Identity and Immunity
This essay is the first in a series on Poetry and Identity. Each contribution will explore the capacity of poetry to illuminate the complexity and fluidity of human identity. We are grateful to the Lannan Foundation for supporting this effort.
Cabeza de Vaca
from "The Account"
from "Late November"
He was dying even then, even as I hurried from the Intensive Care Unit to the noontime conference. It was the end of the academic year, when all the senior residents were giving their formal talks.
I squeezed through the crowded maze of chairs to my usual seat off to the side of the room, almost against the back wall. The lights dimmed, and the first slide was displayed on the screen at the front of the conference room: a 16th-century rendering of Taino Indians in various stages of a disease that was killing them. The depiction of the savages was grotesque. Their skin was pock-marked with blistering lesions. Their backs were covered with hair, their heads shaved, their bodies contorted and bowed in the presence of the visible Europeans and their more formidable invisible microbes.
For the next hour, instead of a clinical topic like those of past weeks -- "Update on Colon Cancer" or "Strategies for the Management of Peptic Ulcer Disease" -- we heard about the diseases visited upon indigenous New World populations by European explorers, and the dramatic historical impact of those diseases in facilitating a brutal conquest. I was able to remain alert for most of the talk, which was remarkable given that I was post-call and had slept only two or three fitful hours the previous night.
The resident, a young White man from an old Boston family, spoke with heartfelt eloquence about the wholesale destruction of native Americans at the hands of his ancestors. To give us a sense of the magnitude of these events, he added a few comments about AIDS, principally to downplay the consequences of the AIDS epidemic by comparison with the devastation caused by small pox or dysentery. Small pox had been in some instances deliberately transmitted to native Americans, he explained, and certainly was not behaviorally transmitted among such innocent, simple people; furthermore, small pox had decimated entire cultures. AIDS was affecting only relatively small and marginalized groups of people in present-day America, and their chosen behaviors were undeniably responsible for the spread of the disease. I noticed heads nodding in the audience.
My mind flashed to my patient in the ICU, dying by degrees so inexorably, silenced so violently by the rigid plastic tube inserted through his vocal cords and into his trachea, one of the 50 percent of gay men in San Francisco who are HIV-positive or living with AIDS. At least one contemporary culture is dying. I wanted to speak, but the more he said the more mute I seemed to become. Was I the only one in the room who knew or cared?
I tried to understand why my colleagues, other physicians, seemed not to hear this anguish, and why I could not express it. I thought of the insidious ways that the larger culture suppresses unwanted voices. Partly because we often speak languages other than proper English, and partly because of the modes of expression that people of color and queers often employ -- slang, poetry, and oral history -- our voices are less marketable to a homogenizing mainstream publishing industry. Many of us dwell in dangerous ghettos, not near the picturesque bridges of Madison County; thus we tend to be removed from the public discourses that ultimately define America.
I reflected, too, upon the specific problem of my own writing. My poetry -- one slim volume -- seems so puny an effort in the face of the richness of intersecting queer and Latino cultures, and has long suffered under my own efforts to repress it, for fear. Fear that it was not manly enough, fear that it might somehow betray my secrets or the location of my hideout, fear that my linguistic mannerisms or invisible accent or misuse of grammar might embarrass me, fear that I might become the property or the exotic pet of rich White people. Reenacting the countless poems I never wrote, and still may never write, the tears I have stifled at the bedside of a dying patient, the retorts I have squelched on rounds when a homophobic comment is casually tossed off: I admit that I have censored myself willingly, like so many writers outside of the mainstream must -- but never without recognizing the great cost of such self-censorship.
