Tell Me I'm Okay

  Tell Me I’m Okay

  TELL ME I’M OKAY

  A Doctor’s Story

  David Bradford

  Copyright and Imprint Information

  Tell Me I’m Okay: A Doctor’s Story

  © Copyright 2018 David Bradford

  All rights reserved. Apart from any uses permitted by Australia’s Copyright Act 1968, no part of this book may be reproduced by any process without prior written permission from the copyright owners. Inquiries should be directed to the publisher.

  Monash University Publishing

  Matheson Library and Information Services Building

  40 Exhibition Walk

  Monash University

  Clayton, Victoria 3800, Australia

  www.publishing.monash.edu

  Monash University Publishing brings to the world publications which advance the best traditions of humane and enlightened thought.

  Monash University Publishing titles pass through a rigorous process of independent peer review.

  ISBN: 9781925523331 (paperback)

  ISBN: 9781925523348 (ePDF)

  ISBN: 9781925523355 (ePub)

  www.publishing.monash.edu/books/tmio-9781925523331.html

  Series: Biography

  Design: Les Thomas

  Cover design: Les Thomas

  Contents

  Copyright and Imprint Information

  About the Author

  Author’s Note

  Acknowledgements

  Part OnePre-AIDS

  Chapter 1First and Last

  Chapter 2Growing Up

  Chapter 3University

  Chapter 4Vietnam

  Chapter 5London

  Chapter 6I Meet Michael

  Chapter 7Return to Australia

  Images

  Part TwoAIDS

  Chapter 8The Wave on the Horizon

  Chapter 9The HIV Antibody Test and Its Controversies

  Chapter 10The Queensland Babies

  Chapter 11I Leave the MCDC

  Chapter 12The Demise of Fairfield Hospital

  Chapter 13All My Patients

  Chapter 14Cairns

  Chapter 15Ronald

  About the Author

  DAVID BRADFORD was a gay Sexual Health and HIV/AIDS Physician in Melbourne and Cairns. He graduated as a doctor in 1965. After ten difficult years, including Vietnam, he discovered his specialty. During the AIDS epidemic, his patients became his life. In retirement, he and his husband live in Melbourne.

  Author’s Note

  Some minor personal details and the names of all the patients who feature in the stories in this book have been changed, but the stories are as true and accurate as my memory allows. Ronald (not his real name), as a patient still living with HIV in Cairns, has read and approved the section detailing his case history. Doctors and other health professionals with whom I worked and who are mentioned in the book are referred to by their actual names. Most of those who appear within the text have had the opportunity to read and comment on the relevant section.

  This book is dedicated to the many nurses and army medics I have worked with down the years, but especially Olga Anderson and Rita Quinn, Bob Allen and Alex (Chuck) Berry, Tom Carter, Beth Hatch and Peter Hayes, Jeni Mitchell and Tess Slater, Barbie Brayshaw and Paul Stephenson, and Chris Remington and Kel Browne. I could not have survived without them.

  Acknowledgements

  A great number of people have assisted by reading and comment-ing on earlier drafts of this book. I want to thank all of them, but especially my dear friend Glen Pike from London, Noah Riseman, and Raden Dunbar, who all gave a great deal of their valuable time reading my manuscript, correcting glaring errors, assisting with re- writing sections, critiquing my grammar and style, as well as being unfailingly helpful and encouraging. I also want to thank the following people who have read and commented helpfully on the manuscript in one or other of its many versions, namely Jeni Mitchell, Peter Hayes, Phil Carswell, Liz Christmas, Felicity Guthrie, Anne Mijch, my brother Philip and my cousin Lyn Bannerman. My colleague and much respected friend Dr Peter Greenberg has been a huge source of encouragement and support from the very start of the project. My editor at Monash University Publishing, Duncan Fardon, has been invaluable. As well, I want to thank Nathan Hollier, Laura McNicol Smith, Joanne Mullins, and all the team at Monash for their advice and ready assistance. Finally, my toughest but most loving critic has always been my husband Michael – words are inadequate to thank him.

