KEVIN’S BELLY STARTED TO cramp as he watched Ray Hernandez stride toward the podium. Scanning the hotel ballroom, he couldn’t see an empty seat. There had to be at least five hundred people here. He became aware of another unpleasant sensation. Sweat was running down his flanks.
Kevin had spoken to audiences of two hundred doctors. Ray had told him speaking to two thousand wouldn’t be any more intimidating. From the podium, he explained, you can make out at most two hundred faces. The rest are a blur in the background. Kevin was not reassured.
“It’s my great honor to welcome you,” said Ray, beaming with charm.
Kevin focused on his boss’s amplified voice, confident and mellifluous. He hoped he could mimic it. Although he had been wary when the new chief of medicine took over at City Hospital, unsure of what it would mean for his fledgling career, it was hard not to like Ray. Especially once it was apparent that Ray wanted to see him succeed as much as Herb did. This kind of regard from an older man had been outside his experience before coming to San Francisco. Even Kevin’s own father had shown little interest in what he might make of himself.
“Our opening lecture will be given by one of the world’s experts on a new disease that has captured the medical community’s attention, Acquired Immune Deficiency Syndrome—AIDS for short. Many of you know the syndrome by its former name, GRID, which was changed when it became obvious the disease is not exclusively ‘gay-related.’”
Kevin’s heart was racing. He tried thinking of someplace tranquil. Ray’s home came to mind.
“Our speaker, Kevin Bartholomew, leads the AIDS program at City Hospital, a new division of our department of medicine which I established because the number of patients with this condition is growing so rapidly in San Francisco. But take note. AIDS won’t be limited to a few ‘liberal’ US cities. It will become an important disease globally—as you’ll hear when Kevin shows you data emerging from other parts of the world.”
In a last ditch attempt to control his anxiety, Kevin visualized Ray’s collection of yarn paintings, the tremulous combinations of bright colors, plush zigzag, and round shapes—the sun, a man aiming a bow and arrow, peyote cactus. But it was time to walk to the podium now.
It’ll be over soon, he thought grimly.
“We’re also proud of Kevin’s creative productivity. This year alone, he’s published papers in the Annals, the Journal of Infectious Diseases, and…”
Ray savored the moment, keeping the best for last, a feather in his cap for having supported Kevin from the beginning.
“The New England Journal of Medicine,” he boomed.
Stuttering, Kevin thanked Ray. He stared at a Post-It sticking to his palm. Scribbled on it was the first sentence of his talk. The words made sense, but he didn’t know what to say next. He pressed a button that advanced a slide carousel at the back of the room. A sketch appeared on the screen depicting the structure of a novel retrovirus named HTLV-III. Laboratories in Paris, San Francisco, and NIH had just simultaneously discovered it in lymph nodes removed from patients with AIDS. Those with the syndrome of milder signs and symptoms that often preceded AIDS—AIDS-related complex, or ARC—also had HTLV-III in their lymph nodes.
Speaking to the screen, the words flowed. Kevin guided the audience through a series of figures that demonstrated how the retrovirus reproduced itself. Logically, effortlessly now, he described HTLV-III tricking human helper T lymphocytes into swallowing it and, once inside, hijacking the cells into making new viral particles.
His listeners were intrigued and a bit frightened by this devious pathogen that targeted the cell most responsible for coordinating human immune defenses against invading microbes. Kevin could have been telling a ghost story at a campfire as he explained the current hypothesis for the source of the epidemic. There was a reservoir of HTLV-III in a remote central African forest from which the retrovirus had crossed from chimpanzees to humans, who then transported and transmitted it around the world.
The room hushed when he said patients with AIDS were the tip of the iceberg. A larger population of people with ARC and a far, far larger population of asymptomatic HTLV-III- infected individuals might all eventually progress to AIDS. Worse, this was a global epidemic. The number of new AIDS cases in the Americas, Europe, and Australia was doubling every six months. His bleakest slide estimated that a quarter of a million people in the United States alone were already carrying the virus.
He ended with three “good news” slides. First, the risk of viral transmission to health care workers exposed to AIDS patients’ blood appeared to be very, very low. Only one proven case had been documented, a nurse in England who had no risk factors other than an accidental needle-stick. Second, a diagnostic antibody test was being developed. As soon as it was proved to identify retrovirus carriers accurately, any infected blood donors could be screened out, eliminating transmission of the retrovirus by transfusions. The antibody test could also be used as a public health tool to prevent further sexual transmission. Third, and most important, understanding the structure of HTLV-III had given bench scientists targets for designing drugs to treat the infection and halt the immune system damage it caused.
Kevin finished by thanking Ray for the invitation to speak. He glanced at the red digital timer below the podium. It read twenty-nine minutes. He pressed the reset button, gratified his lecture was done before the timer reached thirty and a light would begin to flash. He heard a crackling din like surf. He looked up from the timer to see everyone in the hall clapping.