Amazingly, prior to that moment, I had never even heard of AIDS. My resident was stupefied by my ignorance. He laid out the unadorned truth. These men are all dying, he said. They are wasting away – just melting into their beds. They will be our patients until they expire, he predicted.
Sure enough, when I went to the bedside, I found these patients to be mere skeletons – thin, emaciated, with parched lips, vacant eyes, and hollow temples – the familiar visage of an end-stage cancer patient just before death. Their sparse hair was falling out, and their dry skin was flaking away. They responded feebly to questions with barely the strength to drink from a straw. Their faint, fetid breath would not bring fog to a mirror.
These were hollow men, pale ghosts of their former selves. And they were half my patients. The other half were patients with diseases of the heart, lungs, and liver – the usual fare for an Internal Medicine resident. For the remainder of my training, this would be the ratio: half and half.
At that time, AIDS had a name, but no one knew how the immune deficiency was acquired or why it specifically singled out gay men or intravenous (IV) drug users.2 There was a theory going around that individuals who used intravenous drugs and men who had sex with men were exposing their bodies to a bombardment of foreign substances (antigens) that were somehow breaking down their immune systems. Unless you practiced those behaviors, you could not get AIDS.
This was wishful thinking, however. Much more likely was that AIDS was caused by a novel infectious agent, transmitted by either sexual contact (gay men) or by blood exposure (IV drug users). This was not a popular theory among my colleagues in the training program, however. If AIDS were caused by a transmissible disease, then it would be contagious. A contagious disease could be spread theoretically to anyone, including us.
From The Ailing Nation, Chapter Seven: Compassion
My training experience in the early 1980s was ruled by AIDS. Although I had not even heard of the disease while in medical school in the Midwest, by the time I had arrived in New York, it was an epidemic of astonishing proportions – afflicting half our hospital’s patients. The two most important features of AIDS were that it invariably took the life of the patient, as there was no known treatment at the time, and it threatened the lives of health workers. In this respect, AIDS presaged the arrival of Ebola and COVID-19, for which the danger to caregivers was a prominent feature. But Bellevue has always had a special role for fatal infectious diseases throughout history: smallpox, yellow fever, typhus, tuberculosis, and then AIDS. We were the hospital of final resort for residents of New York City with nowhere else to go. And when all else failed we had one final offering to the dying patient: compassion.