Understanding this destructive process may be the only way to avoid it, but such understanding required a sustained concentration that eluded me as I listened to the talk. I began to daydream, instead, about the possibility of a kind of homosexual country of origin, a different and fabulously free New World, a place whose existence seemed plausible to me after the long and tortured journeys I have made across oceans of disavowal to the deepest reaches of my heart. On each of these journeys, a vast and unexplored continent stretched before me there, in the shape of a man's body. A people inhabited the land, a people not unlike the Tainos, Choctaws, or the Mayans -- peaceful, highly intelligent, literate, and tolerant of relationships between members of the same sex. These people, though possessed of a clear sense of identity, were faceless to me, and their immune systems apparently functioned differently. They were as naked to the microbes of hate and inhumanity as their bodies were to me. They had incredibly long eyelashes, and their eyes were green. They disregarded the ample evidence that significant quantities of gold, silver, and gemstones lay beneath the surface of their land, which itself was beautiful.
Though I too wished to strip off my clothes, shed my immunity, and make love to one of their men beneath the warm sun as I allowed my skin to become more brown, something kept stopping me. What was it? I spoke a different language, I wanted to convert them to Catholicism, I wanted to translate their poetry to fit my own interpretations, and most of all I wanted their gold, and so before long I developed the overpowering urge to obliterate them. I wanted to invent stories about them, stories that would make them belong to me. At the same time, I wanted to recreate them in my own image, the image of what existed in the distant culture of violence and hatred I knew I could never leave behind.
So I devised a diabolical plan, involving a new disease that affected only African slaves and so was little understood. I knew they would not be naturally protected against it; during my time among them, I had observed they became ill and died with exposure to the most common of diseases. It would be an interesting experiment in the pathogenesis of a terminal illness, and would provide at the same time the opportunity to discredit their approaches to healing. Perhaps I would even become famous, and I would have the most renowned laboratory in the world. Best of all, it was a disease transmitted by sexual contact, and so my preaching to them about the ungodliness of fornication and the possibility of redemption in the Savior would have a deadly vehemence.
A young chieftain tried to speak with me, unaware of my plans. His hypnotic language seemed to emanate from the heart. I stared into his green eyes, admiring his long, girlish eyelashes. The sun pressed down upon us, with a weight I could only liken to a great grief. I realized that I was falling in love with him, which made it all the more difficult to infect him. Just as our lips were about to touch, just when I thought for the thousandth time that I would finally be able to pinpoint exactly where I was, a dim alarm sounded from far away. The high, piercing tone persisted, but I was too deeply lost somewhere in my heart to orient myself correctly, lost irretrievably in the densest of jungles....
When the annoyed resident sitting next to me shook my arm, I realized the noise in my dream was my beeper, and we were already in the question-and-answer period of the talk. I was not sure how long I had been asleep, but when I saw the telephone number to which I had been summoned I bolted from my chair, and raced down the hallway to the mechanized doors, which admitted me to the aseptic ICU. Finally at my patient's bedside, I saw in the pulsing monitors and read-outs that he was hypotensive and tachycardic, on the brink of death.
We had been having trouble ventilating him since his first day in the unit; this was his fourth bout of pneumocystis pneumonia, which had caused complete white-out of both lungs, and he remained hypoxic despite the administration of 100% oxygen. His partner huddled with his parents, and they all stood by the bedside crying, courageously refusing to be drawn into the vortex of his downward spiral. Miraculously, after some fluids and the initiation of dopamine, his blood pressure stabilized and his heart rate came down, both hovering within the near-normal range. I had the distinct sense that he had weathered a force more powerful than any tropical hurricane, and that he had been saved without much undue suffering, only to lay wrecked upon the shoreline of that same distant and deserted land in my heart. As I looked down upon his fiercely handsome face, still handsome despite its relentless effacement by AIDS, despite the plastic tube taped at an angle securely to his delicate cheekbone, I noticed for the first time his delicately long eyelashes.
