Stanley Siegel, LCSW – Exquisite Unions: Final AIDS

[An excerpt from The Patient Who Cured His Therapist: And Other Stories of Unconventional Therapy by Psychology Tomorrow’s Editor-in-Chief Stanley Siegel]

I was teaching family therapy at the University of California at Berkeley and working with the AIDS Project at a medical hospice in San Francisco. My job, in collaboration with the visiting nurses, was to deal with the staff, the physicians, their patients, the patients’ survivors, and their families. The issues were bereavement, the anticipation of death, and the patients, who before dying were demonstrating psychological problems that were damaging their relationships with their loved ones and making the inevitable lonelier for all concerned.

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All of the cases were tragic; all of the work left scars. All the players, in their way, were unforgettable. If I had to select one story, representative of the heroism of com­ munity under siege, one that managed to reflect their hope and optimism despite the bleakest of circumstance, I would choose easily the story based on the case of a man I shall call Martin Miller.

FINAL  AIDS

San Francisco, Winter 1987

A nurse referred the case to me. She had been treating Martin at home for three years in his struggle against certain deterioration. The local health community preferred to treat AIDS patients at home for as long as possible, and I think it was a wise and humane course. Martin had by this time an advanced case of Kaposi’s sarcoma, the cruel cancer most specifically common to AIDS patients. He also had pneumocystis pneumonia, another classic AIDS-related problem.

He was deep into the final stages.

The nurse referred Martin to me because he had at­ tempted suicide and failed. She was stunned into a nervous stupefaction more by Martin’s failure, it seemed to me, than by his attempt; suicide was by no means an unheard-of course of self-treatment in that place at that time.

Like many AIDS sufferers who have reached the end of their tolerance for agony, Martin had swallowed a “death cocktail,” a morphine-based concoction of four different poisons, any one of which should have dispatched him to eternity the moment it touched his lips. I have suspected since our first encounter that the nurse’s befuddled awe regarding Martin’s survival was based on a more extensive knowledge of events leading up to the apparent miracle than was prudent for her to reveal.

Traditionally in these “cocktail” cases the visiting nurse tended the bar. Being closest to the patient for the longest hours, she was at once the likeliest of her care-providing colleagues to be so compassionate, and also the best able to procure the most effectively lethal spirits quietly. Tradition­ally, not wanting to make any mistakes or cause any more suffering than the unimaginable suffering they already had seen endured, those who mixed the “death cocktails” were generous in their pouring.

Also, like many of the nursing personnel I met during that sustained, heartbreaking period of my life, this partic­ular nurse was sufficiently inclined toward spirituality to suspect, and to suggest quite frankly to me, that Martin had somehow kept himself alive – however unwittingly or sub­ consciously – because he had some unfinished business, though he may not have known exactly what it was. In fact, she thought my value was that I might be able to help him define what it was, so he could take care of it and then, of course, die.

Respecting her premise at least for the moment, I visited Martin Miller and his lover, Tyrone Weeks, at their ironically cheery, colorful Victorian house on one of the hills in the Castro District of San Francisco, an almost exclusively gay community not far from the Haight. They lived in an apartment in the back of the house, accessible by a private gate and a cement path lined with calla lilies­ long-stemmed, bell-shaped white flowers that were as wel­coming as they were sensuous. The living room of the apartment faced a tiny garden out back, and Martin’s hos­pital bed, which dominated the room, allowed him to face that way, too. Their word processors stood as sentinels flanking the window on the garden. Martin was a novelist­ scriptwriter; Tyrone wrote copy for small advertising businesses.

Martin was, in a word, wretched. His internal organs were scarred and his skin blotched with purple sores. He was frail, disfigured, gaunt-the very image of death. So far re­ moved was he from even the concept of well-being that I could not imagine what he had looked  like as a healthy man.

