Realizing he was a member of a tangled (a favorite word of the author) group of transsexuals, James felt himself trapped in a conundrum of gender (he felt and considered himself female) versus sex (he was genotypically and phenotypically male). “To me gender is not physical at all but is altogether insubstantial; it is soul, perhaps, it is talent it is the essentialness of oneself” (p.25).  

After some fruitless interactions with the medical profession, Morris travels to Casablanca in the summer of 1972 to undergo sex-changing surgery and becomes Jan Morris. Unlike many if not most transsexuals, post-operatively Morris fared quite well emotionally and was quite happy with the change.  

Jan Morris’s writing is as humorous and eloquent as James Morris’s was. She describes how magazines like Rolling Stone, publishers like Random House, and thousands of readers have never cared what gender or sex was holding the pen; how life changed in clubs, restaurants, and in taxicabs, where Jan met the first man to kiss her, post surgery, “in a carnal way” (p.151). Morris records that “all I did was blush.” 

As the chronicle of one sensitive and highly literate man’s journey from manhood to womanhood, Conundrum offers much commentary on the states of mind of a transsexual, a highly polished writer undergoing the humoral, mental, emotional, and cultural changes of such surgery.  

Prior to surgery, Morris writes about feeling deprived of an identity: “I realize now that the chief cause of my disquiet was the fact that I had none. I was not to others what I was to myself. I did not conform to the dictionary’s definition–‘itself and not something else’ ” (p.40-41). All Morris wanted “was liberation, or reconciliation–to live as myself, to clothe myself in a more proper body, and achieve Identity at last” (p.104). It took courage but it was worth it and Conundrum reads like nothing more, and nothing less, than a successful odyssey of the sexual soul. 

Jan Morris died in 2020, aged 94. 

Jan Morris: Journalist, Historian, ‘Writer About Place’ – Faculty of English

Conundrum
Jan Morris 
New York Review of Books Classics, paperback 2006: 176 pages 
Originally published by Faber and Faber, London, 1974 

Web image by medhum

A Most Unexpected Path Laid by a Most Unexpected Disease

Dr. Ross Slotten chose family medicine to serve patients from cradle to grave. But, as he was entering practice, the AIDS virus was entering the community where his practice was situated, and he found himself serving patients much closer to the grave than the cradle. 

In June 1981, a few weeks before I began my internship in family practice [at Saint Joseph Hospital in Chicago], the Center for Disease Control in Atlanta had published the first report of a strange lethal infection among a cohort of gay men in Los Angeles. I had no clue then that the disease would soon kill friends, former lovers, colleagues, and patients; devastate tens of millions of people and their families worldwide; and consume my entire professional life and more than half my chronological one. (p.14)

From both the circumstance of time and place he found himself in, and the sense of necessity and compassion that claimed him, Slotten’s professional trajectory unexpectedly shifted away from traditional family medicine towards specializing in AIDS. His interest in AIDS, however, extended to personal considerations, because as a gay man, he was part of the population at risk, and harbored the same anxieties and fears he saw in his patients and throughout his social circles. His patients were principally gay men because of his geographic location in an established gay community and the resulting referral patterns. The book chronicles both his experiences as a physician taking care of gay men with AIDS, and his experiences as a gay man at risk for AIDS. For Slotten, these experiences were not independent of one another, which makes for rich insights on the complexities of both. 

Slotten spent a lot of time at Saint Joseph Hospital because his patients required intense medical support and specialized services. He tells how he and his practice partner pushed for establishing a specialized AIDS unit in the hospital. They bumped up against usual bureaucratic obstacles, plus a few more concerning issues specific to AIDS patients, but they ultimately prevailed. Slotten “was to spend the next fifteen years there, often heartbroken, occasionally inspired.” (p. 109) In contrast to his commitment, he recounts how some specialists he called for help with particular patients refused when told they had AIDS. Those occurrences stuck with him: “I couldn’t forgive those other physicians for abandoning me and my patients in the hours of our greatest need.” (p. 108)

With whatever little time he had left for volunteer and advocacy work, Slotten stayed local. He talks about the volunteer-run health clinics where he worked (e.g., the famed Howard Brown Clinic), and the housing facility he helped set up for homeless people with AIDS. He left protesting at the Food and Drug Administration, the National Institutes of Health, and the annual International AIDS Conference to others while he focused on his patients, his studies, his volunteer work, and his own safety.