I came home that night, exhausted, and began to write intensively for the first time in many months. As I put pen to paper, I felt again boiling in my own blood the conflicts between the heavily armored Spaniards and Englishmen whose tongues still have expression in my voice, and the debilitated and diseased Indians whose darker coloration has survived in my skin. Enslaved by my ancestors, alienated by my profession, I wondered whether my words could be of use to anyone. The horizons of my impotence extended in all directions, from inescapable guilt for having so far escaped HIV infection, to nagging ambivalence regarding the falsely reassuring exhortations about safe sex coming from the medical profession, to an enforced speechlessness as queer culture disintegrates before my eyes. I couldn't continue to respond merely with morphine to what I perceived as a consequence of a similar aggression, a gay man dying of AIDS.
When I was in medical school, I first understood that identity was somehow intertwined with immunity. Those people who knew who they were seemed magically protected from disease; those who were marginalized and splintered seemed especially susceptible to illness. The fellowship of man conferred resistance to disease, while selfish individualism induced it. Now I understand that this perceived distinction is grounded upon differential access to health care, bias in the delivery of care, differences in levels of education, and other confounding parameters that reflect political empowerment; back then, all I knew was that poor patients said very little and asked almost no questions.
At that formative moment in my life, I contemplated my own body as a potential locus for the diseases I was learning about. I imagined a strange and particular pathophysiology at work among my genetically discordant cells. Two sexes dwelled inside me, providing twice as many opportunities for disease to take root; I wondered whether I had twice as many organs, whether I contained a rudimentary uterus and pair of ovaries laying dormant in the depths of my body from which my "unnatural" desires arose. As my eczema worsened, I worried that my immune system, in attempting to distinguish self from non-self as it combed over the most intimate secrets of my every cell, might be finding unacceptable some overgrown protein marker in my skin that I had inherited from my Cuban grandparents, and initiating a process of rejection that would lead to the autoimmune destruction of my lungs, my larynx, my entire being. Every bluish vein, every orifice, every dark place where organs functioned, all were potential points of entry for my eventual unmaking, a process in which I was complicit because of who I was, and was not.
In this way medicine provided a method for pathologizing myself, a way to confirm what it had been telling me in other ways since I had first considered a career in medicine: that I did not belong, and that I was not welcome. That I was unhealthy. Similarly, and more important, it was simultaneously speaking in the same exclusionary terms to the very people it was supposed to be helping. My allegiance to any of these disadvantaged groups, which I feel most strongly to gay people and people of color -- not coincidentally, two of the groups most devastated by AIDS -- makes me feel like a traitor to my profession at times, just as my writing of poetry does.
I can consider myself fortunate, at least in one respect: my patients give me the comfort and reassurance that my profession denies me as I attempt to battle AIDS. Even as the illness overtakes them, their bodies invaded by opportunistic pathogens, they still find room in their hearts to keep me safe. Their generosity seems inexhaustible, despite the belligerence so many of them encounter as they negotiate their way through the labyrinthine X-ray suites, laboratories, hospitals, and pharmacies of the medical otherworld. They share their narratives guardedly, at first, unsure of whether they will have time to finish telling them; they seem painfully baffled that they should go on living with a disease everyone, especially physicians, insists is fatal.
Why should the medical profession remain so hostile to a segment of the population whose need for its most attentive and expert care is so urgent? Under assault for its self-serving largesse and perceived growing distance from patients, the profession responds by attacking a group of people whom it finds weaker and who even dares to speak up for its rights. The fact that these people may practice behaviors of which medicine does not approve, because they are viewed as addictive or unnatural, only encourages this aggressive response. Finally, the profession's fury is only heightened by its inability to cure either the disease or the behaviors that it finds distasteful and that place people at increased risk of acquiring the disease. Because curing takes precedence over caring, again the profession is forced to confront its impotence; that AIDS patients might take more solace in Thom Gunn than in Anthony Fauci is beyond its comprehension.