Yet whenever Tyrone’s eyes met his, even for fleeting sec­onds, Martin’s eyes brightened in the most astounding way with affection, admiration, respect, gratitude, awe, and the most palpably tender love I had ever seen. The two touched frequently – pats on the shoulder, gentle hand clasps, Tyrone brushing Martin’s thinned hair behind his ears or away from his forehead, Martin reaching out and resting his bony palm on Tyrone’s forearm, thigh, or shoulder. Tyrone was devoted and dedicated to Martin in so classic and even saintly a way that I felt privileged to be present at so private and poignant a time in their lives.

Because Martin was so weakened, Tyrone answered most of my questions. Among the first was my standard inquiry into the history of their relationship, and I was extremely surprised at the opening answers: that Tyrone and Martin had met and become lovers only two years before. It was a startling piece of information. I knew that the nurse had been seeing Martin for three years. That meant, obviously, that the men had become lovers long after Martin had been diagnosed.

Naturally, I began to wonder why Tyrone had chosen to love this doomed man, especially at such mortal risk. That curiosity required that I learn as much as possible about Tyrone first. He was very open, and as he talked, I could not help but notice Martin’s rapt and admiring attentive­ness.

Tyrone was an only child, born and raised in Utah. When, in his early twenties, he revealed to his family that he was a homosexual, they rejected him outright: no debate, no hesitancy, no compassion, no attempt at understanding. In their eyes he was the lowest form of life, and they said so. They cut him off, and would not speak to him or even about him.

Tyrone had responded by rejecting his family. He left home and moved to San Francisco. There, surrounded by a supportive community of other gays, many of whom had moved to San Francisco for exactly the same reasons, he formed new, concentric circles of friends and surrogate fam­ ily members, and declined even to send the most innocuous messages to his family in Utah – not Christmas greetings, not even a birthday card.

Several years before Martin and Tyrone met, Tyrone’s mother had become grievously ill, sick enough to make her have second thoughts about her behavior toward her only child. She called Tyrone and made what he thought was a feeble – but what was in all probability heroic – attempt to reacquaint herself and reconcile their differences.

“I did not handle that very well,” Tyrone said, as Martin watched in deepest sympathy. ”Maybe she caught me off guard, but at the time I simply could not bring myself to forgive her. I was quite cruel in my rejection, and abrupt. I think I was even impolite. Petulant. I even hung up on her. Jesus,” Tyrone sighed, “three months later, I received a letter from a  cousin of mine, who basically chided me, con­demned me, really, for not showing up at her funeral the month before. It was the first I had heard of it. To this day, that was all I had heard of it. She was dead and buried a month before I knew anything about it.”

Tyrone’s eyes glistened as he spoke, and Martin’s gaze was locked on him. Then Martin’s face seemed to relax into a strangely knowing gaze, his expression half spousal, half parental. As Tyrone struggled to tell of his mother’s death, I struggled myself to avoid crying with him.

Suddenly Tyrone looked at me directly and said, ”Then I met Martin.” He paused to look at Martin, who was grin­ning peacefully. Tyrone continued, saying that since they had met, his whole source of happiness had been his rela­tionship with Martin.

Perfect.

I looked over at Martin, too, and for a split second I suspected that he knew what I was thinking: that their re­lationship had given Tyrone the opportunity to dedicate himself to a loved one in the way that he had not dedicated himself to his mother. This painful and tragic relationship was as much a gift to guilt-burdened Tyrone as it was to stricken Martin. I was continuing to work this out in my mind as Tyrone continued to speak rhapsodically about their relationship, until he abruptly lapsed into a pause that filled the room with silence.

I looked up and saw the two of them gazing  into each other’s eyes. I tried to say how moved I was by their rela­tionship, which I described as perfect in its unselfishness and the profound opportunities it offered, each to the other. Not only had Tyrone offered solace, comfort, and affection to Martin at a cruel and crucial time in his life, but Martin had given Tyrone a profound gift as well – the opportunity to repair his past, to care for an ailing loved one in the way that he had missed caring for his mother.

