An Unwelcome Visitor from the Past

A young man at the Chateau Marmont had been coughing for two weeks. He had a fever, and my stethoscope revealed lung noises typical of pneumonia.

I enjoy diagnosing pneumonia because, in an otherwise healthy person, it’s the only common illness with a cough that doctors can cure. Everything else is a virus. 

I didn’t like this particular diagnosis. It takes a tough germ to cause pneumonia in most people, so unpleasant symptoms begin quickly. This man’s cough had persisted for some time. Furthermore, he was gay and admitted to having unprotected sex. I suspected that he had a pneumocystis infection. Pneumocystis is a fungus so benign that it lives in the lungs of most of us, causing no trouble.

Until forty years ago, it was rare, affecting patients already sick with cancer or serious diseases requiring drugs that suppressed immunity. Doctors were mystified when Pneumocystis began attacking previously healthy young men during the 1980s. It turned out to be the most common sign of AIDS.

It’s rare again today because we track immune cells of HIV patients and prescribe preventive drugs when the numbers drop. This young man had not been tested, but he was no fool. He cut short his visit and returned home.

A Death

A guest at the Park Sunset complained of the flu. His temperature was 101; my examination was normal, but patients with influenza have a normal exam.

He looked miserable, but he was forty-one and in good health, and everyone with the flu looks miserable. There was no reason not to give the usual remedies and check back later. This happened long ago, but I still remember the inexplicable feeling that something was not right. I couldn’t bring myself to leave him in the room.

Leaving after extracting a guest’s promise to go to an emergency room is a bad idea. If the guest decides not to go and something dreadful happens, I’m the last doctor he’s seen. Calling paramedics was another option, but they might not share my unease.  

Explaining that he required further attention, I drove him to the nearest hospital. The next day I phoned. He had been admitted and died a few hours later. The doctor who cared for him was as mystified as I. We theorized he was suffering an overwhelming infection from an unknown source. Perhaps he took drugs. This was early in the AIDS epidemic, and victims sometimes died abruptly when their immunity vanished. We never found out.

You Must See "The Dallas Buyer's Club"

Everyone agrees it’s one 2013’s outstanding films. On Rotten Tomato’s site, a spectacular 42 of 42 reviewers approve. Matthew McConaughey delivers an Oscar-winning performance as a homophobic Texas good-old-boy who learns that he has AIDS in 1985.

Defying his doctor, who announces that he has thirty days to live and that no treatment exists, he pulls himself together, searches for treatments in places beyond the influence of the medical establishment (Mexico, for instance), smuggles them into the USA, and distributes them to AIDS victims despite government persecution.

Although I recommend The Dallas Buyer’s Club, I left halfway through. I couldn’t bear it because it contains every dumb Hollywood cliché about physicians and science.

Every doctor is a jerk except (a) the beautiful young woman doctor who finds Matthew McConaughey cool and (b) the seedy, unshaven doctor whom McConaughey stumbles upon running a Mexican clinic. After announcing that he has lost his US license (undoubtedly for being too compassionate), this doctor explains that his regimen of vitamins and immune boosters will help.

I am not one of those tiresome people who insist that movies stick to facts. History is boring and complicated. American movies must tell a coherent story with an upbeat ending and an admirable hero (Matthew McConaughey has flaws, but they are cute flaws: he is oversexed, a spendthrift, rude, and he lies – but only to bad people).

At that time, a hundred Mexican clinics sold AIDS treatments. None worked. Everyone who took them died. No American audience would accept Matthew McConaughey passing out fake drugs, so the screenwriters tweak the historical facts. In the movie, the drugs work.

I’m puzzled why conservatives denounce Hollywood for turning out liberal propaganda. The Dallas Buyer’s Club is a Tea Party dream. The government is a heartless oppressor. That includes the FDA which the writers confuse with the FBI because they create a menacing agent who threatens to arrest Matthew McConaughey. This FBI… I mean FDA agent never says “Your drugs don’t work!” He says “Your drugs are not FDA approved!” which, since he’s a villain, means they do work.  

Let me know how it turns out.