The 2020s are approaching when Slotten writes about the preceding three-and-a-half decades. As he finishes the book he is still caring for people with HIV, but the horrible complications of AIDS are now infrequent since the availability of effective medications. His practice had been reliably stable and predictable for some time, a circumstance he could only dream of when he first started. That dream ended abruptly just as the book was released on July 15, 2020: Covid was surging.

Moments of Horror, Relief, Calm, and Then…

Slotten’s perspectives correspond with the trajectory of AIDS over the thirty-five years his memoir spans. Particular periods are discernable, beginning when gay men were presenting with illnesses associated with profound immunodeficiency of unknown cause. Another is the time of peak AIDS death and destruction represented by the moment in 1992 when Slotten hears from the Chicago Board of Health, “that no one had signed more death certificates in Chicago than I had.” (p. 122) The next moment arrives at the turning point when highly active antiretroviral treatment (HAART) became available, transforming HIV/AIDS for him “from a universally fatal disease…into a chronic one like diabetes…it was almost beyond belief.” (p. 186) Then the prolonged period of relative calm when AIDS became controllable—even preventable—with Slotten noting during a moment in 2016 that, “It had been almost a decade since I’d cared for someone with advanced HIV infection, and I hadn’t lost a patient to AIDS since 2004.” (p. 202)

The AIDS epidemic is known for and measured by the number of deaths that occurred. Slotten wants us to remember the misery the disease causes.

For those who didn’t experience that terrible time, or who’ve forgotten how terrible it was, let my chapters serve as a warning to the complacent and the ignorant: untreated HIV is as ruthless as any terrorist and as destructive as a nuclear device. (p. 3)

He drives this point home when he recounts the stories of individual patients tortured by Pneumocystis carinii pneumonia, Kaposi’s sarcoma, cytomegalovirus retinitis, herpes simplex infections, cryptosporidium dysentery, AIDS wasting syndrome, AIDS dementia complex, and progressive multifocal leukoencephalopathy among other medical horrors, and who often suffer many at the same time. And, all the while, he had little to offer but his wits and his compassion. 

Both attributes would be called upon again in 2020 as Covid struck. Though those with Covid did not produce nearly the fatality rate of AIDS, not nearly the severe comorbidities of AIDS, not nearly the stigma and prejudice as AIDS, and not any of the governmental insouciance seen with AIDS, it still caused a lot of death, suffering, grief, and misinformation at a time when only supportive care was available. Like AIDS, though, the Covid pandemic was transformed into a manageable syndrome with the availability of an effective vaccine, new antiviral agents, and better clinical management regimens.

Complacency remains a threat to the reemergence of any infectious disease. Indeed, AIDS is reportedly rising in poor and developing countries in 2026 as funding for AIDS treatment and prevention programs has been withdrawn from donor countries, mostly that from the United States. Lessons from Slotten’s book may thus be called upon again.

Notes

Book citation:
Slotten, Ross A. Plague Years: A Doctor’s Journey through the AIDS Crisis. University of Chicago Press, 2020. 224 pages

Plague Years is a good companion to the documentary film, 5B, which reports on how San Francisco General Hospital coped during the early years of the AIDS epidemic, and Rebecca Makkai’s novel, The Great Believers which features the stories of a group of gay men in Chicago also during the early years of the AIDS epidemic.

Dr. Slotten was a guest on an episode of The Clinic & The Person podcast to discuss his experiences during AIDS epidemic as he reported them in his book, and how well they match up with what we see in 5B and read in The Great Believers.