As I talked – probably droned – on about Tyrone’s devo­tion and attentiveness allowing him to make up for what he could not do and felt he should have done, Inoticed Tyrone crying and nodding his head in agreement, while Martin smiled knowingly, even happily, as if I were saying words that he had only been waiting to hear.

As if that weren’t sufficiently moving, Martin then looked directly at Tyrone and said the rest of what I was thinking:

“I’ve been waiting for this moment.”

Tyrone nodded. He knew it now, too.

“I’ve been waiting for you to understand,” said Martin, “that not only have you given me the gift of love, but that you’ve paid your penance. I’ve been waiting for you to let go.”

They embraced, weeping. I embraced the two of them, also weeping. I don’t recall a more profound or touching moment in my life. The irony loomed as if it were a fourth person in the room.

Martin was now free to die. He had somehow stayed his sentence, sidestepped the “death cocktail,” until he was sure that the person closest to him was free. Was it possi­ble? We came to work every Monday morning, and the first item on the agenda was a reading of the list of AIDS pa­tients who had died during the weekend. The list was short­est just before Christmas and New Year’s, and longest just after the holidays. I had no doubts that people kept them­ selves alive for that last celebration of generosity, hope, and love. I have no doubt that Martin kept himself alive for the same motivations.

Martin died the following evening. Tyrone called days later to say that Martin had left me something and that he would drop it off at my apartment. I couldn’t imagine what it was, but when Tyrone brought it to me, he presented the package with a wry, conspiratorial grin.

It was Martin’s word processor.

It reminded me of my feeling about therapy as art. The artist sees and depicts what we know about ourselves and our world but have not yet developed the skills to depict for ourselves – to reassure and fortify ourselves in the face of doubt. It was my privilege on that San Francisco day to articulate what Martin Miller most assuredly knew about his life but lacked the detachment to envision and then sculpt into a communicable form. On another day and with an­ other couple, I used improvised drama to reframe a perspective and reveal the perfection of a relationship. On this day I had used words, had processed  Martin and Tyrone’s relationship and given it back to them in simple prose, the art form that happened coincidentally to be their favorite and their livelihood.

POSTSCRIPT

Despite Tyrone Weeks’s geographical and emotional exile from his family, who condemned his homosexuality and injected him outright, he was driven, as we all are, to repair his damaged relationships with them, particularly with his mother. I believe that this drive was so strong that he was willing to imperil his emotional stability and even his life in order to achieve the balance he sought. He could not repair his relationship with  his mother while she was alive, but the desire remained so powerful after she died that it even influenced his selection of a mate. In the interest of repaying that debt, Tyrone coupled with someone whom he new he would have to bury. In fact, he may have coupled with Mar­tin in part because he would have to bury him.

The power of deceased family members cannot be under­ estimated. We often inherit a legacy that for many of us, guides, and in the more extreme cases, even control our lives. We often see in lesser forms how the powerful influence of tradition and the desire to repair our pasts manifest themselves in our choice of a mate.

It could be argued that there was no real problem with Tyrone and Martin or their relationship. Neither partner was acting symptomatically. Martin’s choice to commit suicide was certainly understandable, and in that milieu, it was ac­ceptable. I even find it understandable that his physiology did not cooperate with his willed attempt to die: The two lovers had a loose end that needed tying before they could part, as the nurse who referred them to me had suggested.

Out of pure generosity, concern, care, or altruism, Martin wished to communicate to Tyrone that Tyrone had paid his penance and made restitution for his past by devoting him­self to Martin, and that Tyrone need not suffer anymore for his ruptured relationship with his deceased mother. And Tyrone wanted to hear this, especially from a person he loved and had cared for until death.

Ironically, neither of the two professional communicators was in a position to put the message into words. So I did. It was a privilege.

Posthumously, Martin described my simple contribution to their relationship by the gift he bequeathed to me – the word processor.

Stanley Siegel, LCSW | Intelligent Lust

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