Out of the gay rights activism in the 1970s came AIDS activism in the early 1980s. By then, the incidence and severity of AIDS had become evident and caused enough fear to generate social backlash against those with the disease. This, along with federal government insouciance at the time, made it necessary for gay rights activists to extend their remit into advocacy for health care specialization and research advancements for AIDS. The expanded activism was visible on the streets and at governmental research institutions (e.g., National Institutes of Health). Where it was also taking place, and not in such an obvious way, was within certain hospitals.  

San Francisco General Hospital answered the call first in 1983 when it created a special unit for the care of people with AIDS in “Ward 5B.” The unit was in operation through its move in 1986 into Ward 5A to accommodate more patients, and until 2003 when advances in antiretroviral treatment of AIDS made the unit no longer necessary. But throughout, the struggle to maintain and advance the unit medically, socially, and politically persisted. The documentary film, aptly named “5B,” covers the struggles, successes, and failures of the unit, and the activism required of the staff and advocates for its creation and ongoing viability.  

From the Inside 

The story is told from various perspectives through interviews with key figures in the unit’s development and operation, and with archival footage of the unit and AIDS activism in the community. The most prominent among the key figures is Cliff Morrison, a clinical nurse specialist who spearheaded the idea for the unit and then managed it. Several other nurses who served in staff and supervisory positions are also featured. Participating physicians include Paul Volberding, an oncologist at the time who became pivotal in the development of effective HIV treatments, and Julie Gerberding, a physician treating patients on the unit who later became the Director of the Centers for Disease Control (CDC). Lorraine Day, the chief of orthopedic surgery at the hospital when the unit opened, is heard often as an opposing voice. Hank Plante, a local television news reporter, also appears frequently to offer his perspectives on many of the social and political issues swirling around the unit. Among other participants are AIDS activists, volunteers, and family members of unit patients. 

Several storylines frame the documentary including how nurses drove the unit’s inception and then were instrumental in running it. “Nurses were in charge,” said Volberding, admiringly. Interwoven throughout the film are the experiences of the patients and individual nurses, including one nurse who was infected with HIV from a needle stick. “Those nurses were the real heroes,” said one activist.    

Rare is the story, though, about heroes who aren’t confronted with daunting challenges, and thus this documentary includes a storyline involving attacks the unit nurses encountered from inside the hospital. The nurses of this unit practiced in ways they considered safe but not in such a manner that would preclude them from touching patients or require them to don so much protective gear they become unseeable. Nurses and clinicians from other units objected and did not want to be compelled to adopt practices they thought endangered them on the occasions they took care of AIDS patients. The film follows this story through union grievances and public debates to their conclusion, which sided with the unit nurses and their advocates. The spirit of activism among the unit staff was pivotal in fending off the many challenges they faced. 

Keeping in Touch 

The documentary reveals stark juxtapositions that can manifest in the midst of an infectious epidemic, and in particular when an epidemic selects an identifiable group that is unwelcome in mainstream society. Two juxtapositions that stand out are the emotion of love with that of fear, and those who are deemed worthy with those who are considered disreputable. 

No treatments for the HIV infection or for the many horrid and lethal diseases resulting from AIDS were available when the unit opened—it was “a very, very unpleasant death” as one nurse put it. The nurses saw a big part of their role as offering love: “Here you were allowed to love your patients.” They offered it through human touch. Morrison’s view was, “If we can’t save these folks, we’re going to touch them.” To touch the patients in this way required that they balance it with the risk of exposure to infection and still comply with universal precautions. Nevertheless, fear was prevalent—some people were “truly hysterical” according to Gerberding—and it touched off conflict among the health care staff. “People were afraid…we found ourselves attacking each other…everyone was so stressed,” is how Volberding described the situation. This balance is one that is continuously negotiated in health care settings, but it was more pronounced during the early years of the AIDS epidemic, and at San Francisco General, it had to be mediated by hospital and union officials. 

At the time unit opened, and for a long while after, people with AIDS were scorned. The gay lifestyle was linked to the disease and so a view held by many was that the gay community deserved to be struck down by this plague. They were not worthy of all the human resources, technology, and money the disease required. The documentary brings this sentiment to life by showing the actions some people took to prevent getting these patients help, and the actions governments didn’t take to help them. Also shown, however, was how the activism of health care professionals and others in Ward 5B helped to overcome these obstacles. Without it in the case of the unit in Ward 5B, the activism in the streets outside the hospital alone may not have been enough.  

But Then 

These fevers abated some when medical advances produced treatments that obviated the need for AIDS units, and changes in societal attitudes led to more acceptance of gay lifestyles. The next epidemic that targeted marginalized and susceptible groups would determine whether lessons learned from the time of this unit had been incorporated in response protocols. That opportunity came the year this documentary was released in 2019 when Covid struck elderly people first and hardest, and especially those in communal living arrangements.  

Note: 

The documentary was featured on the podcast episode, How Terrible It Was: Three Takes on the AIDS Crisis with Dr. Ross Slotten, which can be accessed here on medhum. In addition to the documentary, the podcast episode included the novel, The Great Believers, and the memoir, The Plague Years: A Doctor’s Journey through the AIDS Crisis were discussed. The author of the memoir, Dr. Ross Slotten, joined the podcast as a guest. 

