As a pediatrician in the 1980s, Ken Haller comes across a disturbing X-ray.
Ken Haller is a Professor of Pediatrics at the Saint Louis University School of Medicine and Cardinal Glennon Children’s Hospital. He is President of the Missouri Chapter of the American Academy of Pediatrics and serves on the boards of the Missouri Foundation for Health and the Gateway Media Literacy Project. He has also served as President of the St. Louis Pediatric Society; PROMO, Missouri’s statewide LGBT civil rights organization’ and GLMA, the national organization of LGBT health care professionals. He is a frequent spokesperson in local and national media on the health care needs of children and adolescents. Ken is also an accomplished actor, produced playwright, and acclaimed cabaret performer. In 2015 he was named Best St. Louis Cabaret Performer by the St. Louis Post-Dispatch, and he has taken his one-person shows to New York, Chicago, Denver, and San Francisco. His special interests include cultural competency, health literacy, the relationship of medicine to the arts, the effects of media on children, and the special health needs of LGBT youth. His personal mission is Healing. Ken is also a member of The Story Collider's board.
This story originally aired on Aug. 4, 2017, in an episode titled “Epidemics.”
Story Transcript
In the summer of 1981, I was beginning my pediatrics residency at Lenox Hill Hospital on Manhattan’s Upper East Side. The year before, I'd done a rotating internship at Nassau Hospital in Mineola, Long Island, about ten miles from where I grew up in a town called Hicksville. Yeah. I know.
It had always been my dream growing up in those post-war tract house suburbs, that someday I would live in New York City, especially after I was old enough to be able to buy tickets to the Long Island Railroad and go in by myself and see the skyscrapers and the parks and the museums and the Broadway shows.
It wasn’t until that year, though, that it really happened. What was really best about it was that I was moving in with Bob Corsico, my boyfriend, my partner, my lover. It was the ’80s.
And a funny thing, even though Bob and I met and became friends and fell in love in Omaha, Nebraska, when we were both students in Creighton University, Bob grew up in Syosset, Long Island, about two miles from where I grew up. It’s kind of like we were always meant to be together, like kismet.
The thing is when we both graduated from our respective programs, we moved east together. That first year, I lived in hospital apartments in Mineola and he lived at his parents’ house, got a job in the city and would commute in each day on the train. So finally, after a year, we were going to live the dream and live in New York City.
For those of you who may not have been adults in the 1980s, or even on the planet, for gay men to move in together in those days was kind of a big deal. I mean, just three years before that, Anita Bryant and her Save Our Children coalition had succeeded in overturning a gay rights ordinance in Miami, Florida, by expounding on how horrible homosexuals were with children. So it wasn’t something that you did lightly, especially if one of you was going to be going into a training program to become a doctor who takes care of kids. But love would find a way.
Now, Lenox Hill Hospital started out many, many years ago as the German dispensary in 1857 to serve the growing German community in New York’s east side. So basically, it really was a community hospital. It had a very small pediatrics program, only four residents in each of the three years. That meant that each of us spent a little bit of time at other hospitals, larger institutions, to get sub-specialty training that we just couldn’t get at Lenox Hill.
Which is why, in August of 1981, I found myself at Memorial Sloan-Kettering, then, as now, one of the premier cancer hospitals in the United States, to do my pediatric hematology-oncology rotation. I was taking care of kids from all over the world with cancer and leukemia. Memorial was the place where the mysterious cases were sent and, for many, including kids, it was sometimes the hospital of last resort.
Each morning, our team -- the attending physician, the residents, the interns like myself and the medical students -- would go down to the radiology department and go over the x-rays that had been done the day before with the radiologist. We had just finished up when he said, “Wait a minute. I know you guys are peds, but I wanna show you this one film that’s really interesting.” That’s when he sort of rifled through the x-rays that are on his desk, picked one up, and slapped it up on the back of the view box.
“Take a look at this. What do you think?”
We all stood in silence as we regarded this strange film. In my head, I started to go through the checklist that I learned as a third-year medical student about how to read a chest x-ray. Okay, by the size and soft tissue it appears to be a thin adult, probably male since no breast shadows were evident. Good quality film. No rotation. Heart size, normal. Normal shape. Lungs… something about the lungs.
For the most part, they were almost black fields indicating that the x-rays had gone clear through the mostly air of the lungs to expose the film behind, interrupted at regular intervals by the gentle white arcs of the ribs bordering and encircling the chest. But in the black, where there should be nothing: more white. Something. Some things blocking the x-rays, floating in space and looking like giant cotton balls.
Fluffy infiltrates is a term that radiologists sometimes use for lesions such as these. I thought I could rattle off a few things that might cause 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?”
“Twenty-seven-year-old, previously healthy white male.”
And I thought, That makes no sense. This is the sort of thing that’s usually seen in a fungal pneumonia in really old people.
“Yeah,” the radiologist said, “he's been coughing for a few months. Anyone wanna guess what this is?”