  Part One

  Pre-AIDS

  Chapter One

  First and Last

  My very last patient, Sam, was an Asian man in his early twenties. He lay compliantly on the couch, exposing his nicely-rounded, naked buttocks. I feared they were all-too-slim for the present purpose, so I administered the penicillin injections as gently as I could, one into each cheek. Sam was lucky; he had the benefit of my forty-eight years’ experience. I let him rest for five minutes, then patted him sympathetically on the shoulder. He looked up, smiling. ‘Thank you, Doctor. That very good injection. Not like last time – very rough nurse in Taipei.’

  It was 2013, the afternoon I retired from medical practice. How strangely appropriate, I thought, that Sam should have had syphilis. The first patient I ever treated for a sexually transmitted infection also had syphilis. That had happened in 1967 when I was an inexperienced Australian army doctor in Vietnam. The consultation had taken place during a morning sick parade in the Regimental Aid Post (RAP)1 of an Australian Artillery Regiment in Nui Dat. I remembered that Gunner Len had acquired the infection in Bangkok during five days’ rest and recreation (R&R) leave.

  The treatment for syphilis hadn’t changed in forty-six years; my environment had changed a lot. While I was treating Len in the barn-like, concrete-floored aluminium RAP, it shook with the near-continuous blasts of heavy 155mm guns firing from the American base down the road. The never-ending whump-whump of helicopter blades reverberated overhead. By contrast, in 2013, the late-afternoon tropical sunlight filtered through the louvered windows of a well-equipped, purpose-built sexual health clinic in Cairns where all was quiet and peaceful.

  Between my first and last case of syphilis, I have treated many patients with sexually transmitted infections (STIs) in Nui Dat, London, Melbourne, and Cairns. They were aged between thirteen and eighty-five: gays, straights, and transgendered people; female and male sex workers; office workers, labourers, housewives, single mothers, school children, doctors, lawyers, and even a few politicians. During the last twenty-five years of my working life, HIV infections made up the largest part of my practice, but the case-load always covered the full spectrum of STIs from pubic lice to tertiary syphilis.

  Throughout my years of practice, people have often asked me why I decided to specialise in sexual health. The question is not surprising given that sexual health doctors are not held in the same regard as those who work in other medical specialties. The simple answer I always gave was obvious to me – I did it because I liked it. More than that, I liked the patients. For example, I liked the eighty-five year old Polish orchestra conductor who caught gonorrhoea fifteen times, and I liked the big, black Brazilian man who hugged me, and kissed me full on the lips, when I told him his HIV test was negative. This spontaneous display of relief and happiness visibly shocked the very straight male medical student who happened to be ‘sitting in’ with me that afternoon. Then, during the years 1985 until 1996, there were my numerous, memorable AIDS patients whom I could only watch helplessly as they disintegrated and died.

  I remember too, without particular fondness but with grudging understanding, an angry businessman who acquired gonorrhoea in Indonesia, and then unwittingly passed it on to his pregnant wife. Nor could I help myself having a
soft spot for the handsomeidentical twins who shamelessly shared their respective girlfriends, and their infections. I once treated a transgendered sex worker who was so pleased with her new breasts that she demanded I give them a squeeze. And there was the young man who allowed me to photograph his ‘pearly penile papules’, then for years afterwards would phone to ask if I was still using that slide in my lectures.2

  We sexual health physicians don’t grow rich, but we have a wealth of stories – wry, funny, and sad – all illustrative of the human condition. This book tells many of my own stories, and describes the circuitous path I followed to eventually reach my chosen specialty. As well, I’ve recounted the stories of some of my patients, among whom Gunner Len in Vietnam had the distinction of being the first, and Sam in Cairns the last, in a long line of always notable clients.

  Gunner Len was heterosexual – a regular army soldier, not a national serviceman. He’d been in the forces one year when the army sent him to Vietnam with the 4th Field Regiment. Nineteen years old, he was the youngest in a family of eight children. They lived in rural Queensland and jobs in the area were scarce at the time, so joining the army was one of very few occupations available to him. His oldest brother had also been in the army and encouraged him to enlist. Len was short and stocky, good-looking, and instantly likeable with an irreverent, larrikin sense of humour. He was employed in one of the gun batteries, and, like all gunners who loaded and fired guns, was well-built and fit.

