Physician’s Privilege

A new memoir about the AIDS crisis reveals the flaws and benefits of a clinician’s detachment

In a kinder world or a gentler time, Dr. Ross A. Slotten’s memoir about his experience as a primary care physician during the AIDS crisis in Chicago might feel niche and, at times, endearingly awkward.  Interesting more for the position he held during an important and chronically overlooked catastrophe than for Slotten’s skills as a memoirist, the story nevertheless contains enough charm to stand on its own. The second chapter opens with Slotten’s background as a writer—scant—and his early interest in literature. “In those days I was such a fucking snob! Perhaps I still am,” he confesses.  The answer, unquestionably, is that yes, yes he is. This snobbery, combined with the clinical detachment characterizing much of the prose, infuses the account with a precision and clarity that cuts through the potential for melodrama or packaged and processed grief. They lay bare both the toll wrought by the unchecked spread of HIV and the failures of government to address a killer that disproportionately affected people mainstream society considered undesirable.

Read in the COVID-times, that clarity becomes a devastating indictment.

Gay, closeted, and longing for California, Slotten began his career as a primary care physician by setting up practice with a colleague who remained at his side through the duration of the crisis. Despite owing the National Health Service Corps service in underserved, poverty-stricken areas, he explains that he set up practice at Seton Medical Center on the North Side because  “Ronald Reagan, whom we otherwise despised for his public homophobia and failure to address the AIDS crisis before it spiraled out of control, created the so-­called private practice option that allowed young doctors like us more freedom of choice.”  While Slotten frankly explains that this program had been intended to help rural areas that had difficulty recruiting doctors, in the next breath he spends just as much time explaining how this arrangement allowed him to remain in Chicago and indulge in international travel.  

This acknowledgment of privilege without lingering or reflection fits with Slotten’s self-accusation of snobbery, and sets the reader up to receive a later observation: “Sometimes I wondered what kept me from throwing myself off the precipice, either literally or figuratively … Questioning motives sows doubt; doubt leads to indecision; and indecision to inaction, the worst possible response to a crisis, especially for a doctor. So I simply did not question my motives.” This tidy summation, meant to explain how he endured the crushing strain of the work, both explains so many of the character faults unreflectively displayed, and much of the behavior we can observe going on now, in the current pandemic.

Anyone familiar with the progress and circumstances of the AIDS crisis will find little new information in this memoir, but the history and informational elements of the narrative aren’t where it shines. Instead, Slotten’s narrative voice breaks free of his tendency for clinical distance in the brief anecdotes about relationships and patients. “Despite her age, she was still a sexual being and would make remarks that startled me,” he writes. “When an octogenarian broached the topic, somehow I thought he or she was being ‘cute’ and I laughed…having never considered that the desire for sex, like the lust for life, doesn’t end until your final breath.” These anecdotes are cannily spread throughout the memoir, in conversation with each other across the years even when the narrative doesn’t explicitly connect them. The humorous story of the sexually frank older woman has echoes in a later, far more serious story: “In the late 1980s one of my patients, a chronically depressed man in his mid-­fifties, convinced his reluctant HIV-­positive boyfriend to fuck him without a condom. Like a wife who chooses to die on the funeral pyre of her dead husband, he expressed a wish to go down in flames with his lover.” Superficially unrelated, both stories at their core feature a patient with a new-to-Slotten perspective on the relationship between sex and mortality, while planting a flag for quality of life. These subtle thematic underpinnings are the source of most of the book’s satisfying nuance.

Tempting as it is to read the memoir entirely as a once-removed commentary on the current pandemic, the text resists that and, presciently, argues against the urge to turn the AIDS pandemic into a prologue for COVID-19. In discussing Rock Hudson’s 1985 revelation that he had AIDS, Slotten comments, “His death in early October raised awareness of the disease and doubled federal funding, though it was still far below what was needed to combat an epidemic.” While this might feel like a similarity to the federal failures in handling the current pandemic, the next sentence immediately makes such superficial mapping impossible: “But the stigma of AIDS persisted, and AIDS forced many gay men out of the closet.” This dimension of the disease, where victims carried the additional weight of a society that would shun them not just for being ill, but for the actions of a full and fulfilling life that put them at risk of the illness, was a unique and defining factor in the AIDS pandemic and one that simply does not map onto our current circumstances. 

Slotten tries to end on an upbeat note, sharing the story of a recent patient freshly positive for HIV. That patient, Slotten relates, is unlikely to ever develop AIDS and, as long as he maintains access to treatment, is likely to live a fairly normal life. He can’t make it through the anecdote, though, without sharing, “For those with access to care and who are compliant with their medications, death from HIV is no longer inevitable or even likely.” Sitting right there, as unexamined as so many other casual quips of privilege throughout the memoir, is the truth that makes the AIDS pandemic a relevant, active force today, as well as a warning for any potential “solution” to the COVID-19 pandemic. Access to care is vital to the outcomes and the upbeat, hopeful image capping off this physician’s reflections—and because he’s a physician, it’s taken for granted that his patients have that. Yet there was a need to specify this requirement, because for the gay men contracting AIDS now, that access isn’t guaranteed. That same vulnerability lies in wait on an even larger scale with this new pandemic.

Ross Slotten, M.D., Plague Years: A Doctor’s Journey Through the AIDS Crisis, $20, University of Chicago Press, 224 pages.

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Jessica Eanes is a freelance writer and editor living in Chicago. 

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