Web image by Medhum.org

The narrator has enjoyed a mostly healthy life. He has traveled to Europe and once was treated for syphilis while there. He has been together with L for seven years. Both men are writers who teach at the university. Now, the pain that grips him defies exact description (even for a professional writer). The closest comparison that he can conjure is having someone’s hand plunge into his body and twist his guts along with the sensation of being kneed in the groin. He’s reluctant to seek medical attention since medical facilities are especially risky during the pandemic. So he waits and hurts. The pain is soon accompanied by fever, chills, and aching of the limbs. 

He decides to go to urgent care. After a brief evaluation, he’s referred to the university medical center ER. Covid testing is negative. A CT scan reveals an aortic dissection (tear in the aorta) associated with aortitis (an inflammation of this large blood vessel). He is told that such a tear is frequently fatal. He’s lucky to be alive. The narrator is placed in the ICU and treated with IV antibiotics, fluids, and antihypertensive medications. The vascular surgeon recommends holding off on any operation (either a stent or a graft), hoping the tear and inflammation will stabilize and heal. 

Hospitalized for a week and a half, the narrator confesses his feelings of helplessness, shame, bewilderment, and fear. He is intrigued by the bustle of the hospital – almost electric with human energy – but despondent over the seemingly omnipresent suffering there – his own, that of fellow patients, and even the distress of healthcare workers. He is most impressed by and appreciative of his ICU nurse, Alivia. As for the physicians involved in his care, the narrator notes the stark clinical detachment of many doctors. Reflecting on a visit from a rheumatologist, he concludes, “I was nothing to her, really, I was her job, she would clock out and enter her real life” (p124). He craves to sense some vulnerability and genuine concern emanating from his physicians. As for empathy, the narrator reveals some of his own when he decides, “it must be hell to be a resident” (p129) in training. 

The search for possible rare etiologies of his condition comes up empty. As his condition slowly improves, the narrator still worries about his current predicament and the future: “I was an enigma, they said, a conundrum, they were running out of ideas” (p121). The waiting for and indecision about any kind of surgical intervention wears on him. He wonders if it might be best to have an operation. 

But the narrator never has surgery. A repeat CT scan confirms stability of the aorta and resolution of all inflammation. He is discharged home on oral medicines and continued IV antibiotics. Frequent follow-up appointments with his doctors and imaging studies of his aorta are scheduled. His partner L lovingly tends to his needs. His sister G arrives to help too. The narrator’s prognosis is murky. Did he dodge a bullet? Or are further problems with his aorta inevitable? How does a person cope with such chronic uncertainty. Although the narrator is weak and emotionally rattled, he is happy to be alive, pain-free, ambulatory, and home with his lover. Shouldn’t that be enough? 

The novel reads more like a memoir than a work of fiction. It is impressively authentic and accurate about medical matters – the lingo and professional behavior of physicians, nursing care, clinical procedures, what it feels like to be a patient. Readers will rightfully consider whether the book’s author is perhaps recounting his own experience with a serious health problem.  

In this novel, the human body is depicted in many ways: sensuous, serviceable, surrendered to others, surreal when sick. The narrator’s experience of illness includes a warping of time, the pull of memory, the weight of regret, the need for truth, and the magic of love.  

The poet-protagonist is occasionally irritated by the language and metaphors spewed by doctors and nurses. The use of broad-spectrum antibiotics is explained to him as a “carpet bomb approach.” He is warned about the caustic effect of IV drugs and that his veins might “burn out.” This medical lexicon prompts the narrator to ponder “who taught these people, who gave them their vocabulary, their stock of images” (p86).  

We don’t need a novel (even an exceptional one like Small Rain) to remind us about the randomness and chaos of ordinary life, the uncertainty of health in the future. But we can look to great literature for inspiration, to help us understand and cope with those looming, difficult experiences. The word rain is both a noun (drops of moisture or a spiritual blessing) and a verb (something sent down in abundance). Whether it is tears (of pain and emotion), love, or gratitude, the rain in this story is hardly small.  