Title image credit: 
James Steakley, CC BY-SA 4.0 <https://creativecommons.org/licenses/by-sa/4.0>, via Wikimedia Commons 

Documentary information: 
Film title: 5B
Directors: Paul Haggis, Dan Krauss 
Studio: Vertical Entertainment 
Viewing source: Amazon Prime 
U.S. release date: June, 2019 
Run time: 134 minutes  

Trailers from 5B Film

Born in Berlin to a Jewish father and a Christian mother, Harry Benjamin (1885-1986) became a physician in 1912 at a time when German physiology and medicine had much to celebrate. He ended his days in New York City more than a century later, a much lauded, if controversial founder of the entirely new field of transgender medicine. The path was not easy as his own transitions were often painfully turbulent: bullied as a schoolboy for being neither Jew nor Christian, shunned in wartime America for being German, accused of quackery for being an advocate of glandular therapy. And he transited the Atlantic many times always both at home and alien on two continents. Nevertheless, he kept his faith in the miraculous effects of hormones and held fast to an undiminished will to help people live happier lives. 

Using intimate diaries, letters, and interviews in both German and English, Alison Li has written a sensitive, insightful biography that not only traces this remarkable life, but also tracks the birth of endocrinology and the advent of an unprecedented discursive consciousness that challenged social norms. Her earlier biography of J.B. Collip, biochemist of insulin fame, provided her with extensive knowledge of emerging hormones; she handles the technicalities with deft, accessible prose.  

From witnessing the “resurrection” of a moribund patient with dried thyroid medication, Benjamin was captivated by the potential of hormones to bring even the sickest of people to perfect health. Initially intent on the rejuvenating possibilities, he thought of his work as “gerontotherapy” –treatment of the elderly – not so much to live longer but to live better. He became a devoté of Eugen Steinach and his procedure – which aimed to enhance hormone production of the gonads by suppression (through X-irradiation) of their competing elaboration of eggs or sperm. As the female and male hormones became commercially available as pills, they were added to the protocol. Inevitable slippage led to equating (or reducing) these goals to enhancing sexual prowess and attractiveness. 

Along the way, Benjamin encountered many prominent figures, and we read their impressions of each other. Havelock Ellis, Alfred Kinsey, Robert Masters, and Robert A. Wilson make appearances. The semi-autobiographical novel Black Oxen (1923) of his ever-loyal Californian patient, Gertrude Atherton, proclaimed the power of glandular therapy to a wide public and cemented Benjamin’s reputation for dealing with problems of sexuality. From listening carefully to each patient, he realized that the socially pervasive male/female binary failed to reflect individual identifications and orientations; gender was not a duality but a spectrum. Language had to evolve too and that is another theme of the book.  

Married to a much younger woman, Benjamin consulted Sigmund Freud when his desire for her waned; however, thinking of himself as a courtly ladies’ man, he was offended by Freud’s suggestion that he could be a latent homosexual. The experience conditioned his mistrust of psychoanalysis. Choosing physiology over psychology, both men, we learn, underwent Steinach’s treatment.  

With an office in New York City and later a satellite in San Francisco, Benjamin moved in a heady circle of artists, writers, politicians, and intellectuals—striving to find comfort in their own identities. He viewed the source of what became gender dysphoria as something biological.  Instead of fixing the mind, he sought to repair bodies to match minds. For some, peace came from simply living as one of the opposite sex, for others it was hormones, and eventually, for some, it was surgery. Benjamin befriended Christine Jorgensen and collaborated with a few surgeons willing –even eager–to develop operative interventions that resulted in physical sex change. After their transition, he continued to follow his patients to understand if and how the procedures had helped their quality of life. 

Always in private practice, never associated with academe except through research organizations of his own creation, Benjamin was dismayed by how his work was shunned by the medical establishment. From 1929 to 1935, he waged a lengthy lawsuit against Morris Fishbein the crusty leader of the American Medical Association for having disparaged him and his work. Benjamin wanted a retraction and an opportunity to explain in the pages of JAMA how his treatments were based in scientific research. He never got it. 

Nevertheless, at the end of his long career Benjamin witnessed the establishment of gender identity clinics at universities beginning with John Hopkins University and extending to some twenty sites by the late 1970s. He also witnessed their numerous closures in the 1980s as a struggle was waged between those who saw gender dysphoria as a mental illness– not deserving of physical intervention, and those who followed Benjamin’s pragmatic, biological approach.   

With curiosity and tolerance, Li probes the convoluted path of Benjamin’s career. She recreates the atmospheric ambience of exotic pre-war Berlin and the heady optimism of post-war America. She privileges the stories and perspectives of well-known trans people –Renée Richards, Reid Erickson, Jan Morris and many others. Without defensiveness, she presents the current criticisms of Benjamin and his so-called “standards” that had been generated to guide the medical approach to people with gender dysphoria. She treats the critics with the same attentive balance and consideration that Benjamin gave to his patients.  

As a physician, Benjamin could scarcely formulate solutions to the distress of those who sought his help in any way other than through a disease model. His efforts brought their plight out of the shadows of deviance and crime to the attention of well-intentioned minds who applied pills and procedures to serve their complex needs, empowering them to live openly, and enabling them to eventually reject the disease model entirely. Trans is diversity—one of many to populate the postmodern world. This is a very good book. 

Wondrous Transformations: A Maverick Physician, the Science of Hormones and the Birth of the Transgender Revolution   
Alison Li
Chapel Hill NC: University of North Carolina Press, 2023 

https://uncpress.org/book/9781469674858/wondrous-transformations
https://alisonli.com

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