So perhaps I should not be so surprised when I continue to hear from my colleagues the reflexive refrain that has been their primary response, besides outright silence, to the epidemic thus far: safe sex, safe sex, safe sex, two words that would drown out all poetry. Besides doing little to prevent transmission of the AIDS virus -- mottos are far less effective barriers than actual latex -- this approach may be in fact counterproductive. Not only does it engender resentment in a gay community tired of the ceaseless attempts by the larger culture (whose own men loudly proclaim their refusal to use condoms because they are said to limit their pleasure during sex) to neutralize the expression of its sexuality, but it also reflects an ignorance of the complex issues facing gay men and the many other emerging "high-risk" groups of people. Setting aside for the moment whether some behaviors (such as receptive oral sex or insertive anal intercourse) are as likely as others (such as receptive anal intercourse) to transmit HIV -- the scientific evidence for which is dubious indeed -- such blanket statements about plain sex fail to address the many other factors that contribute to further HIV transmission.
I have encountered numerous patients in my own clinical practice who respond to this message with a sense of hopelessness and, though it might seem paradoxical, lack of control. Many see this catch-phrase, and the ill-conceived (though well-intentioned) ad campaigns it has spawned, as simply an echo from a black, possibly bottomless chasm. The diversity of expression, the complexity of response possible only through the poem, is repeatedly flattened by each new bumper sticker. The body no longer feverishly throbs and swells, but instead is cut-off, sterilized, devitalized, and chastened. Almost as nullifying as silence itself, the sanitary images and nice bland words we can say in public that seem to be the staples of the public health establishment's representation of AIDS must be abandoned. In their place, like red graffiti sprayed across billboards, more poems must be written.
As native Americans in many cases responded fatalistically to the mass deaths of their people, so, too, do a growing number of people in the communities most devastated by AIDS want to surrender. Young gay men are coming out and establishing their identities while facing overwhelming numbers of casualties in a war that might appear to them as impossible to win -- over 10,000 AIDS deaths by January 1994 in San Francisco alone, the vast majority of them gay men, and disproportionately people of color. I have heard some express the desire to become infected with HIV, to "get it over with." Instead of a gorgeous elegy, I hear in them the distorted parroting of the slogan, just as curt, just as deadly. These startling deathwishes often come in the wake of a particular friend's, ex-partner's, or role model's recent death from AIDS. Not only does this reflect the conflation of an AIDS diagnosis with simply being gay, a terrible consequence of the overly-repeated safe sex messages directed exclusively at young gay men that thereby isolate them, it also underscores what little recourse the medical profession has to offer these frightened, grief-stricken, and confused young people.
So when critics of AIDS education point to the alarming rise in new cases of HIV infection among young gay men as proof of the failure of these efforts, demanding funding cuts and censoring already too-insipid public health campaigns, the irony becomes painfully apparent; it is difficult not to see a conscious strategy at work. Hatemongers define AIDS as a homosexual disease, aiming to limit expenditures to combat it; AIDS activists target their scarce resources to hammer upon those perceived to be at highest risk of HIV infection; by so narrowly defining their target group, educators end up fulfilling their enemies' most delirious prophesies. All of this only heightens the guilt, hopelessness, fear of (and loss of pleasure in) sex, powerlessness, judgment-impairing substance use, and denial that are all expected responses of a group of people witnessing its own annihilation.
Efforts to interrupt the cycle that leads to the further spread of AIDS might focus instead on how best to articulate the psychological sequellae of surviving in the wide-open jaws of death, and not just upon attacking the supposed risky behaviors that many consider integral to gay identity. Asking individuals about the roots of such self-destructive impulses, in the context of complete and more accurate information about behaviors that transmit the AIDS virus, would likely save more lives than millions of glossy pamphlets espousing safe sex. Asking them to write about their experiences and exposures, which is beginning to occur in the growing number of writing workshops for people living with AIDS, might illuminate novel strategies for avoiding new infection.