  This was Len’s first time attending the RAP. When I met him, he’d been in Vietnam four months and back from his R&R leave in Bangkok for three weeks. He explained that he had developed an unpleasant sore on his penis. Quite unembarrassed, he cheerfully dropped his jungle greens and showed me the lesion. After examining him and feeling the sore through a pair of rubber gloves, I was sure of the diagnosis even though I had never seen it before. The sore was hard, apparently painless, and there were tell-tale, enlarged glands in his groin. Although the result wouldn’t be available for several days, I took a blood test to confirm that Len had syphilis.

  We chatted as I worked, and I asked how he had liked Bangkok.

  ‘Bangkok, Doc? I didn’t see much of it. I spent the whole five days in my hotel room.’

  ‘Were you sick?’ I asked somewhat naively

  ‘Nah, Doc. From the bus on the way to the hotel, it looked like a typical crowded, noggy dump. Besides I was too busy to be bothered.’

  ‘Too busy! On your R&R?’

  ‘When we checked in, they told us we could ring for anything we wanted – food, booze, girls – any time, and it would just go on the bill. Why bother going out, hey Doc?’

  ‘So you got a girl for your stay?’

  Len laughed and winked at me:

  ‘Not just one girl, Doc. I had one the first night, but she wasn’t much chop. So I pissed her off and rang for another. That one was a bit better so I kept her for twenty-four hours. Then I rang and said I wanted someone real special and they sent a little ripper, so we stayed together for the rest of the time. It went in a flash, so no time for sightseeing.’

  ‘You didn’t happen to use the condoms we issued you, I suppose?

  ’ Len adopted an injured air.

  ‘Yes, I did, Doc. But there were only twelve in the pack. In the end I just thought, what the hell.’

  ‘Well, soldier, I’m sorry to say I think you have syphilis.’

  ‘Syphilis! Shit, Doc. That sounds bad.’

  ‘It’s only bad if you don’t get treated. Fortunately, penicillin cures the infection at this early stage. But it means a big shot in your bum today, and you’ll need another blood test in six weeks. Then, to makesure you’re cured, a blood test every three months until you go home. And, no more fucking without condoms, Gunner Len.’

  ‘No sweat, Doc.’

  With his characteristic good humour, he hopped onto the couch, and bared his muscular bottom. But, I’d never done one of these kinds of injections before. The slow-release penicillin used for treating syphilis was thick with the consistency of toothpaste. It was difficult to inject even for an experienced doctor, so I struggled quite a bit over that first attempt.

  ‘Shit, Doc! That fucking hurts!’

  ‘Sorry, mate, but it’s a big volume to inject. Fortunately, you’ve got plenty of meat on that backside of yours, so it won’t hurt for long.’

  With a few groans, Gunner Len stood, pulled up his pants, and, with a rueful smile, left the RAP. Thus ended my first, and rather tentative, encounter with an STI patient.

  * * *

  I had already met Sam, my final patient, ten days before when he’d come to the clinic. He hadn’t had any symptoms – he had just wanted a sexual health ‘check-up’. Sam was on a working holiday in Queensland, and, not surprisingly in the circumstances, was shy. Here he was with an unfamiliar doctor, in a foreign country, not too conversant with English, and he was gay. He had no way of knowing what sort of reception he could expect. It takes courage to walk into a sexual health clinic for the first time.

  I tried to put him at ease, and Sam soon lost his shyness. He told me he’d recently been with a few casual partners, and three months before, ‘in the heat of the moment’, he’d allowed one to fuck him without a condom. Almost immediately, Sam had regretted what he’d done. At the first consultation I had given him pre-test counselling, and, with his consent, I’d done the necessary tests – swabs, and urine and blood samples.

