I can see the sky through the narrow window; it’s morning. I’m half asleep when the nurse comes into the room. I watch her go to the board that hangs on the wall in front of me. She erases the name ‘Rose’ and writes ‘Leah.’ She’s young and friendly and very energetic. She says, “Good morning,” takes my blood pressure, asks me if I’m hungry, says breakfast is on its way and that my doctor will be here soon. She asks, on a scale from 1 to 10, what my pain level is. My knee is only faintly throbbing, but I tell her 8 anyway; I know it’s best to stay ahead of the pain. She says she’ll bring me some morphine and then she’s gone. 

It was a difficult night. I couldn’t move my left leg, couldn’t sleep on my side as I normally do. The night nurse came in every few hours, checking on me, giving me pain medication. I would’ve liked to talk to her, but she’s quiet, and busy.  I dreamed of my partner Kirk being in the room last night, but now I know he really was here. I can see the things he brought me from home; my robe, sweat pants, a 6-pack of ginger ale. 

When I did fall asleep last night, I’d try to move my leg, tweak my knee and wake myself up. The room felt small and cramped and dark and I kept thinking about the past and the AIDS unit and the patients I saw there. I had to keep reminding myself that I will be going home, home to Kirk and a group of friends who will help me get through the first few weeks of recovery. I won’t be dying in this room, in this bed. But I could see them, the men on the AIDS ward, and how they did die there and did not go home. 

Leah returns with the morphine. She confirms my name and my age and then watches me as she injects it into the tube in my arm. She asks me how I’m doing. I tell her I’m okay and then, after a pause, that I used to work at San Francisco General, back in those terrible early days of the AIDS epidemic. I ask her if she knows that right here at St. Mary’s the first AIDS dementia unit in the entire world was created. She nods her head as I talk, removes a plastic bag from the IV pole above my head, but she’s not really listening. She puts the empty morphine hypodermic into a biohazard container and leaves. 

An elderly man wearing a white paper hat rolls my breakfast into the room, but the morphine has kicked in and I’m not really hungry. I close my eyes for a moment and when I open them, there’s a group of doctors standing around my bed. I recognize one of them from the operating room last night. He’s pointing at a tube that’s in my leg and draining fluids into a bag on the floor. When he sees I’m awake, he asks me how I’m doing. I feel like I’m on display and try to pull myself up in the bed. The faces of the team standing around me are so young. I want to tell them that I remember sitting with AIDS patients back in the 1980s, when the teams of doctors just like them would do rounds just like these. I want to tell them how the interns awkwardly stood at the foot of the bed, listening to the doctor describe symptoms of a disease that no one knew how to treat. I want to describe their faces and how they would stare at the misery that was occurring before them. 

But instead, my eyes close and I drift off to sleep. 

When I awake, the doctors are gone. The clock reads 11:15 and the room is filled with sunlight. The television is on; there’s news about the Middle East. It’s strange to see photographs from the outside when this room has become the world for me. I try to follow the images on the screen and remember how I used to sit and watch television with the patients on Ward 5A. There were times when there wasn’t anything to say and we would just sit quietly and watch TV  together. I remember November 1989 when the Berlin Wall suddenly came down. I went from room to room on the unit, turning everyone’s television on, making sure that the patients knew that somewhere in the world walls were coming down. I remember someone died that day and I wondered what it was like for him, to be leaving, knowing this moment in history was happening. Did any of it matter to those who were dying? 

The man with the paper hat returns with lunch. I haven’t eaten anything in almost two days and when I lift the plastic lid I see a piece of chicken and a few pale spears of asparagus. I pick off a piece of chicken and take a bite of the limp asparagus. Whenever I eat asparagus I remember my grandmother. She was a young woman during the Great Depression when food was scarce and so many were struggling. Whenever we were in her house we had to eat everything she put on our plate. If we didn’t like it or didn’t want it, she’d tell us how terrible it was when she was young and the days when people had nothing to eat. “You will never know,” she would say. “You will never know how bad it was, having to stand in line for bread, having to go to bed hungry!” If my father was at the table, he would talk about the war in Europe, how he saw many people starving, how terrible it was for the children there. Some times they would argue with one another, yelling at each other about what was worse, having to live through the Great Depression or being a soldier in the war. Over and over they would shout to each other, and us, “You will never know!” each trying to convince the other of the terrible suffering they had seen and experienced. 

I would sit still while they argued back and forth, staring quietly at the asparagus on my plate. I would think to myself that they’re both right, I will never know what it was like for them to be hungry or to be a soldier in a war. My grandmother would make my sisters and I sit at the table, sometimes for hours, waiting for us to eat the awful canned asparagus she had put on our plates. What good does it do to tell people about the terrible times you’ve been through? What does it achieve? I spit the asparagus out into my hand and put it back on the hospital tray. 

There’s a knock at the door and a woman comes into the room pushing a gray plastic walker in front of her.  She says her name is Susan and that she’s the physical therapist. She shakes my hand and asks me if I’m ready to get out of bed and go for a walk with her. I can’t believe what she’s suggesting, my new titanium and plastic knee is barely 24 hours old. Susan pushes the call button on the side of the bed and the nurse arrives. They disconnect the tube that is draining from my leg and then pull back the covers. Susan rolls the walker in front of me and smiles. I look at her in disbelief. 

“What do you think,” she asks. “Do you want to take a little walk with me?” I tell her I’m not sure, I haven’t gotten up since yesterday, that the surgery was only last night. She asks me to sit up and then slowly helps me swing my legs over onto the floor. I’m a little dizzy when I first sit up. “Great,” she exclaims. I’m hesitant and she says, “Mr. Wolf, your old knee is gone. It’s gone and it won’t hurt you any more.” I reach forward, grasp her outstretched arms, and slowly stand up by the side of the bed. “Take a deep breath,” she says. I do, but I’m afraid to take a step forward. “Really,” she says, “believe me. It can’t hurt you anymore.” 

To be continued . . .

I’m lying in a big bed, being rolled through the long empty corridors of St. Mary’s Hospital. The male nurse who pushes me is quiet and, since we’re heading for the operating room, I feel anxious. I want him to say something, I want to see his face. I want him to ask me how I’m doing. 

