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Blood Brothers

NOW THE MEDIA HAD DISCOVERED the “gay plague.” Every morning the newspaper and every evening the television news had another sensational story. Who could blame them? It was new, it was contagious, and it had to do with sex.

Although our group had gathered convincing evidence that AIDS was not confined to gay men, for a while that remained our secret. Actually, not quite a complete secret. Eventually we notified the Centers for Disease Control of our findings. The CDC sent a task force to meet us, saw some of our patients, reviewed our data, and helped us with special immunological testing. We heard from the agency that some patients from the Haitian community in New York City had come down with same illness. We were preparing our data for publication.

For most of us in the original study group, AIDS among Haitians remained a part-time endeavor. Margaret, however, was devoting more and more of her energy to the problem. She followed the largest number of patients and came to the office to see them practically every day of the workweek, instead of the one-half day a week usually devoted to the faculty private practice. She and Art P. were planning a trip to Haiti to look for evidence of the syndrome there.



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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Blood Brothers NOW THE MEDIA HAD DISCOVERED the “gay plague.” Every morning the newspaper and every evening the television news had another sensational story. Who could blame them? It was new, it was contagious, and it had to do with sex. Although our group had gathered convincing evidence that AIDS was not confined to gay men, for a while that remained our secret. Actually, not quite a complete secret. Eventually we notified the Centers for Disease Control of our findings. The CDC sent a task force to meet us, saw some of our patients, reviewed our data, and helped us with special immunological testing. We heard from the agency that some patients from the Haitian community in New York City had come down with same illness. We were preparing our data for publication. For most of us in the original study group, AIDS among Haitians remained a part-time endeavor. Margaret, however, was devoting more and more of her energy to the problem. She followed the largest number of patients and came to the office to see them practically every day of the workweek, instead of the one-half day a week usually devoted to the faculty private practice. She and Art P. were planning a trip to Haiti to look for evidence of the syndrome there.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti She talked about the subject with an urgency and an excitement the rest of us didn’t seem to share. I continued to follow Previlus, Belony, Régis, and a few others. Previlus was doing reasonably well. His skin continued to itch, despite a host of nostrums prescribed by the dermatologists, and his diarrhea flared sporadically. He missed many of his scheduled appointments and then would show up unexpectedly, explaining how difficult it was to get down from Belle Glade. However, he continued to work, his weight was stable, and he developed no new infections. He was grateful that I was caring for him. Belony was slowly declining, and I could not put my finger on why. Each visit he required more assistance from his mother to get up on the examining table. He said very little. His mother reported that he spent his days lying in bed. Régis was doing the best of the patients I followed. He felt well, his appetite was good, and he was gaining back the weight he had lost during his bout with pneumonia. He would come to the office in a suit and tie looking like a foreign ambassador. He made light, pleasant conversation with the office staff. For a while he was doing so well that I thought he might be the first spontaneous recovery. But his lymphocyte count remained low, and tests showed that he was still immunodeficient despite his outwardly robust appearance. One bothersome problem was the development on both ankles of the same type of itchy bumps that plagued Previlus. I did not even attempt to offer the dermatologist’s explanation of “insect bites” to Régis. Fortunately, since he was so concerned about his appearance, the bumps were hidden beneath his trousers. Margaret asked me if I knew anyone who had B+ blood type. I answered that I was B+, knowing full well that in answering I was also volunteering for something. I wondered if she had somehow checked in advance. She wanted to mix the lymphocytes and sera from our Haitian patients with “normals” and inject them into marmosets. Régis was B+, and that being a relatively rare blood type, she

