and hadn’t heard, about these clusters of cases. Someone said something about sexual contact, someone else a tentative name for it called Gay Lung Disease, another made a wisecrack about fags. I was silent, staring at patterns of shadow and light.

Once we got back to the inpatient floor, there were a lot of sick kids to take care of, and I didn’t have much time to think about the X-ray or the 27-year-old guy with — what? This thing with no name. It wasn’t until much later, as I finally finished my day and walked the 15 blocks to my apartment on 2nd Avenue near 80th in the dark, still-hot August evening, that the unease of the morning returned.

I got home late that night. Bob was there. He’d already eaten. As usual. “I saved you some,” he said, fixing a plate for me. As usual. “Another long day, huh?”

“Yeah,” I said quietly, looking up at him as I poked at my food, almost examining him. “Yeah, long day.”

In bed that night I held Bob as he slept. I listened to his breathing — his strong healthy breathing — and I wondered about the future. I wanted this moment to last forever. I didn’t know then that this 27-year-old guy I would never meet would be one of the first gay men who would be diagnosed with a disease that would briefly be called GRID for the Gay-Related Immune Deficiency before becoming known to the world as Acquired Immune Deficiency Syndrome or AIDS, and that a virus which would be dubbed Human Immunodeficiency Virus or HIV had already spread to so many of my friends and would kill many of them in the years to come.

I didn’t know then that Bob and I would split up three years later, but that we would become the very of best friends very quickly afterwards, and that we would remain best friends until he died on Thanksgiving weekend 1994 of this disease and this virus at the age of 36.

I didn’t know then that Bob would come to me in a dream in 1997, a visitation that I know against all reason and all science to be a real because it was interrupted briefly by a phone call I did not answer but which I later found out was from Bob’s mother who felt compelled to call me at that exact moment, just to see how I was.

I didn’t know then that Bob would comfort me in this dream, this visit, that he would tell me that death is nothing to fear, that he would always be with me, and that he would always love me.

Like… Kismet.

I didn’t know then that — though I would be spared the virus — this day would be the split between Before and After in my life and that I would be one of the survivors to tell the story of my people in the time of Plague.

I didn’t know any of this on that sultry night in 1981, holding my lover as he slept peacefully in the August heat, or earlier that morning standing frozen in the dark, staring at the chest X-ray of a nameless 27-year-old gay man, but I did know, as I finally fell into a troubled sleep, that life as I knew it had changed forever.