Where AIDS Has Come To Dwell
By Fitzhugh Mullan
Sept. 26, 1995
For many of us, AIDS remains a seemingly distant phenomenon that is more rumored than real-a Bosnia, a Rwanda, an earthquake in Japan. This is not true, of course, in some quarters of America. Abigail Zuger, an infectious diseases physician in New York, has written a small, gripping book depicting "the steady drizzle of human loss [that] HIV has brought to the inner city." Her subjects are her patients, eight men and women seeking help for their advancing disease and its tentacular complications. The setting is a public hospital in the Bronx where, Zuger observes, AIDS "has less to do with sexual politics than with individual citizenship, less with abstractions of art and morality than with the mundaneness of food, shelter, child care, and Medicaid cards. No disease shows up the crazy quilt of American medical care for the shabby thing it is among the sick-to-death poor better than AIDS."
AIDS was introduced into the Bronx-as in a growing number of inner cities-by means of intravenous drug use. Fueled by continued drug use, and amplified and disseminated by sex, AIDS is now consuming those still on the streets as well as those who have long since left them or were never on them. Zuger captures the voices of astonishment as well as the voices of pain that describe the full invasiveness of the epidemic: " `I was just a kid back then . . . off the stuff for six years now' . . . in a program, back in school, in a good job, haven't seen that man in years, just got married, had a fine fat little baby, just slipped up once, or twice . . ." The HIV virus is now resident and prospering deep in the Bronx.
Drugs lie beneath or very near the biographies of all of Zuger's patients. A longtime drug user, Michael Soto went clean when he discovered he was HIV-positive, making a new resolution of little import to his disease. His wife has serendipitously dodged the HIV bullet and cares for Michael and their daughter. Lydia Rios was not so lucky. Her husband, Eddie, a likable, hyperactive man whom Zuger characterizes as running at "78 rpm in a 33 world," has a long history of drug use. Well into his illness, she is diagnosed as HIV-infected. She follows a rapid downhill course, and Eddie ends up ministering to her. Cynthia Wilson and her 60-year-old mother both have AIDS-the separate and parallel bequests of drug-using boyfriends.
AIDS is now a chronic (in the sense of long-term) and immensely complicated disease. "Strong Shadows" tells about the special struggle of those caring for AIDS patients in public hospital systems where missing medical records, lost X-rays, discontinuity of care and reluctant consultants are standard fare. She talks about the avalanche of patients and the challenge of budgeting her attention-"My time is diced up into tiny twenty-minute pieces and fed to the sick." Despite the multiple ramifications of AIDS, she reports her core vocabulary to be a starkly primitive one: "five or ten concrete nouns (fever and headache, cough and sweat), no abstractions, two adjectives (good and terrible), one adverb (pretty), and about seventy-five brand names."
In an epoch in which self-satisfied AIDS moralists want to draw a line between "us" and "them," Zuger's patients instruct us in the fallacy of such notions. The destruction wrought by AIDS cuts a far wider path through the Bronx than the simple "punishment" of those who have been "immoral." It kills bystanders, it tears up families, it weakens communities. For those who believe in forgiveness or second chances, AIDS has no such scruples. It respects no conversions and shamelessly reaches out years later and puts its terminal brand on those who have long since abandoned their high-risk ways. There is no "us" and "them" in an epidemic.
"Strong Shadows" should be read as a cautionary tale for those who want to look the other way as AIDS continues to spread. Abigail Zuger has brought a clinician's vision and a poet's touch to a tough and important topic.
The reviewer is a public-health physician and the author of "Plagues and Politics: The Story of the United States Health Service."
© 1996 The Washington Post Co.
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