But all I can see are the fluorescent lights floating past. I’m rolled onto an elevator. The nurse asks a woman and child to step aside and pushes the ‘DOWN’ button. The woman visitor won’t look at me but the child does. I smile at her and she smiles too. 

When the elevator doors open, I’m pushed past a sign that reads ‘MEDICAL STAFF ONLY.’ The air is icy cold and I shiver. I’m wheeled through a set of doors into a room that’s completely white. I see people with blue masks over their faces. I recognize the anesthesiologist who spoke to me earlier. My surgeon steps into view. “What are we doing for you today Ed?” he asks. He’s confirming what’s about to happen for the surgical team. I tell him that my left knee is going to be replaced. The handrails on both sides of the bed are lowered and I’m guided into something that looks like a giant swing. Blinding lights are moved into place while my left leg is strapped into a harness. The anesthesiologist whispers in my ear that I will be asleep soon. I feel something touching the area above my left knee. I hear him say, “It’s time to insert the femoral shunt.” I can feel it, something being inserted into my groin, and I panic. “I’m awake,” I shout. “I can still feel my leg.” I’m terrified, but everyone is busy, preparing for the several hours that lay ahead. An oxygen mask is placed over my nose and mouth. “Breathe deeply Mr. Wolf. You’ll be asleep soon.” 

The next thing I’m aware of is being in a large ward with others who’ve also just come out of surgery. I see machines monitoring blood pressures, oxygen masks over faces. I can feel my left knee, far far away, faintly throbbing. A nurse leans over me and asks, “On a scale of 1 to 10 (she holds up all her fingers) what is your pain level?” I’ve been prompted earlier in the day to say 9, no matter what my pain level really is. I whisper 8 and she injects something into the IV that’s in my arm. I drift off again. 

I wake up in a small room. I can see the night sky through a narrow window.  The clock on the wall says 9:10. I was taken down to surgery at 4 in the afternoon. Five hours have passed. It’s over. 

When I turn my head I can see through the partly open door, out into the hallway. I can’t hear anything. I wait for someone to come in. I start to drift off again. 

There’s a knock at the door and when it opens I see myself coming into the room. It’s 1986. I’m in my mid-30s. I say, “I’m one of the counselors here on the ward and I wanted to come by and say hello, to see how you’re doing.” I look at myself. My hair is darker; I’m thinner. I watch myself move towards the bed. The only chair is by the window, so I stand at the side of the bed, looking down. I seem friendly, confident and present. I’m not exactly smiling, but I’m open. I look like someone that might be easy to respond to. 

I talk to this younger version of myself, tell him I’ve just had my knee replaced, what it felt like being pushed through empty hospital corridors. I describe the terrifying moment when they inserted the femoral shunt while I was still awake. I start to tremble and the young man leans forward and puts his hand on mine. He asks me how I’m feeling now, what my pain level is. He must have read my chart because he knows I have a partner; he asks me about Kirk. A nurse comes into the room to check my blood pressure and help me into a clean gown. The young man excuses himself and steps out into the hall. 

And suddenly, I’m back there, San Francisco General Hospital, 1986, walking from room to room on Ward 5A, which is the AIDS Unit. All 20 rooms on the ward are occupied and there are other AIDS patients throughout the hospital; the patients are waiting to come to Ward 5A where they know the primarily gay and lesbian staff won’t be afraid of them. Each room holds one bed, each bed holds a gay man, each one diagnosed with Pneumocystis, pulmonary KS,  toxoplasmosis, cryptococcal meningitis, failure to thrive. All fatal diseases. 

Some of the patients have visitors, others are alone. Some of the visitors stand in the hallway, not wanting to go into rooms, not knowing what they should say, not knowing what they will see — just waiting. A mother tells me she hardly recognizes her son because KS lesions have disfigured his face. A young man calls out, asking me to come into his room. He wants his boyfriend to lay down next to him; I can see that the boyfriend is afraid to do so. An older man weeps loudly at the end of hall. As I approach him, I see that he’s yelling, not crying; someone calls the security guard from the emergency room. 

All day long, patients are admitted, diagnosed, discharged — some die. Almost all of them are gay men. The staff works as quickly as possible to get to everything that needs to be done over the course of a 12-hour shift. It’s hard to know, at times, how to be helpful to some of the patients. There’s talk of medications, of rehabilitation, assisted living, support systems and recovery. But the understanding is that most of these patients will die of AIDS. 

When I worked at the hospital I lived in the Bernal Heights District of San Francisco. It took me 25 minutes to walk home each day. When I wasn’t at work, I could see the hospital from my living room window. At the hospital, I could see my apartment from the Visitor’s Lounge at the end of the hall. It seemed impossible to separate my experiences on the AIDS ward from the rest of my life. 

When I moved to San Francisco in 1976, I worked in a printing factory with 2 gay men and a young woman. In 81, I began working in a typesetting company with 6 other gay men. By the time the 80s came to a close, they were all dead except one. 

Once I got involved in AIDS service work, the number of sick and dying in my life was impossible to keep track of. Many of my co-workers at the volunteer agency that I worked with, all of the early clients whom I volunteered with, even some of the nurses from the AIDS unit; all  dead and gone by the time the successful HIV treatments arrived in 1995. And this gruesome litany doesn’t yet include any of the close friends I had before arriving in San Francisco, the gay men I went to school with in Florida in the late 60s, the friends who I lived with in New York in the early 70s, when the gay liberation movement was just beginning. Out of all those comrades who became ill, none of them are alive today. And, of course, I’m not alone with this story. So many others could tell this same tale, could write these same words, if they’d been able to survive. 

As I lay in my bed at St. Mary’s, I can see out into the corridor through the open door. It’s late. Noone’s there. When I look around the room, I see the clock, the dry erase board with the date and my nurse’s name: Rose. I can’t find the television’s remote control. It’s easiest to just lie back and close my eyes. Others have laid here in this room during the late hours; in that way I’m not alone. And I know that in the morning the physical therapist will come and help me take my first few steps with my new knee. But for now, the great sadness rises up out of me, as it does from time to time. 

So much death, so much loss. Why? What is the point of all that suffering? 

To be continued . . .

You can read part one and part two by clicking on the Related Articles links below.