I have in the past adamantly resisted the simplistic notion that what I do in bed is the principal source of my identity. Clearly, sex and identity are intimately and complexly related. Even so, I persisted in thinking that some elements of my identity had little or nothing to do with this rich interplay of gender, desire, and power. I resented the assumptions of the majority culture that because I was gay, I was not man enough to become a physician, was doomed never to fall in love and form a stable long-term committed relationship, rejected all the teachings of my religion, would be so unfulfilled I might be driven to suicide, would never write a poem of worth. But I went to medical school and became a physician, I met a man who will always be the love of my life, I have maintained an interrogatory faith in God, and I have not killed myself -- and none of these occurrences seems, except perhaps in retrospect, surprising in the least. I have kept writing, in spite of myself. So the specific experience of having another man's cock inside my mouth, or having mine inside another man's rectum had to be trivial, seemed totally irrelevant.
In the face of the AIDS crisis, however, these physical expressions of love seem revolutionary indeed, as revolutionary and as physical for me as the act of writing poetry. Some might call them unpatriotic, even traitorous and punishable by death. Like the "illegal aliens" who penetrate the forbidden border of this country for the desperate chance at a better life, and who have been targeted in California by one of the most venomous campaigns ever conceived to protect American national integrity (and incidentally, to prevent their access to public education, health care, and other costly services), I too have been transformed into an otherworldly being. Ironically, the native Americans welcomed their strange visitors from Europe, providing them with sustenance and shelter, often worshipping them as godlike figures; they were repaid with genocide, and the few survivors were dispossessed of their lands and the remnants of their cultures. Now some of the prosperous descendants of those who killed and enslaved have resurrected these practices in the present day in their responses not only to AIDS and undocumented immigration, but also to health care reform and countless other issues. Whatever border is violated, whether crossing the imaginary line that divides the United States from Mexico or Haiti, or enjambing a line break too suggestively, or passing through the portal of the eroticized anus of a lesbian or gay man, someone stands accused.
That accusation is as audible in the safe sex mantra as it is on the floor of the United States Senate. It was present even in my own initial encounters with queer patients, and certainly contributed to my own sense of despair in fighting AIDS -- until I realized that our sexual acts are among the few shards of identity that we do own, that we must own. Even if they do not comprise entirely our identities, we must give them to ourselves freely and without remorse or encumbrances. The affirmation of our identity can provide us with the same kind of immunity to which other groups avail themselves. If they are to continue the struggle to stop AIDS, young gay people and people of color must view themselves as pluripotent and vital, not simply as the next powerless victims, intubated and voiceless in the ICU. They need to know that they will write the poems future generations will read with astonishment and gratitude; in the same breath they should enjoy sex, not fear it.
The poem just might be the safest and most pleasurable sex of all. It is the private space where the rhythms of ecstatic love-making can be felt without barriers. It is the place where anything can be said, where nothing like it has ever before been imagined; it is the bright laboratory where the virus is understood, and cured. It is what gets into your blood and makes you feel so alive, it is the rhyme that returns you to childhood. It is the accumulated wisdom of the ancient healers who called upon Apollo and his lyre to restore his supplicants to health, and it recalls the percussive chants of the medicine men; it is all the rage and passion of Marilyn Hacker, it is the bitter tears of Mark Doty. It is felt in the heart, in the genitals, in the mouth and tongue. The poem is the purest distillation of life itself.
My plea, then, is that the poets among us must continue to sing. AIDS is now a vital part of a larger queer identity; accepting that can never destroy our collective immunity from persecution. Nor, however will it stop the efforts to eliminate us. Still, it is an essential step in liberating all the oppressed groups that are drawn together by AIDS. The metaphor of national security as immunity is heightened and perpetuated by the view that a loss of immunity and power inevitably accompanies HIV infection. As my patient in the ICU might have said, removing the tube from his trachea and casting it aside, his voice miraculously restored -- if only he had found the inspiration, and the time and the encouragement to write (and if I can dare to be so presumptuous as to attempt to paraphrase the words I imagine him whispering to me in the recurring dreams I continue to have about him since the day he died, only a few hours later that same afternoon) -- no AIDS death can be the burden any individual person must bear, nor can we ever hope to end the epidemic. It is forever a chapter of our undying history. It is etched indelibly in great poetry upon our bodies; it has taken far, far too many lives already.