  Before Sam’s second appointment, on the last afternoon of my career, I checked the results. I had been concerned for him; he could easily have acquired human immunodeficiency virus (HIV) infection from the sexual encounter he had described. Anti-HIV treatment, which stopped AIDS developing, was now effective. It was relatively free from side effects, and was available in Australia and in Sam’s home country, Taiwan. A diagnosis of HIV infection was no longer a death sentence, as it had been from 1980 through to 1996. But, for a young man, it was an unpleasant prospect to face a lifetime of daily tablet taking and regular medical monitoring, as well as the lingering stigma still associated with the diagnosis.

  Fortunately, Sam’s HIV antibody test was negative,3 and so were the swabs for gonorrhoea and chlamydia. But, he hadn’t escaped entirely unscathed. With the help of the Chinese-English dictionary in his smart phone, I gave Sam his results. No, he didn’t have HIV, but he did have syphilis. All he needed was an injection of penicillin into each buttock and he would be cured.

  Injections done, and with the help again of his electronic translator, we talked about tracing his contacts. He would have to tell his previous sexual partners to attend for a check-up. I told him about PEP – post-exposure prophylaxis for HIV – and advised him to attend within seventy-two hours, but the earlier the better, if ever he had another high-risk exposure. A doctor could then prescribe him a month’s prophylactic treatment with a combination of anti-HIV drugs. After some last minute advice about future condom use, and a follow-up examination arranged, I showed Sam to the door. Here, he smiled and fervently shook my hand. Finally, on the way to being cured of syphilis, my last patient departed and my medical practice came to an end.

  * * *

  1An RAP is the army equivalent of a civilian GP surgery.

  2Pearly penile papules are variants of normal anatomy. They can be mistaken for penile warts.

  3A positive HIV antibody test indicates the presence of HIV infection.

  Chapter Two

  Growing Up

  I was born in 1941 in a cottage hospital on the Blue Mountains, a month before the Japanese attack on Pearl Harbour. I am the eldest of three children, all of us mountain babies. Like me, both my sister and brother were born in Katoomba. My father was a pharmacist. He had enlisted for service in World War II, but after three weeks was discharged. At the time the army had enough pharmacists, so he was sent home to maintain an essential service. My parents were evangelical Christians who started out as Plymouth Brethren in Katoomba, then joined the Baptist Church after our fami
ly moved to Sydney when I was seven. They were genuinely devout and Christianity permeated everything. Our home life was intimately bound up with all our church activities. On religious grounds, my family would not participate in many harmless recreations that Australian families took for granted, such as watching movies, going to the theatre, or dancing. Of course, there was a total ban in our home on swearing, telling doubtful jokes, drinking alcohol, or smoking. My mother and my sister never wore lipstick or make-up and would not even have their hair permed. Also, for them, wearing shorts or slacks was not permitted. Sundays were set aside for church, Sunday school, Christian Endeavour and, as we grew older, the church youth group. We were not allowed to study, do homework, or go swimming on the Lord’s Day. Despite these restrictions, we three kids had a happy childhood and we were well-loved and cared for. My mother’s fondness for books and reading was instilled into each of us at anearly age. I accepted my parents’ way of life without question and I wanted to be as committed a Christian as they were.

  After our move to Sydney, we lived with my maternal grandparents at Dolan’s Bay, and for eighteen months I attended Caringbah Public School. There, I formed a friendship with a quiet, steady classmate called John Sullivan. But, in reality, John’s main attraction for me was his older brother, Paul. I thought Paul was a golden boy. There was soft down on his sturdy arms and legs, and his head was crowned with a mop of flaxen hair. The veins on the back of his hands and forearms stood out in a manly way. At the age of eight I desperately wanted to stroke them but I had no idea why I had this urge. Glowing in the sunshine, Paul would wait each afternoon on the school steps for John and me to join him for the bus trip home. Paul was in sixth class, at the top of the school and aged about eleven or twelve. He was a champion cricketer and all-round good sportsman. His nature was as sunny as his physical appearance. On the bus, John and I would sit together while Paul leaned over the seat in front to regale us with stories and jokes, his face in our faces. He simply bubbled over with good humour and happiness. On afternoons when Paul had to stay behind for cricket practice, I found the bus trip home dreary.