November 3, 2011

I’m heading to SFO within the hour, returning to South Africa to follow-up with the counselors we trained in April & August. It’ll be summer there now, and I’ll be spending more time outside of the bigger cities, into the more rural areas. I’ll post my impressions and photos when I can. When I return, I’ll have a few days to rest up, and then into the hospital for a knee replacement. What a ride this year has been! 

November 4.

My employer paid for business class for me to get to South Africa and back home again. Such a generous gift, especially given the length of the flight and the condition of my knees. As the economy passengers walked past me, I heard some say, “He’s the 1%.” I felt like making a sign that read, “Have worked for non-profits for 25 years.” Reminds me to not make assumptions the next time I’m heading back to economy. 

November 5

The plane descends to Durbin, looking like Santa Barbara, lots of red tile roofs and bougainvillea along a blue sea. When the cabin door opens, the air smells like Florida. I’m so tired and stiff, I stumble as I leave the terminal. I meet Arnold, who will take me to the hotel. He asks me where I’m from and then says, “I’ve been to California!” Durbin reminds him of Santa Barbara too. He asks me why I’ve come so far. 

We drive along the Indian Ocean. I tell him I’ve come to support staff working in vaginal microbicide trials. He’s never heard of microbicides, says they’d be a miraculous gift to Africa. We get quiet. He says he & his wife have been trying to get pregnant; they’re discouraged. I tell him midwives often advise couples to not try so hard; it’s difficult to create a life under such pressure. He says it’s good advice. 

I arrive at the hotel. What was once a large mansion has been turned into a guesthouse. When I open the door to my room I see a big screen TV on the wall, a huge tub in the bathroom. It’s big enough for me to get all the way in; a chandelier hangs above it. I recall the 1% comment I heard muttered on the plane, then ease down onto the bed. It’s been 31 hours since Kirk dropped me off at the airport. Time to sleep! 

November 6

A rainy day in Durbin, reviewing our materials for the week, taking naps, waiting for my colleague R to arrive. Walked thru the neighborhood around the hotel, passed a field with a large circle of white rocks in the middle. I remember seeing it yesterday, when there were women, all dressed in white, sitting on each stone. It seems a sacred circle of some sort. There’s lightning tonite. Tomorrow, our 1st clinic visit.

circle of stones 

November 7

Our driver arrives early to take us to our 1st clinic visit, an area called Valley of a 1000 Hills. We drive between hills lined with eucalyptus trees; it’s like Marin County back home. We pass more circled stones. The driver tells us of a religious sect who follow the teachings of someone called “The Black Jesus.” They don’t believe in worshipping inside, so services are held outside, within the circle of stones. 

Gandhi lived here 20 years, began non-violent non-cooperation due to racism he experienced here. Gandhi was one of the 1st people to call for release of Mandela, thus his home is a revered place now. The clinic staff welcomes us; they’ve seen 100s of women since we were here, women who often live in the mountains surrounding the clinic, walking many miles to come here, as well as to shop and retrieve drinking water. 

It’s lunchtime as we leave, passing more circled stones, and churches, mosques, and temples to Sai Baba. We stop to have a bunny for lunch. It’s a half loaf of white bread, hollowed out and filled with curry. Everyone eats with their fingers; it’s very tasty. The driver hears me talking about a gay bar in Johannesburg and says there’s one in Durban called ‘Bean Bag Bohemia.’ R and I decide to check it out soon. 

November 8

Our site visits continue; staff we trained are happy to see us, reporting positive outcomes from the counseling approach we introduced in April. We travel through vast fields of sugar cane, spying huge mansions in the eucalyptus trees, informal settlements high on the hills. The contrast between the haves and have-nots is striking. I’m riding in small cars and my knees remind me of my impending surgery when I return. 

Our driver tells a harrowing story about being a truck driver before he worked for the clinic; a hijacking, a gun battle, a narrow escape with his life. He says more about the people who worship in the circle of stones. When I return to the hotel, I find a story of mine about the early days of AIDS has been published on-line. 

November 10

We’ve been to 6 sites now, interviewing over 60 counselors, nurses and pharmacists. Our first refresher training goes well. On the ride back to the hotel, our driver shares his concerns about the fate of South Africa when Mandela dies; he’s almost 94, frail, reclusive. The driver says that many are increasingly worried, afraid that the country could possibly erupt into civil war when their beloved visionary is gone. 

We go to the gay restaurant near the hotel for dinner. We sit outside. Other tables quickly fill with gay men and lesbians. The discussion about Mandela weighs heavy. The economic disparity, the legacy of apartheid, the racism we see and feel everywhere. Is it all a powder keg, waiting to explode? As we return to the hotel, the rain begins to fall. A huge storm blows into Durban. During the night, the power goes out. 

November 11

The next day we go to our last Durban site visit. En route, we pass the public market. I want to stop but the driver says it’s too dangerous. During our lunch break, I find the driver and ask him to take me. We spend 45 minutes walking thru the peoples market. Oh how I wish you could have been with us! I took my camera and will post photos as I am able. One of those truly unforgettable life experiences! 

market scenes

November 12 

We leave Durban early Saturday a.m. Our flight will head north for our next site visit, a small city outside Jo’berg called Klerksdorp. We tell our driver where we’re headed; he warns us that some of the white Afrikaners we’ll meet will be very racist. He shares awful stories about how he’s been treated by them. When he sees the pained look on my face he says, “Don’t worry, they’ll like you. You look just like them.” 

We land in Jo’berg and are met by 2 black men. They’re pleased when we see the large sign they’ve made with our names on it. They take our luggage and go to the car, which is too small for me. I force my body into the front seat and my legs immediately begin to throb. I can tell they feel bad, but there’s nothing we can do. They say the drive will take 2 hours. Then we take a wrong turn from the airport and get lost. 

It’s my most challenging experience on the trip so far. The drivers try to get back to the highway, R tries to get the GPS to work (the instructions are in Afrikaner). I groan in pain. It would be humorous, except it’s not. The drivers are boyhood friends, speak to each other in their native tongue. They’re aware of my great discomfort, trying their best. Finally R gets the GPS to work; we’re back on track!  

We leave the city, cross high plateaus. I want to get thru the discomfort of being cramped, lack of air conditioning and water. I don’t want to seem the racist Afrikaner I look like. There’s tension in the car until I ask the driver about the huge hills on the horizon. He tells me about the gold mines, how they folded, brought unemployment and misery to the region. I start to come out of myself; my discomforts lessen. 

