Ifirst met Dr. James Carroll Hill in 1974 when he was a program officer in the infectious disease grants program at NIAID ten years before I became director. A research microbiologist at Berkeley, he had been transferred from San Francisco in 1969 as a navy officer to head a division in the Department of Microbiology at the National Naval Medical Center in Bethesda. When he retired from the U.S. Navy in 1974, he joined NIAID. As much as he liked the East Coast, he still loved San Francisco and often visited friends in the Castro District in the late 1970s and early 1980s.
I remember quite clearly the first time I spoke with Jim, in the summer of 1975, long before we worked on AIDS together. We were both in the weekly meeting of the Executive Committee of NIAID in our seventh-floor conference room, where the director and program officers gathered to discuss administrative and policy issues of the institute. Jim was there to present and discuss a vaccine trial for meningococcal infection, a common cause of meningitis in college students, for which he was the program officer in charge. I was there to present a research project in my lab related to treatment of vasculitis. Jim was tall and immaculate in his appearance with perfectly trimmed hair, a tan suit, light blue shirt, and bright yellow tie. He caught my eye and introduced himself with a warm smile.
In 1983, after several years as a program officer, he left his scientific position and became an administrator in the NIAID intramural research program, where I had recently been made a laboratory chief. This was when our friendship began. Jim emanated kindness, dignity, and a refreshing lack of cynicism. I hoped that someday I would get the opportunity to work even more closely with him. The opportunity soon arrived when I became NIAID director in 1984.
I immediately asked Jim to become my special assistant. Special assistant in the federal government is a catchall phrase that can mean nothing—or everything. With Jim, it meant everything. He cared deeply about NIAID, the AIDS crisis, and me.
Before accepting the position, he asked to see me alone in my office. He closed the door, and with an anxious look on his face said, “Tony, I am gay, and I don’t want this to cause you any embarrassment.” At the time, being gay in a public government position was not widely accepted. Jim went on: “If you think that it will be a problem, just tell me and I will stay where I am. No hard feelings.”
I put my arm around his shoulder and said with a smile, “Jim, you are totally clueless. I have known you were gay from the moment I met you ten years ago in the NIAID conference room.” Jim was visibly relieved. But that encounter brought into sharp focus for me what I had witnessed with so many of my AIDS patients. Although many parents of AIDS patients embraced their children’s sexual orientation and were with them constantly on our clinical wards, others did not know that their child was ill or even that he was gay. Often the patient was reluctant to tell his parents that he had a lethal disease for fear of rejection. Once Jim and I got that out of the way, we were off on our mission together.
Jim often made me laugh even when it seemed that everything was going wrong. He was born in Manila, Arkansas, a town that I along with probably a couple hundred million other Americans had never heard of. When visiting dignitaries, often from foreign countries, arrived at the NIH and I briefed them on our activities with HIV/AIDS, Jim always joined me. If they asked where we were from, I said Brooklyn, New York, and for better or worse, everyone had heard of Brooklyn. Jim said with a twinkle in his eye, “I am from Manila, Arkansas,” a statement that was almost always met with a puzzled look. Jim would then say, “Just think of Manila this way: we sell Velveeta cheese in the gourmet section of our supermarkets.” He had another Arkansas favorite that he would use when I looked particularly stressed. He just smiled and said in his Southern drawl, “Tony, back in Arkansas we would say that you look like hammered shit!” Jim was the only person I ever knew who could walk into a room during a crisis when I was seething about something and within a minute have me hysterical with laughter, merely by saying something disarming like “Well, aren’t you a hoot today.” Or his favorite was “Lighten up, Tony, things could be worse; we both could be picking cotton in Arkansas; trust me, I’ve done it.” You just could not help but love him. When the deputy director of NIAID, whom I inherited from the previous director, stepped down, I immediately promoted Jim to that important position.