Small Rain: A Novel 
by Garth Greenwell 
New York: Farrar, Straus and Giroux, 2024, 320 pages 
ISBN 9780374279547 
Web photo by Pawel Nolbert 

Strauss and Schonberg were products of high German culture and were inspired by the notion of bildung, that man’s perfection is achievable by embracing the humanistic arts. Of all the elements of culture – visual arts, literature, sculpture, dance – for Germans, music was considered the ultimate and most noble embodiment of the human spirit. How could one maintain this enlightened vision of bildung after witnessing the dark years of the Third Reich? That is the tragedy that confronted these two men. Strauss, a non-Jew, had to reconcile his prestigious position in the German musical establishment and his social status with the need to toady up to the Nazi brass to save the lives of  members of  his family by marriage who were Jewish. He never renounced Hitler or the Nazi party. Schonberg, who earlier in his life followed Gustav Mahler’s lead  and converted out of Judaism to the Lutheran church, was still forced into exile to escape the Nazis, and thrived in a German expatriate community in Los Angeles. The world war reawakened his self-identity as a Jew and forced a reassessment of his relationship to his fellow Jews. Eichler sees Strauss’ Metamorphosen and Schonberg’s Survivor of Warsaw as timeless musical monuments to those who suffered and perished at the hands of the Nazis, works that gain their special power by being expressions of each man’s inner turmoil.

Britten and Shostakovich lived in an entirely different world than Strauss and Schonberg. Nonetheless, they too suffered though the ravages of the Second World War. Britten, a gay man and committed pacifist, never served in active military duty. But he witnessed the nightly bombings of England and the German artillery attacks along the coastline near where he lived. Shostakovich was alternatively celebrated and reviled by Stalin. He lived a life of continuous dread, trying to survive as a person and musician when a death sentence could come at a moment’s notice at the whim of the Great Leader. Britten was commissioned to write a musical piece to accompany the dedication of the Coventry Cathedral which had been nearly destroyed by a night-long Wehrmacht bombing raid; Shostakovich was inspired to write his 14^th Symphony after reading  Yevgeny Yevtushenko’s 1962 poem “Babi Yar”.  For Britten, the War Requiem was a pacifist’s response to the self-destructiveness of war and the grievous loss of a generation of young able-bodied men; Shostakovich’s work was his attempt to come to grips with the moral blindness of the Russian people who denied their complicity with the Nazi murder of 33,000 innocent Jewish men, women, and children at the ravine outside Kyiv in broad daylight, in one ghastly day.  

This overview hardly captures the dense description of these four men and the turbulent times they lived through. There are astonishing subplots and characters in each composer’s narrative. Eichler retells how Schonberg originally reached out to Serge Koussevitsky to premiere Survivor of Warsaw. When the conductor demurred, the inaugural concert ended up being performed by a community orchestra and choir in Albuquerque, New Mexico. When Britten toured the Displaced Person camps after World War II and played piano accompaniment with the violinist Yehudi Menuhin at Bergen Belsen, the intensity of his playing profoundly affected a young Venetian woman named Anita Lasker, who survived the Holocaust only because she had been enlisted to play in the inmates’ orchestra, directed by a colleague of Strauss and Schonberg. There is so much in Time’s Echo and the best advice is to allow yourself to be immersed in the book. 

Eichler is a precise and enthusiastic writer, and he fully captures the emotional toll of living through the two World Wars, in Germany, England, and Russia. The inhumanity of the trench warfare in World War I, the insane hatred driving the Nazi genocide of the Jewish people in Europe, the unprecedented destructiveness of World War II, the senseless starvation and killing of millions of Russians during the forced agricultural collectivizations and the German siege of Leningrad – all of these are depicted by Eichler in stark prose. 

There is so much to comment on. Let me focus on one point – Eichler’s assertion that music is the optimal way to memorialize events in the past. To begin, one might question the need to remember altogether. In Zachor (University of Washington Press, 1982), Yosef Dov Yerushalmi documents how important memory is to the Jewish people. History is not a simple record of dates and facts. Instead, history and memory are meant to bring the past to life and reinforce faith and commitment. But David Rieff, in the book In Praise of Forgetting: Historical Memory and its Ironies (Yale University Press, 2016), suggests that overemphasis on memory of past events can ensnare people in a web of accusations and counterclaims and weaken individual agency. And do the musical memorials composed by the four composers point a way forward to overcome the failings of the past or do they create an emotional trap? The swirling currents of hatred circling our world today give pause to any notion that the works of these composers have brought us any closer to a world of tolerance and peaceful coexistence.  