The driver talks of boyhood in Soweto. He uses “olden days” instead of apartheid, talks of the 2/3 unemployment now, government corruption, poverty, hunger, struggles to find anything to do, to eat. I ask what can be done; he says, “I don’t know; I’m not a politician.” We drive over a crest in the road. I look out over a vast plain, a vista so far and clear; it’s the farthest I’ve ever seen. My heart splits open. 

When we arrive in Klerksdorp, my legs, thankfully, have fallen asleep. The city center’s empty; the town died with the gold mines. We turn onto beautiful tree-lined streets, huge white mansions behind brick walls. Its late afternoon and the domestics sit in the shade, waiting for rides back to their township. We pull up in front of one of the large homes; a tall white man and several housekeepers come out to meet us.

It’s my 1st African guesthouse experience, sharing space with a family who lives here.  An elderly housekeeper serves all the meals, washes all dishes, all laundry, etc. She’s invisible to all but R and I. We thank her, ask about her day; we see her. She tells us she has lost a key and she’s in big trouble; the owner has yelled at her and will do so again. It’s so painful to watch and not know how to intervene. 

We’re stuck here for the weekend. Unbearable heat, no e-mail access, and a fearful housekeeper. We can’t say anything to the owner about the maid; it could make things worse for her. It’s complex because he is, in many ways, a good and generous man. He clearly loves his children, has a houseful of pets he loves, is a lawyer, his wife a nurse. It all seems perfect, except for the poor treatment of the invisible maid. 

November 13

I toss and turn all night. I stick to the sheets, the almost full moon shines thru the open window. I keep hearing the maid say, “He will shout at me again!” What to do? In the a.m., the owner offers us his car. We drive to an animal preserve. The wheel is on the right, we have to stay in the left lane. “Far right,” we shout, when we have to turn. “Little left,” we shout again. We laugh all the way to the preserve. 

Impalas, wildebeests, rhinos, giraffes. We drive on red dirt roads, relieved to be away from the hot house and the helplessness of the situation there. I’m struck by the beauty of land and wildlife. I think of the strangeness of it being November, suddenly aware it’s the 2nd Sunday of the month, the 17th anniversary of Bob’s death. A close friend of almost 30 years, he took his own life to escape the misery of AIDS. 

(Interrupting my African travelogue to share the wonderful news that, waking up in Johannesburg this a.m., I read that 'We Were Here' is officially shortlisted for an Oscar Nomination. Thanks to David, Bill, everyone involved in the creation & support of the film. I'm feeling tired & far from home. This news will get me thru my last week here! Hugs to all!) 

Driving slowly, ostriches and wildebeest crossing the road ahead, thinking of Bob and others who died of AIDS so long ago. The mystery of how grief works. So acute at 1st; then the slow lessening. I used to dread November, bringing its memories of Bob’s terrible passing, and my father’s 2 weeks later. This year, I’d almost forgotten about it all. If there’s one absolute certainty about life, it’s this: it goes on. 

November 14

We go to the clinic in the a.m., meeting with nurses and counselors who see 6-7 women a day, week after week, month after month, finding ways to support them using the vaginal gel that someday may be shown to protect them from HIV. The staff’s dedication is endlessly inspiring. When we return to the guesthouse to get our bags, we find the white owner himself is going to drive us the 2+ hours back to Johannesburg. 

I’m struck by his thoughtfulness. He’s fixed the a/c, removed the front passenger seat so I can sit in the back and stretch out. I’m still so troubled by his treatment of his housekeeper; I ask him his opinion of what’s happening in Africa. The issue, he says, are the blacks. “I don’t mean to offend,” he says. “But they are different from whites, very different.” It gets quiet. He says, “I don’t want to offend.” 

I tell him I won’t be offended, tell me the difference. He waves his hand out over the highways, the mills on either side. “White men built all of this . . . infrastructure. If a white man sees an empty field, he does something with it.” I say that for centuries, Africa was doing just fine without highways or mills; and besides, what’s wrong with empty fields. He says I can’t understand because I don’t live here. 

They lack ‘steam,’ he says. I tell him about all the resourceful, committed, resilient and compassionate people I’ve just spent weeks with. They’ve got plenty of steam. “Ah,” he responds, “but they don’t have engines.” Our discussion heats up, he saying it’s evolution, they lack capability, me saying that access to education and opportunity have a lot to do with capability. “Let’s stop,” he says. “We’ll never agree!” 

I try one more time. “What’s your vision for the future for South Africa?” He tells me of his youth here, his military service in the Congo as a peacekeeper, of friends and family who lost everything in Zimbabwe and Angola when they were evicted from the only countries they ever knew. He says he used to have a vision, but now, (he holds his hand in front of his face) now it’s all blocked by a dark cloud. 

We enter Jo’berg traffic, glad the drive’s over. I hear shouts & bull horns, drive thru a crowd in front of our hotel; employees are on strike. We unload the car, thank our driver. I take his hand, say I wish that something changes, that he’ll see a future again someday. Then I’m ushered away, checked in, led to an elevator by a nervous bellhop. He says he had to sneak into the hotel to avoid a beating; he’s a scab. 

He opens my door and leaves, refusing the tip I offer. I see the chanting strikers down below, then lay down and fall asleep with the tv on. During the night I’m awakened by Oakland mayor Jean Quan’s voice explaining why police raided the Occupy Camp. I watch protestors being dragged away on African television. I realize now that we’ve been chanting all these years is true: the whole world IS watching. 

November 15 

Our last clinic visit’s in the a.m. When we finish, we go to the airport. R. leaves; I stay behind to do 2 last trainings. We’ve worked & travelled so well; I’ll miss her companionship. I’m driven to the next hotel. It’s the same one I stayed in back in April. It feels so right to be where my African adventures began so many months ago. I look down from the 21st floor. My knee throbs; it will be gone in 2 weeks. 

November 17 

The trainings go well. A great moment: gathering everyone in a circle to read them “The Giving Tree,” a story about a tree and a boy who takes her leaves, apples, branches; eventually her trunk; at the end, she’s a only stump he can sit on. It’s a story of unconditional love; but in this room of caregivers, it becomes a cautionary tale of the dangers of poor boundaries. Everyone commits to taking care of themselves.   