Jim had a deep understanding of the challenges faced by the at-risk gay community, and he continually taught me the nuances of these challenges. In addition, the gay community trusted him as one of their own, and this made it much easier for me to integrate myself into the community. Jim’s Capitol Hill town house on Sixth and C Streets in Northeast D.C. served as the meeting place and gourmet restaurant where countless discussions took place between me and the activist communities. It was not an unusual sight to see AIDS activists sitting with me around the fireplace in Jim’s living room debating the communities’ most pressing questions. All the while Jim went back and forth serving wine and tending to the meal that he was preparing in the kitchen.
Jim was also the world’s greatest traveling companion, for me at least. He often accompanied me on international trips to AIDS scientific conferences where I usually gave a keynote lecture and participated in meetings with foreign health officials. Jim felt personally responsible for seeing to it that we were never late and never missed our flight. I was compulsive enough without Jim in the picture, but he brought the process to new heights. As we headed out to Dulles International Airport for a trip to Paris or Bangkok or Cape Town, Jim calculated the maximal time for each phase of the trip starting from leaving his town house on Capitol Hill to my house across town. Normally this was a fifteen-to-twenty-minute trip. Jim built in the possibility that there would be major traffic problems between those two destinations, and he allowed one hour for the trip. Never mind that it might be 6:00 a.m. on a Sunday with not a car in sight. He also factored in double the amount of time each step took to drive from my house to Dulles, check in at the airport, get to the gate, and board the plane. We often arrived several hours before flight time, long before this was the common protocol. In fact, we did this so many times that we became friendly with a waitress at one of the airport restaurants where we spent hours eating hot dogs and drinking beer as we waited and waited for our plane to board. After a few such encounters with her, when she saw us sit down one day for our usual hot dogs and beer, she came over and said with a straight face, “Hi, guys, flying to Europe? When does your plane leave…tomorrow?”
In 1978, four years after he joined NIAID and six years before I hired him as my deputy, Jim entered a clinical trial for a hepatitis B vaccine. As part of the trial’s screening protocol Jim was discovered to already be infected with hepatitis B virus. Although he had no symptoms, he had mild chronic persistent hepatitis. This condition was common among sexually active gay men. This diagnosis put Jim under the care of one of the world’s leading experts on hepatitis B, Dr. Jay Hoofnagle, who happened to be our colleague right there on the NIH campus at the National Institute of Diabetes and Digestive and Kidney Diseases.
One day in July 1985, I was sitting at my desk working on a lecture when Jim walked in looking worried and closed the door behind him. I instinctively knew that something was very wrong. His eyes were moist as he said that he was going to tell me something, and he would understand if I had to let him go as my deputy. I was struck with a terribly ominous feeling and blurted out, “Jim, for goodness’ sake, what the hell are you talking about?” Tears ran down his face as he told me. “Dr. Hoofnagle just did the newly available test for HIV infection on my serum sample, and it came back positive.” I lost my breath and could barely speak. I had taken care of endless AIDS patients over the past four years, but this was the first time a person so close to me, indeed someone whom I loved, was found to be infected. He repeated: “I would absolutely understand if you let me go. How bad and inappropriate would it appear and how would people react to the knowledge that the deputy to one of the leading AIDS researchers in the world, who was also the director of the National Institute of Allergy and Infectious Diseases, was stupid enough to get infected?”
I threw my arms around him and said, “Jim, you crazy son of a bitch, there is no way in the world that I would ever let you go. And so drop that idea right now.” It was so typical of Jim to worry more about an imagined negative effect on my public image or that of the institute than about the fact that he now had a deadly disease with no known treatment. That was Jim Hill. But this situation was also representative of what was occurring every day out in the community. There was still so much stigma and shame associated with being infected, and it would take several years before that changed; even today in some parts of the world it has not completely disappeared.
Fortunately, his CD4+ T cell count was reasonably good, within the low-to-normal range, and the level of virus in his blood as measured by the crude techniques available in 1985 was not very high. We composed ourselves and mapped out a plan for his care. We would follow and watch him until a treatment became available and hope that his condition did not deteriorate rapidly.