The attending said, “Fungal pneumonia.” I thought, Cool. Nailed that one.
“Nope,” the radiologist said, clearly pleased at having stumped a clinician. “Anyone else wanna take a guess?”
Silence.
The radiologist looked over the crowd, and with a sly smile, he said, “Pneumocystis carinii pneumonia.”
His audience did not disappoint. This revelation actually brought a gasp from the attending. For myself, I thought, That’s impossible. Pneumocystis was thought to be a protozoan and a very rare cause of disease in otherwise healthy human beings. In fact, my only previous experience with it had come the year before when I was doing a month of internal medicine at Nassau Hospital. I saw this woman in her late eighties who was diagnosed with it just before her death. For it to be present in someone this young and this healthy was inconceivable.
The attending was mirroring my thoughts. “How do you know that’s it?”
“Pulmonary did a biopsy, but shouldn’t your next question be, what’s a pneumonia doing at Memorial?” We looked at each other. Yeah, it should. Why, indeed, would an infectious pneumonia be admitted to a cancer hospital?
Again, the radiologist scanned the crowd and said, “Because he was originally referred here for Kaposi’s Sarcoma.”
Again, his audience was thunderstruck. Kaposi’s Sarcoma is a form of skin cancer that often looks like a bluish-purple bruise. In fact, most people think it is a bluish-purple bruise until they realize after weeks or sometimes months that it hasn’t gone away. That’s when they go to the doctor to have it checked out and they get the bad news.
But again, it was only seen in very old, sick people whose immune systems were not working. What was going on with this twenty-seven-year-old?
“Yeah, so the guy comes in. They find out he's been coughing and they get this chest x-ray. He's been losing weight. They find out it’s pneumocystis and they're stumped. So they talk to other docs around town. They find out that he's not the only one with this stuff going on -- like five, six cases like this, pretty much like it, right here in New York. And you know what they all have in common? They're all homosexual.”
I don't know if I broke into a sweat. I imagined that my face flushed and I’m pretty sure that my heart started pounding like one of the jackhammers out on York Avenue. I stared at the x-ray for something. What?
“Wait a minute,” the attendee said. “I think I read something about this in Morbidity and Mortality Weekly Report. These clusters of homosexuals coming down with these weird diseases. Here, San Francisco, Atlanta.”
“This is one of them,” the radiologist said, as if he were presenting a rare white tiger.
Pneumocystis carinii, Kaposi’s Sarcoma, fluffy infiltrates -- words I'd heard, things I'd seen, but, in the pit of my stomach, I knew I would see them over and over and over again in hospitals, in clinics, in bars, in friends. Something bad was happening, and this guy, this twenty-seven-year-old, he could be me. Someday, I wondered, would I be him?
I don't remember that much more of the conversation that followed as people started talking about what they’d heard and hadn’t heard, what they knew and didn’t know about these clusters of cases. Someone said something about sexual spread. Someone else, something about a term she’d heard before called Gay Lung Disease. Someone else made a wisecrack about faggots. I stood silent staring at patterns of shadow and light.
Once I got back to the inpatient floor, I had a lot of sick kids to take care of and it really didn’t give me time to think much about this guy with this thing with no name. It wasn’t until much later as I finished my work and I was walking slowly the fifteen blocks back to my apartment at Second Avenue near 80th in the dark, still, hot August evening that I started to feel the unease of the morning return.
I got home late that night. Bob was there. He’d already eaten, as usual. “Long day, huh?”
I said, “Yeah.”
He fixed me a plate, as usual. “Yeah, long day,” I said as I looked up at him, almost examining him.
That night I held Bob in bed as we slept and 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 twenty-seven-year-old guy I would never meet would be one of the first gay men diagnosed with something that would briefly be called GRID, for Gay-Related Immune Deficiency, and later would become known to the world as Acquired Immune Deficiency Syndrome, or AIDS, and that a virus that would be dubbed Human Immunodeficiency Virus had already spread to many of my friends and that many of them would die in the coming years.
I didn’t know then that Bob and I would split up three years later, but that we would become very best friends very soon after that, and we would remain best friends until he died at the age of thirty-six on Thanksgiving weekend 1994.
I didn’t know then that Bob would come to me in a dream in 1997, a dream which I know to be a real visitation against all reason and all science because it was briefly interrupted by a phone call which I did not answer, but which I found out later was from Bob’s mother, who was calling and said she felt compelled to call at that moment just to ask how I was.
I did not know then that, in that dream, Bob would comfort me and tell me that he was at peace, that death was nothing to fear, that he would always be with me and he would always love me. Kismet.
I didn’t know then that this day would mark 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 on the time of plague.
I didn’t know any of this as I held my lover on that sultry night in August as he slept peacefully in my arms, or earlier that day as I stood frozen in the dark, staring at the chest x-ray of a nameless, doomed twenty-seven-year-old gay man.
What I did know, as I finally fell into a troubled sleep that life, as I knew it, had changed forever.
Thank you.