November 18

During the days, the counselors & I explore ways to support women in clinical trials. Nights, I sit in my room on the 21st floor, looking out over Jo’burg & beyond. I write to you. I follow the Occupy Movements back home, talk to my beloved Kirk. When violent rain and lightning storms roar across the city, I go out on the balcony, lean over the railing and feel their power. Once, I do it naked. I highly recommend it. 

November 19 

My last day arrives; suddenly I’m back at the airport, sitting in a Business Class Lounge with other white men, most in suits. An open bar in front of me, covered with bottles of booze and canapés and cream puffs. How to make sense of all the disparities of the past weeks? I’ve tried to be kind & open to everyone I’ve met; it’s the best I could do. For now tho, a chocolate éclair, and a ginger ale before I fly home! 

November 22 

My year: 3 continents, 6 countries, 7 states, 24 cities, 57 flights, 130,000 miles, 142 taxis, 87 hotel rooms, 18 HIV trainings, 52 screenings of “We Were Here.” Thank you, so very much, to everyone who picked me up, helped me down, put me up, helped me in, brought me food, made my bed, found the time, shook my hand, shared their views, read my posts. Take heart my friends: Life, at least from here, begins at 60!

November 28, 2011

Tomorrow morning, Kirk drives me to St. Mary’s hospital. By 3 pm, if all goes well, I’ll have a brand new titanium knee. I’ve been told the challenge (and my work) will be to stay ahead of the pain over the next few weeks. Please send me a good thought tomorrow, Tuesday, about 10 am, when the surgery begins. Imagine me on a horse, riding out ahead of the pain, free and clear and easy. Yes! Free and clear and easy!

No shade, no shine, no butterflies, no bees,

No fruits, no flowers, no leaves, no birds,

November!”

Thomas Hood 1844

Tamara sticks a needle in my arm and begins drawing four tubes of blood. I’m coming back to this hospital next week for a left knee replacement and there are a lot of tests that need to be done beforehand. Tamara speaks with an accent and I ask her if she’s from Russia. She says yes and I tell her I’ve just returned from Ukraine. We get into a discussion about gay rights in Ukraine vs. Russia. She thinks gays are much better off in Russia but I know it’s very repressive there. We’re starting to argue when I back off. Not good to bicker with someone who has a needle in your arm. 

As I drive away from St. Mary’s hospital here in San Francisco, I remember that World AIDS Day is coming soon. I’ll be recuperating from surgery that day, hopefully reclining in front of a television under the influence of many opiates. If I were able to go somewhere to honor World AIDS Day this December 1st, where would I go? Since I’m so close to Golden Gate Park, I decide to drive over to the AIDS Memorial Grove. Would that be a place to stop and remember what we’ve lost and what we’ve accomplished? 

I used to get lost on my way to the AIDS Grove in the vastness of the park; there were no clear signs back then. But now there’s a big one marking the spot: De Laveaga Dell AIDS Memorial Grove. I pull over, park, and head down the concrete walkway into the dell, smelling marijuana as I walk slowly along on my painful knees. The Grove is beautifully manicured. Everywhere I wander there are benches, tiled pathways, perfectly placed boulders, and everything, everything, has the name of a donor on it. GAP Foundation, Wells Fargo, Falcon Studios. The Grove is maintained by volunteers and I love that, especially since volunteers are the reason that the early AIDS response around the world was so effective. 

The dell is mostly empty. As I look for a place to rest, a young couple comes down the path, asks me where the Japanese Tea Garden is. I tell them how to find it and then sit down on a bench. A handsome jogger, pushing a baby carriage in front of him, whizzes by. This bench has been donated by the family of a man dead of AIDS, a man about my age. As I imagine what it would be like to come here on World AIDS Day, I hear a loud buzzing sound and, when I look up, a huge bee comes flying directly into my face. I try to swat it away with my hands but instead it comes even closer. I can hear it next to my ear and I swing again, knocking it against my collar and then down into the back of my shirt. Instantly I feel an intense sting on my right shoulder blade. I jump up and starting hopping around, slapping my back with my notebook, doing a Charlie Chaplinesque dance in the middle of the AIDS Memorial Grove. 

As I stand there, a helicopter flies overhead. An elderly fast-walker passes by, smiling at me. My shoulder blade is on fire. Am I getting short of breath? I try to remember the last time a bee stung me. Am I having an allergic reaction? Suddenly this perfectly manicured garden feels very empty. I decide to go back to my car. As I head up the walkway, a tennis balls comes bouncing down the hill and rolls across the path in front of me. I know there are tennis courts somewhere in the park, but not close to here. Perhaps someone has thrown a ball for their dog? As I wait to see if someone comes, I see another magnificent boulder with a plaque on it, this one remembering Ryan White. No one appears to fetch the ball. This beautiful garden is feeling like a lonely graveyard. I don’t think I’d want to come here on World AIDS Day. I get in my car and drive away.

I head across town to the Castro District. Here in San Francisco, many call the Castro Ground Zero for the AIDS epidemic. Maybe this is a more appropriate place for me to find a spot to commemorate World AIDS Day. My shoulder continues to throb as I pull up in front of the Castro Theatre; I can’t believe I found a place to park. I look up at the marquee to see what’s showing on December 1st. Perhaps I would’ve come here. But they’re going to be doing the Sing-along Sound of Music and I think no, that’s not where I’d want to be. 

Around the corner from the theatre is the Holocaust Memorial. I remember when it was first commemorated. Perhaps that would be a more fitting place to remember World AIDS Day. The memorial consists of 15 marble columns installed on a very narrow piece of land between two busy streets. Each column ends with a pink triangle on top. A plaque states that the memorial is in remembrance of the LGBT victims of the Nazi regime. I talk to a man who’s picking up litter alongside side the memorial, but it’s hard to hear each other because of all the traffic noise. He says he’s a volunteer and that this little piece of land was procured by our mayor in the late 90s. He says it was all very political. I stand for a moment, imagining being here on World AIDS Day. A bus comes roaring by. And then another. It’s too noisy here for me, too congested. I move on. 

