Friday, July 27, 2018

Angels in America: reflections

I trained in obstetrics and gynecology in Brooklyn NY.  I began my residency in 1983 and finished in 1987.  I was in Brooklyn when young men who were previously in the peak of health began dying of a mysterious disease which attacked their immune systems, produced Kaposi's Sarcomas on their skin, gave them terrible oral candidiasis, chronic diarrhea, ulcerated mucosal membranes, herpes blisters, genital warts, and Pneumocystis Carinii pneumonia.  Then there were atypical viral meningitis cases.  There were also some women coming down with these symptoms.  Immunodeficiency.  AIDS.  HIV.  People would hear the answer to their blood tests, and some would commit suicide.  Some went home to die.  No one was certain what else could be done to mitigate this plague.
When I was in internship and residency, it was required that we put an i.v. into every woman in labor, before the baby came, to be able to treat quickly any postpartum hemorrhage or other crisis.  We had a little machine in Labor and Delivery to be able to spin a hematocrit, to know if the patient was already anemic before delivery, to be prepared even better for meeting the crisis that might kill her.  Some of the women in my neighborhood, especially Orthodox Jewish women, were having a dozen children, having been instilled with the hope that they could help replace children for so many relatives lost in the Holocaust.  These women were very anemic and often exhausted, and at great risk of hemorrhage after delivery, as the uterus may not close down well when it is tired.  Some of the women in my area were from one of the many sub-cultures in Brooklyn, and some were drug addicts.  Putting an iv into the arm of a pregnant woman who is writhing and wiggling with the pain of labor is not always an easy task.  The risk of non-cooperation or panic is inadvertent fingerstick contamination of the person starting the iv.  All during my career, there were advances being made to make this less risky, but in the beginning, we all were moving very fast, and often didn't put gloves on, to get the iv going, as delivery was imminent, and we needed to get the patient ready, and the hematocrit had to be on the chart. 
And so, gratitude:  because when I got to California, my HIV test was negative.  Otherwise I couldn't have even gotten a job in my field, or had my career at all. 
     I have been watching the movie "Angels in America".  I guess it came out in 2003, but I was working, and never saw it.  I wanted to see it, and I read the reviews, but until today, I had not gotten to see either the play or the movie.  I am riveted, deeply riven, by what I remember from my time in Brooklyn, from the death of young and beautiful men, from the bewilderment of mothers like Mrs. Pitts, and from the kind of guy Roy Cohn was.  It is an amazing thing to me that Tony Kushner wrote that play, and centered it in 1986.  It is an amazing thing about faith, about how we consider time, and what we think about all the shadowy things in complex places like New York.  About 2 years ago I read the book by Abraham Verghese, "My Own Country".  He was an Infectious Disease specialist, trained in NY at the same time, and went to Tennessee.  His book is about the beautiful young men who went home to die, in Appalachia.  Yes, there were some medications, like AZT, which helped keep some of the young men alive, and helped raise their T cell counts enough to keep them from contracting every damned infection we could name, as well as several new ones.  Every day and every week there were funerals, and people were talking about miracle cures, and what adjunctive supplements might help your immune system to stay strong. 
     One of my best friends in college and afterwards was gay.  He was very fluent in German, and was in Heidelberg during the beginning of the AIDS epidemic, and by the time he came back to the US, there was more information, more prudence, more ways to help.  But still, he watched and help many friends die, and one of our mutual friends went blind before he died, a terrible thing for a librarian who loved beautiful books. 
     There is so much I did not understand about the whole epidemic, even as a doctor.  And it was quintessentially male, in some ways;  the attention to it, the men who rose to the challenge in medicine to try to stop the wild fire it was;  the complexity of the immune system.  One of my women friends was a lab tech at UCSF, and she was one of the first who saw the cells in the lab, the blood work, the problem;  working with hematologists at the vanguard of the medical front to treat, to deal with, to attempt to find a vaccine.  Luckily, she also did not get stuck, she is alive, like me. 
     Watching the movie was amazing, and there is that weird and wonderful coincidence of Joe's being a Mormon, and the kookiness of the angel appearing even to his mom.   There is the self-defeating oddity of Joe's wife, very much like most women who find out they are married to a gay man, and can't get past the excoriating feeling that somehow it was all their fault, and the basic terrible unhappiness and sadness, tension, anxiety, despair.  I was glad she got out.
     And there is Roy Cohn, the epitome of cynicism and mean and nasty use of power.  What a tour de force by Al Pacino.  Wow, that is acting!   And also Meryl Streep.  I loved her playing Ethel Rosenberg, and I really loved her helping Lou remember the words for the Shema.  But my favorite character was Belize;  such a complex character, and with great sweetness and compassion, even as he is hemmed-in by cynicism and very difficult realities. 
All in all, a fabulous movie, and deserving the accolades it got. 
A powerful story, with powerful characters, and of course, since I like angels, it was interesting to see the struggle with the angel, and the whole dilemma of prophecy, the uncertainty about what it means.  I love those big wings, and the hallucinatory experience of the heavenly committee.