The years went by and life went on for Jim and me, working intensively together on the business of the institute. We traveled together nationally and internationally, visiting medical centers that NIAID was funding. I often gave lectures, with Jim always making sure that everything went smoothly and the logistics were executed perfectly.
Jim became closer and closer to me and my family. He loved children and occasionally pinch-hit as a babysitter for our eldest daughter, Jennifer, who was born in 1986, and dropped in for dinner at our home. Then, on March 16, 1989, our second daughter, Megan, was born. Christine and I were considering who would be a good choice to be her godfather, an important position of honor among Italian American and Irish American Catholic families. It took us less than a minute to decide that Jim was the man, and he became Uncle Jim not only to Jennifer and Megan but also to Alison, who was born three years later.
I began to see definite signs of Jim slipping in mid-1993 as he appeared physically weaker and began losing weight. He occasionally spoke of retirement, but never seriously pursued it. He was integral to our efforts against this devastating plague, and he wanted to remain in the fight. In the summer of 1994, Jim experienced episodes of gastrointestinal bleeding that required blood transfusions. That August, he underwent a procedure that successfully controlled the bleeding, after which he returned to work, albeit considerably weaker than before.
Soon thereafter Jim told me what I had been dreading to hear for some time. He felt that he had to retire since he could no longer give me the 110 percent he wanted to give me. I tried to convince him that as far as I was concerned Jim Hill even at half speed was better than most anyone else at full speed, but he would have none of it. I was crushed because I knew that now I would not be seeing him every day as I had for the past ten years and also because it was clear to me that he was physically slipping with regard to both his HIV disease and his chronic hepatitis. Jim was well aware of the seriousness of his illness, but in typical fashion he did not focus on himself, and retired at the end of 1994.
Jim volunteered in the clinic over the next two and a half years and quickly gained the respect and admiration of the clerks, nurses, physicians, and patients. He had always been a deeply religious man who often participated in the activities of St. James Episcopal Church near his home. His retirement now gave him more time to devote to church activities. He also allowed himself one indulgence. He had always wanted to own a pickup truck, and now he bought one so he could, as he said, “finally play out my identity as a true Southern boy.” It was quite a sight to see Jim enter the NIH parking lot filled with gray or black Toyotas and Hondas driving his red Ford pickup.
I dropped in often to see Jim in the clinic when I made my inpatient rounds, and he looked weaker and weaker as the months went by. By the spring of 1997, he had terrible complications from his failing liver and the abnormal pressures in the veins connected to his liver. His kidneys also were beginning to fail. We admitted him to the NIH Clinical Center on June 20, 1997, for evaluation. It was clear that he needed surgery to address his problems, but the NIH did not have a person on staff who could perform the difficult procedure required. We decided to transfer him to another hospital.
On June 24, Cliff Lane, Christine, Jim’s close friend Dr. Jack Whitescarver, and I gathered around Jim’s bed to wish him luck and send him off to the referral hospital. As I hugged Jim and kissed him on the cheek to say goodbye, he looked frightened, an expression that I had never seen on him before. He said that it was tough to explain, but he just had a “bad feeling.” We all told him that everything would be fine and that he would be back working in the clinic in no time. Jack Whitescarver volunteered to accompany Jim to the other hospital and bring him home after the procedure.
The surgery was scheduled to take place on June 27, and we anxiously awaited Jack’s call telling us that all was well and that they would soon return to Bethesda. Around 8:30 that evening I heard from Jack. He told me that the unthinkable had happened. During the procedure the catheter had punctured a hole in Jim’s hepatic vein, leading to a fatal hemorrhage. It is impossible to describe the shock, the pain, the anger I felt when I got the news. There was nothing that anyone could do now. Jim, not yet fifty-six years old, was gone, and the sense of grief was almost unbearable.
To this day, I still miss Jim and feel the loss. But he is with me in many ways. Whenever I am stressed out, I think of Jim smiling at me and saying, “Lighten up, Tony, things could be worse; we both could be picking cotton in Arkansas; trust me, I’ve done it.”