I stand in the main intersection of this neighborhood, the corner of 18th and Castro Streets, and look at a spot that the residents here call Hibernia Beach. It isn't actually a beach though; it's just a street corner. It’s one of the largest open spaces in the area and has become a spontaneous meeting place and rallying point. It’s also been a spot where impromptu memorials have been created over the years. There’s a large window in the bank building at this corner, with a wide ledge running beneath it. It creates a natural altar of sorts. I’ve heard people call it the Castro’s Altar. I remember memorials here for Princess Di and Michael Jackson, and endless other tributes to friends and neighbors who have died over the years. Today an artist is trying to sell some of his paintings here. I suspect that there will be many candles here on December 1st^t, photos, teddy bears, old obituaries. It doesn’t resonate with me though; I don’t think I’d come here.

I look out across the intersection and see the drug store on the other side of the street. I can remember when it was called the Star Pharmacy and suddenly, it comes to me, what I would do if I could be up and about this coming World AIDS Day. 

I cross the street and stand in front of the pharmacy window. I pull a sheet of paper out of my notebook and tape it to the glass and then, with a thick marker, write the following words: “On these windows in the early 1980s Bobbi Campbell taped pictures of his KS lesions. He began HIV prevention.” 

Bobbi was one of the very first people with AIDS to begin publicly speaking about the disease. He had terrible KS on his body and taped photographs of himself right here, on this very spot, as his own way to get the word out to gay men in the neighborhood. If I could be anywhere, this is where I would be on December 1st. 

As I try to photograph my homemade sign, the wind keeps lifting the paper off the glass. I try again and again until a hand comes into view and holds the sign in place so I can snap the picture. I thank the man standing next to me. He’s about my age and asks what I’m doing. I tell him of my impending surgery and how I’m imagining where I would be on World AIDS Day if I could be out and about. He’s heard about Bobbi Campbell and has seen photographs of Bobbi’s original signs. I ask him where he would go, if he were going to commemorate December 1st. He looks across the street at Hibernia Beach, and then shakes his head. “I’d go to Ward 86,” he says, “and pay my respects there.” Ward 86 is one of the very first outpatient AIDS clinics in the world. He says that’s where he first found out he had AIDS and where he first started taking the medications that would eventually help him to survive to this very day. 

His eyes are dark and his face is drawn. I can see that he has been through a lot. He looks at me, can see I’ve been through some difficult times as well. “On second thought,” he says, “I guess we don’t really need to go anywhere to acknowledge World AIDS Day. It’s everywhere around us.” He puts his hand on my arm. “It’s inside us, wherever we go.” 

I drive home to the Mission District, thinking about what he’s said, knowing that he’s right. Everyday is World AIDS Day in a way, especially for those who have lost, who have fought, who have worked so hard to find ways to bring this tragedy to an end. 

When I get home, I start to get out of my clothes and into my favorite bathrobe. When I unbutton my shirt, the body of the little bee that stung me in the AIDS Grove drops onto the floor. Before I can bend over and pick it up, our little black kitten Dewey comes running into the room and quickly gobbles it up. How quickly the source of my pain and anxiety from earlier in the day is gone. 

Part One saw Ed leave his native San Francisco and fly to Johannesburg and then on to Durban and Kampala, Uganda. You can read that episode here.

April 18 

On the flight to Uganda yesterday I got up to stretch my legs. I stood back in the galley area, near the toilets, looking out the window. We were flying over a vast confluence. Two mighty rivers, flowing into a delta, all merging together to form a magnificent waterway. There were no roads or houses as far as I could see. Just mile after mile after mile of canopy and wild river. It was one absolutely perfect moment. 

Got up this morning to find a newspaper pushed under the hotel room door. Headlines: “Police vow to block Besigye walk today.” Besigye is the Ugandan opposition leader who was wounded during the protest the other day. Everyone seems calm in the lobby. Our cab driver says he knows a march is planned, but he isn’t worried. When we get to the training, we find out that Mr. Besigye has been arrested and jailed. 

The training goes very well. At lunch, one of the counselors tells me the protests are only the beginning of something bigger that’s coming. She talks about the corruption of African leaders, how happy people were when Obama got elected. She says they had all hoped Barack would set an example to their own leaders. She gets quiet and then adds: “The price of independence here is going to be very expensive.” 

It's 4 a.m. here in Uganda and we're getting ready to get in an airport shuttle. Next stop, Zimbabwe. The newspaper has just been slid under my door. The ominous headline: "Death toll rises to 4 as army steps in." There's also a sidebar article that says: "UCC (Uganda Communications Commission) orders 24-hour shutdown of Facebook." My thoughts are with the people of Uganda and as we slip out of the dark city. 

April 19

12 hours later, we’re safe and sound in Harare, Zimbabwe. Rush hour, sputtering minivans full of people, women walking with impossibly large bundles on their heads, children in perfectly pressed school uniforms. Palm trees, weeping willows, unidentifiable trees towering over all the rest. Black and white birds overhead, musical calls to one another. Smells of coffee and flowers. We’ve got 4 days here . . . Yes!  

April 20 

Wifi has been down for 2 days. Had another great clinic visit. Everyone from the MDs and RNs to the counselors and outreach workers are so dedicated to the study. I do an opening activity in the training where people Agree or Disagree to statements I read aloud. Most agree with this statement: One of the ultimate goals of these trials is to allow women to enjoy having sex without fear of becoming infected with HIV. 

A young man called out to me thru the fence around the clinic. When he put his hand thru, I held it in mine. “Who are you?” he asked. I told him I was a conducting an HIV training. He said he’d been living with HIV all his life (his mom had died of AIDS) and hoped that we were going to do something about the terrible stigma he was experiencing. I told him there was stigma in the US as well. He couldn’t believe it. 

 roadside artists in Zimbabwe 

Tomorrow’s our last training. We’re conducting it in a thatch-roofed building in a garden, the perfect way to bring our work to a close. We’ll head back to Jo’berg on Friday, my colleagues continuing on to the US, me staying behind. On Saturday morning, a driver will pick me up and drive me deep into Kruger National Park, where I’ll stay in one of a group of bungaloes (surrounded by an electric fence) for 6 days. 

Ed and thatched hut training

April 21

We just finished our last training. We’re kinda at a loss. We’ve worked so hard . . . and it has paid off. 3 countries, 4 cities, 6 trainings, 200+ trainees. The participants feel the enhanced counseling approach we’ve brought will help their work with their clients. I left San Francisco two weeks ago tonight. It doesn’t seem possible. I don’t remember the last time I felt so tired and so fulfilled at the same time. 