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti had yet to find a “control.” “It’s only 50 cc’s,” she demurred. So I drew the blood sample from Régis, and Margaret drew a sample from me. “I guess this makes us blood brothers,” said Régis, smiling. All of these patients required lots of attention and we saw them frequently, but the nature of our office waiting room was changing. With the exception of Régis, there was no mistaking that these patients were poorer and sicker than the private patients who shared the waiting area with them. The private patients would consciously or unconsciously sit as far from the Haitians as they could. I’m sure many wondered what they were doing there. If two or more Haitians were waiting, they and their families would chatter in Creole, while the private patients waited silently, with their noses buried in The New Yorker or Sports Illustrated. Sometimes, if a particularly sick Haitian was waiting, a private patient would stare as if seeing an apparition. Still, no overt objections were raised, for the reason the Haitians were there remained a secret. Now, two or three new cases a week were being admitted to the hospital. Only half survived to be discharged. One corridor of one floor was exclusively occupied by Haitian patients with AIDS. Because they were poor, without resources, frequently living here illegally and unaware that this disease was among them, many arrived at the hospital moribund. The residents continued to work heroically to keep them alive, but the high mortality was eroding morale. Leguerre was a case in point. He was admitted with fever and swollen lymph nodes. When presenting him during attending rounds, Jim, his intern, remarked that although his neurological exam showed no localizing signs, his speech did not make sense, even to the Creole interpreter. I commented that even this subtle a change in mental status might be a clue to the kinds of central nervous system infections that afflicted so many of our patients. When we went to his bedside to examine him, we found a patient who had changed drastically since Jim had last seen him a few hours before. He was now paralyzed on one side and unable to speak. Jim was

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti embarrassed at the discrepancy between what he described and what we now saw. There was no need for an explanation, though. I had no doubt that his initial exam was accurate, and Leguerre was not the first patient to deteriorate so rapidly. So, after being up most of the previous night, Jim began another 24-hour ordeal with his patient. The neurology resident had to be contacted to arrange for an emergency CAT scan. Shortly thereafter seizures developed. The patient then needed to be intubated to protect his airway, and a venous catheter needed to be inserted to give him medicines. Another catheter was inserted to drain his bladder. The intern accompanied Leguerre when he went for the scan, which showed multiple abscesses in the brain. The following day Leguerre was a pathetic sight. He was lying naked in bed except for the condom catheter covering his penis and the large bandage covering where the venous line entered his body. He also had an endotracheal tube attached to a ventilator coming from his nose. Despite his paralysis, the nurses had restrained his arms and legs so that he would not jeopardize the critical tubes and lines. His eyes looked only to the left, and he was unresponsive. There is nothing like modern medicine to dehumanize a human being, I thought. Several times during the next 48 hours it would have been easier just to give up. Then after two more days Leguerre began responding to the antibiotics. His seizures stopped, so we removed the endotracheal tube and discontinued the ventilation. By the fourth day of treatment his paralysis was improving and he could speak coherently in Creole and even in broken English. Soon he was walking the halls, with only a slightly spastic gait. I congratulated Jim publicly and told him that, no matter what else happened in his life, he could always look back with pride at his vigil with Leguerre. I think Leguerre realized Jim’s special efforts too, for he smiled at Jim much more broadly than he did the rest of us. On rounds I used Leguerre as an example of how even the most seemingly hopeless case could be sometimes salvaged with prompt diagnosis and treatment and

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti meticulous attention to detail. But three months later Jim told me that Leguerre had been readmitted and died of an overwhelming infection. The word was filtering through the hospital that our Haitian patients were suffering from the same disease that the media was calling the “gay plague.” The beginnings of the backlash were appearing—transportation workers refusing to escort patients for x-rays; nurses worrying about our patients in semiprivate rooms sharing bathrooms with other patients; interns skipping rectal examinations; surgical residents dragging their feet on performing biopsies and necessary operations. Back at the office, Margaret had started seeing gay men with the syndrome. Although she made no announcement, there was no mistaking the fact by those of us who shared the office. Some were stereotypically and openly gay. They dressed effeminately and talked with our secretaries as if they were sisters. Others were recognized only because they came back time and again with the same men. Although some were resigned, and all held up under the strain with remarkable dignity and fortitude, most were anxious. Their anxiety was not helped by Margaret’s schedule, which frequently had her in two places at once. There were frequent outbursts of anger as they waited. Some with Kaposi’s sarcoma had large, red lesions on their arms and faces that announced to the whole world that they were gay and had AIDS, like a modern-day scarlet letter. Some came with their parents. Others came with their lovers. Occasionally couples would know each other and make pleasant conversation about mutual acquaintances or interests. Usually, however, the mood was somber, especially if there were a particularly sick or wasted patient in the group. I had many discussions about this new development riding to and from work with Amal. She is an Egyptian Christian physician who lived with an American family in my neighborhood and worked in our office doing research with Mark on hypertension. She was fascinated with everything American and was an incurable optimist