All of the senses participate in the formation of memory. Proust famously wrote about how the smell of a madeleine evoked deep-seated memories in one of his characters. Eichler gives pride of place to hearing and music. There is no question that hearing a particular popular song or piece of music often triggers recollection of pivotal moments in a person’s life. Eichler has a wonderful feeling for the musical compositions, which range from seven minutes to over an hour long and play such a central role in Time’s Echo. However, I wonder whether most of us can delve as deeply into the content and feelings articulated in a piece of music. It is not the evanescence of sound per se that makes me uncertain, because all sensory perceptions are transitory and both sights and sounds can be captured and reserved for posterity in photographs and recordings. But it is the complexity of classical music that I find daunting. In Rebecca Goldstein’s book 36 Arguments for the Existence of God: A Work of Fiction (Pantheon, 2010), there is a scene in which a math prodigy and his genius friends are sitting around and for entertainment, they challenge each other to sing variations of famous classical music pieces like a Bach prelude shifted up by a third, changed from the major key to minor, or starting from the middle and going backwards. Do we need to understand music with such precision to be moved by the complicated creations of Schonberg, Straus, Britten, and Shostakovich? I’ve listened to the four pieces of music discussed in the book, and though I was moved, I know I was not as appreciative as Eichler of their artistry and nuance.  

Three of the compositions were accompanied by text to focus and amplify the impact of the music. Some of the choices were straightforward, like the poem by Yevtushenko. But the selection of works by Wilfred Owen to accompany the War Requiem and the words that Schonberg wrote to be read during the performance of Survivor of Warsaw contribute greatly to the emotional power of the two works. So much to ponder, so much to learn.

Echoes lose their intensity as they bounce off surfaces and spread out in space. Eichler’s book does not echo, it resonates and amplifies. It is overflowing with content that touches on so many topics and issues. It activates each one and gets them vibrating, different frequencies, different pitches. In the end, Time’s Echo creates a symphony of ideas that we can all read and listen to, one glorious mixed metaphor

TIME’S ECHO
Jeremy Eichler
Knopf, 2023, 386 pp

On this episode, we talk with Dr. Ross Slotten about his memoir, Plague Years: A Doctor’s Journey through the AIDS Crisis. He covers the time from when he entered family medicine practice just as AIDS was emerging, through the crisis, and the decades since as both a physician and a member of the at-risk community of gay men on the north side of Chicago. We also talk with Dr. Slotten about two other sources covering the early years of the AIDS crisis: a documentary film about the first country’s first AIDS unit at San Francisco General Hospital, and a literary novel about a group of gay men with AIDS or at risk for AIDS in Chicago. 

More about Dr. Slotten’s background is here, which includes authorship of the book, The Heretic in Darwin’s Court: The Life of Alfred Russel Wallace (published by Columbia University Press, 2006).

Sources:
Plague Years: A Doctor’s Journey through the AIDS Crisis by Ross Slotten, published 2020, University of Chicago Press
5B, directed by Paul Haggis and Dan Krauss, released June 2019
The Great Believers by Rebecca Makkai, published 2019

Russell Teagarden’s blog pieces on episode sources:
Plague Years
5B
The Great Believers

Recommendations (we didn’t have time to talk about):
Rent (play, movie), Jonathan Larson
Angels in America (play, movie), Tony Kushne
Blue (movie), Derek Jarman

The Clinic & The Person is a podcast developed by our editor Russell Teagarden to summon or quicken the attention of health care professionals, their educators, researchers and others to the interests and plights of people with specific health problems aided through knowledge and perspectives the humanities provide.

Feature image by Iluha Zavaley