The approach we taught is one that all providers should use: patient-centered, non-prescriptive, exploratory, empowering. You (not your doctor, dentist, gyno or therapist) are the expert on the issues of your life. Others can help us help ourselves, but only by 1st knowing what we feel, think and know about the issue being discussed. This strategy is also very culturally competent, as we found out these past 2 weeks. 

Grace, Kennedy, Nazira, Tebogo, Mamolefe, Pearl, Angel, Faith, Godspower, Zodwa, Nukuthula, Dolly, Professor, Philisiwe, Nompumelelo, Qcinile, Jabu, Selvemoney, Tholakele, Lulu, Mandisa, Maletsatsi, Thoko, Lebo, Xolelwa, Noleen, Mpilo, Dudu, Busisiwe, Tandiswa, Zanele, Bongiwe, Mtokosizi: so many beautiful African names. Even tho I struggled at times, everyone got my name immediately. Sometimes they called me Eddie! 

Tomorrow brings a difficulty and a sadness; saying goodbye to A and R, my extraordinary colleagues. We’ve laughed and cried and been amazed and frustrated. We’ve leaned on each other so much and so often as we’ve traveled up and down this extraordinary continent. We knew the power and import of what we were doing . . . the preparation, the anticipation, the arrival, the delivery . . . and now, the letting go. 

April 22

Left Harare this a.m., Good Friday, streets full of people in white, marching, singing. The missionaries have done their work here; Easter is a big holiday all over Africa. Our driver said white men are not the problem; it’s their own leaders. He said people keep looking to the future, rather than trying to do something now to make things better. September elections are coming; he’s worried they’ll be tampered with. 

 Sat next to an incredible woman on the plan to Jo’berg. She was so moved by the work we’d been doing here. She’d lost a brother to AIDS and a child to cancer. Oh, what a soulful talk we had. Her father was the first President of Zimbabwe and when he lost his son in 1986, he warned all the citizens about this strange new disease. They did not believe him til several years later, when many Zimbabwans began to die. 

Arrived in Jo’berg and suddenly A and R were gone, going home to the US. I was moving on to other adventures. The airport is 4 stories high, concourse after concourse, immense numbers of people. Again I was struck by the power and beauty of the diversity all around me. As I stepped through the arrival gates, Joni Mitchell’s voice filled the entire airport: “Don’t it always seem to go . . .” I burst into tears. 

I’ll be picked up shortly for the the day-long drive to Kruger Nat’l Park. There I’ll stay at a camp in the bush for a week and (hopefully) have some close encounters with the other inhabitants of Africa: the wildlife. There will be morning/evening walks and daytime drives. I suspect that I’ll be off the grid and unable to post to Facebook, but I’ll bring my camera and notebook and fill you in when I return, April 28. 

April 22

Many thanks for accompanying me on my journey. Wifi has been erratic, making it impossible for individual responses. But please know how much your thoughtful/caring responses have meant to me. It’s kept me grounded and brought focus to what I’ve been experiencing. I always plan to keep a travel journal, but never do. Because of you and FB, I now have a record of this incredible experience. Big love from a big land! 

April 28

Dear All . . . I have returned to Johannesberg, safe and sound, sun burned and exhausted. I’ve seen everything from rhinos and hippos and lions to monitor lizards, turtles and centipedes. Extraordinary experiences. But it’s been the landscape that has moved me the most. Vast open spaces, full of the original inhabitants. “Let it all in,” the savannah speaks . . . and then, “Let it all go,” in a whisper. More to come. 

April 29

Repacking my bags for tonight’s flight, feeling grateful, amazed, tired, emotional; on the verge of tears. So many good cries this trip; for the diversity of the people, the dedication of staff working in clinics, the women who are using the products which will hopefully, someday, be available to women around the world. And for the wildlife, continuing to find ways to survive in their ever-shrinking environments. 

April 29

Thank you Africa: an incredible experience. Thanks to all who drove me safely around, welcomed me to hotels and clinics, brought food, left chocolate on my pillow. Thanks to all who spoke to me of Africa, it’s challenges and hopes. Thanks to those who sat nearby, riding through the wilds, looking for lions. Thanks again to A and R for being great colleagues. Now, the inevitable ending to any great adventure: Home!

May 4, 2011.

I was hired last year, April 2011, to be a training consultant for the MTN (Microbicide Treatment Network) to help create and facilitate a series of trainings for their clinical trial staff in South Africa, Uganda and Zimbabwe. The trials were trying to assess the effectiveness of microbicidal vaginal gels, products that could someday help women protect themselves from HIV in situations where condoms were not an option.

My colleague R and I were asked to deliver trainings that focused on client-centered approaches to adherence counseling, strategies that would move away from simply directing women to use the gel but instead explore their experience of using the gel; what made it easy, what was challenging. I decided to write daily Facebook updates of my African adventures for my friends and colleagues back home. Since Facebook at that time only allowed 420 characters in their updates, I had to make my entries short and to the point. Here are all my entries, combined, and aptly entitled: 

Africa 420

March 30 

Returned to San Francisco from Washington, DC last night, where I met a lot of new colleagues who are involved in the MTN (Microbicide Treatment Network). They’re studying vaginal gels that could someday protect women from HIV while still allowing pregnancy. Will be going to Africa next week to be a part of the counseling training portion of the clinical trials, along with A and R. A big honor, and very exciting. 

April 7

Off to Africa in a few hours. 3 countries, 4 cities, 6 trainings, 150+ participants. My 2 colleagues and I will teach a client-centered approach to assist adherence counselors. I'm excited, apprehensive, emotional. Bringing laptop and camera; will post updates. Found this African saying: ‘If you want to go quick, go alone. If you want to go far, go together.’ So, if only electronically, I'm taking you all with me! 