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti and a compulsive storyteller. We were in the habit of having wide-ranging discussions about politics, religion, culture, and morals to pass the time as we commuted. She claimed an intense interest in the mysteries of life, which she attributed to her ancient ancestors, the children of Pharaoh. She looked remarkably like pictures of Nefertiti, with large eyes and straight black hair. She often told me it was the Christian Egyptians who were the true descendants of Pharaoh, not the Muslims, who sprang from Arab invaders. She held profoundly fundamentalist religious views, steeled by belonging to a religious minority in her own country. She did not believe in evolution, she interpreted the Bible literally, and she held a Calvinist view of fate. Nothing happened unless God willed it. She had several vignettes she would recount during our rides to work to illustrate God’s active intervention in her life. I was such an intervention—only a beneficent deity would have arranged for her to live in the same neighborhood as me and to have me pass directly by her home on my way to and from work. In exchange for this gift she felt compelled to convert me from skepticism. Fortunately for me, I had had the opportunity to previously practice all the religious arguments as I passed through Catholic high school and college. I therefore took these attempts at conversion as scholastic amusement, while she took them with sincerity and earnestness. On the assumption that the best defense is a good offense, I told her my theory of the homophilic origins of early Christian theology. This theory had been finely honed many years before during free periods in my college canteen. Of course, with all that talk of brotherly love and traveling around with a bunch of guys and never getting married, saying Jesus was gay was an easy first step. But three early followers deserved critical review. Was Judas’ behavior that of a lover scorned? Da Vinci thought as much in “The Last Supper.” And was St. John not the disciple that Jesus loved? Finally, there was Saint Paul. He was a Grecophile and a misogynist. By interpreting the experience of Christ in the light of Greek thought, he linked the God of Love forever to Plato, who clearly felt homosexual love was love in its purest form.

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti Such talk both scandalized and titillated her. She was intrigued that an American would even think about such matters. My conversion from skepticism became one of her priorities. She was fascinated by the closeness of some of the gay couples. “They always come in pairs,” she remarked to Fanny. “Just like Noah’s ark,” I commented, overhearing her whispers. She claimed there was no homosexuality in her country. “Not even among the Muslims?” I countered. She wavered at this and almost took the bait, since she despised the Muslims, but would not concede the possibility of homosexuality among her countrymen. To Amal, AIDS was a punishment visited on the gays for their sins. Better they should suffer here on Earth than suffer the pains of eternal damnation. The Haitians were more problematic, but she was unshakable in her belief that their suffering somehow manifested God’s glory. I did not tell her about Régis, but she discovered him in the waiting room, probably noticing him reading his Bible. She would frequently talk quietly to him and touch his hands until I called him to the examining room. She often asked me about his progress as we started for home. I could not resist asking her what sin God could be punishing him for. “He is strong in his faith. God will not abandon him,” was her reply. Then she paraphrased the story of Job, as if preaching a Sunday sermon. It was no longer possible to hide the fact that we were caring for AIDS patients. Some of the established private patients started making offhanded remarks to our secretaries, and the clinic administration also began making discreet inquiries into what we were doing. The number of gays was increasing faster than the number of Haitians. Margaret faced rising criticism from private patients, administrators, and unfortunately her peers. Régis continued to be unsuspected by the casual observer, thanks to his handsome features, conservative dress, healthy appearance, and perfect English. He began complaining of chest pain and shortness of breath, but his physical exam, chest x-ray, and stress test were

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The Zombie Curse: A Doctor’s 25-Year Journey into the Heart of the AIDS Epidemic in Haiti normal. I suspected he might be sensitized to noticing things that he otherwise would pass off as trivial. Not that I blamed him, but I tried to reassure him that, objectively, he was doing well. He was interested in the results of Margaret’s experiment with our blood. Unfortunately, I told him, his blood had killed my lymphocytes.