April 9

29 hours have elapsed since I locked my door on Folsom St. in San Francisco and entered this hotel room in Johannesburg. Exhausted, but happy to be here. The hotel is right next to the old police headquarters. My cab driver said that up until 1994, if you were black and found in Jo'berg after dark, you were taken there and interrogated. If they didn't like your answers, they threw you out the 10th floor window.

my first sunset in South Africa

April 10

9 hour sleep, then out to the Apartheid Museum. Strong visual history of the long struggle for independence, achieved less than 20 years ago. Sat on a bench with a black youth, watching a video about Mandela. When 2 white men entered, the young man stood and gave up his seat. Feeling awkward, I stood up and offered him mine. He wouldn’t look at me. Am still thinking about what to have done differently in that moment. 

My colleague A and I decide to walk through the hotel's neighborhood. We're the only whites we see. Very powerful, being the only one, the other. I’ve felt it as a homosexual, but rarely as white. We saw many churchgoers and can feel history in the streets, memories in the buildings. We saw two amazing birds in the street: a magnificent stork with a giant blue head, and a huge multicolored duck. Tomorrow: Soweto! 

April 11

Spent morning in Soweto, a vast area outside Jo’berg. It has a long history before, during and after the worst of apartheid. Today it’s a thriving community of over 3 million. Visited the Chris Hani Baragnawath Hospital, the largest hospital in the Southern Hemisphere, possibly the world. Met many of the staff who will be coming to our 1st training tomorrow. Feeling the importance and honor of what’s about to begin. 

April 12 

Off to the training this a.m.: 65 nurses, counselors, pharmacists and physicians will be in attendance. We’ll end by 5, hop in airport shuttle and fly to Durban, where I plan to take a dip in the Indian Ocean, shark nets and all. We received a Travel Security Alert last night: Ugandan activists protesting rising food costs were tear gassed by police. We’re hoping things will calm down soon — we fly there on Sunday! 

Soweto

April 13

Our 1st training was very successful. The passion that the staff has for these microbicide trials is palpable and moving. The hope is that at the end of 3 years, products will (finally!) be available for women to protect themselves from HIV. We arrived in Durban 2 hours ago. The hustle and bustle and huge energy of Jo’berg has been replaced with a tropical mellowness. It feels like an African Key West. 

Visited 2 clinics today; powerful interactions with staff. 5 thousand women will be enrolled; hopeful results should be available in January 2013. Last night, as we arrived at the airport, I walked thru the most diverse crowd of people I’ve ever seen.  The varieties of clothing, skin colors, headdresses, languages, saris, Indians, blacks, and Afrikaners was incredibly heart-opening. Got to my room and had a good cry. 

Went to the Indian Ocean. Shark talk had me nervous. The waves were high, the current strong. The water was perfect though; I went in waist-high. It was warm and welcoming. We hurried back to the road, hailed a taxi, got home before dark. When I checked all my pockets, my beautiful camera was gone! As I toss and turn and try to sleep, I know what I must do, especially in this country with its long history. Let it Go! 

April 14

Our 1st Durban training went very well. Counselors are responding positively to the key concept of our approach, i.e., the client is the expert on her life and her abilities to use the study products (tablets or vaginal gels.) I left home one week ago. Thanks so much to all of you for your wonderfully supportive responses. I really appreciate it. We’re here for two more trainings before we head north . . . to Uganda. 

April 15          

The heat and humidity were oppressive today (air conditioning broke down) as we did our 2nd Durban training. Drank a gallon of water to get through the day. We’re closely monitoring the situation in Uganda which is our destination on Sunday. We won’t go if the situation worsens. Thinking positively, we started our malarial drugs today, a necessary precaution for Uganda. 

Went to an incredible mall to replace my camera. The malls are unexpectedly grand, with lots of security; everyone can go and feel safe. You’d think you were in the US due to their size and selection, except for the unbelievable diversity of the shoppers. Black and white Africans, bi-racial and East Indians, Asian tourists, white Europeans; (we’re not seeing other Americans tho) . . . it’s absolutely fascinating! 

One of the training participants today was a woman living with HIV. She told me that in 1999 her AIDS medications became so expensive (980 rand a month; about $160) that her family chose to cut back on food so she could live. She said they were all starting to starve to death . . . and then the Bill Gates Foundation began providing the medications free of charge. Her spirit was very strong. I’ll never forget her. 

Another powerful moment: an African man practicing his counseling skills as I circulate round the room, offering suggestions, etc. I sense he’s stuck, so I approach, reaching out to touch his shoulder. He sees me out of the corner of his eye and moves quickly from his seat, towards the floor, hand raised, like I’m going to strike him. I feel terrible and apologize. So does he. I wish I could take that moment back. 

April 16

Rainy Durban day. We Just finished our 4th training and have gotten the green light to proceed on to Uganda. It’ll take us most of tomorrow to fly there. We’ll check into our Kampala hotel tomorrow night, conduct the training on Monday, and then fly out early Tuesday to Zimbabwe. We’ll be in Uganda a total of 32 hours -- and we’re feeling confident that we’ll be fine. We’re glad we started our malarial drugs. Onward! 

Had our last dinner in Durban at a great Thai restaurant. Feeling really good about the trainings here, and what we’re bringing north to Uganda and Zimbabwe. We saw a newspaper headline this a.m. that read: “Lion Spotted on Local Beach.” I don’t know if it’s true, or just a way to sell more papers. But I love that image: a lion walking along the sand, looking out to sea. I hope he’s in my dreams. Good night . . . 

April 17

A white airport shuttle driver this morning said the apartheid years in Durban were not as bad as those in Jo’berg, that even in the worst of it, there was enough work for everyone in Durban, which helped keep the violence in check. He asked if I’d noticed how many black men in Jo’berg had scars and burns on their faces and arms. I told him I had, but that I hadn’t really understood the past those wounds reflected. 

I asked the driver what he wanted for South Africa. His response: Stability! I suddenly saw a big spider monkey on the side of the road. Then we saw a dozen more under the trees. He pulled the van over and we watched the mothers and their babies and some older males as they ran along and then jumped up onto a wall. We were amazed to see them, just running free. We thought they were amazing. His response was: Pests! 

We’ve arrived in Kampala, Uganda. The airport sits right on the shores of Lake Victoria. There’s one road that goes into the city and it meanders through an incredible series of neighborhoods: sounds, smells, sights, stores, smoke, soldiers, scooters; it’s a hypnotizing hour-long ride. As we pulled up to our hotel, some armed men came out and checked the bottom of our cab, looking for bombs. What a day it’s been!