Facing the Demon
Shipman, 36, is among the growing number of physicians who are trained to save lives but must settle for less. AIDS kills, and sometimes quickly, but Shipman is dedicated to making a difference in the brief lives of his patients. His strength in the face of this ghoulish epidemic confounds even his closest friends. "He keeps his emotions very close to his heart," says one, "and he doesn't share his suffering with anyone."
Shipman's sensitivity to his patients' anxieties, his frustration with the pace of research and his exasperation with an indifferent health-care industry are particularly acute, since Shipman himself is gay. "There are a number of dedicated and caring physicians who do what I do, and God bless them all," he says. "But too many doctors have buried their heads when it comes to AIDS. I have patients whose teeth are falling out because they can't find a dentist to treat them. In the 14th century, physicians were chastised for not taking care of plague victims. Today the health-care profession has forgotten the reason for its existence when it comes to AIDS. It is to take care of people who are sick."
For more than two years Shipman has searched and failed to find a partner to share his growing practice. His office assistant, Kathleen Mathews, hasn't taken a vacation in six years because, she says, "people are too afraid" to fill in for her. Steve Kalish, an infectious-disease specialist who assists Shipman, thinks that AIDS is simply too depressing for many doctors to deal with. "AIDS patients are always ill, and then they die," he says. "You go home and you can't stop thinking about them." Shipman agrees. "AIDS is not a disease that you can diagnose and walk away from," he says. "You have to talk about death and dying." Yet his work also has special rewards. "There is always the challenge of exploring and analyzing the illness," he explains. "Each patient is different. Of all the fields of medicine I have been exposed to, this is the most stimulating."
The AIDS virus had not been identified in 1981 when Shipman, fresh from the University of Minnesota Medical School, came to Chicago to build a private practice treating cancer patients. That fall he read a piece in the New England Journal of Medicine concerning a handful of gay men stricken with a rare form of pneumonia. In the spring of 1983 he diagnosed his first AIDS case.
"I never made a conscious decision to treat AIDS patients," he says. "It was more like getting sucked into a vortex you cannot escape." In the past five years, death has claimed 74 of Shipman's patients, including a former lover. "It's so sad because they are so young, and it's such a terrible way to die," says Kathy Mathews, 41. "It takes a part of him when one goes. I've seen him break down and cry, or he'll be slumped over his desk. I don't know how he does it. I find it very hard."
At times, Shipman's dedication to the dying can be a trial for the living. At Edgewater Hospital he is demanding and often brutally sharp-tempered with staff members who don't perform up to his standards. If he believes a resident is insensitive, he will bar him from treating his patients. "If you're an incompetent boob," says one nurse, "you better stay out of his way." Concedes Mathews: "He's cranky and compulsive, but he is also very compassionate. He's the only doctor I know who will call a patient to make sure he's taking his medicine. If someone is having a problem, he will just sit and listen."
Ninety percent of Shipman's practice is AIDS-related, and the majority of those with the virus are gay. He has treated four women, a number of male IV-drug users and several straight men with no history of drugs. These heterosexuals, says Shipman, are having "the hardest time telling their lovers and parents because of the immediate assumption that they are gay. They are not gay, but many had sex fairly indiscriminately with multiple female partners during the years when, hey man, it was cool to do that. I try to encourage them to be truthful because along the way it is going to come out. We won't be able to deal with AIDS successfully," he maintains, "until people get over the idea that this disease is dirtier than others."
To protect each patient's privacy, Shipman insists that blood tests be identified only by coded ID numbers, and he refuses to give results, even when negative, over the phone. "Finding out you are HIV-positive can be very traumatic. I don't feel comfortable saying something that has so much importance without being able to see the patient and discuss his or her feelings."
Shipman's daily battle with the disease begins with a bitter cup of coffee in Edgewater's shabby doctors' lounge. After his morning rounds he sees patients at his private office near Chicago's Lincoln Park.
Fueled by macadamia nuts and Diet Dr Pepper, he moves swiftly between examination rooms. One is occupied by a 32-year-old computer operator who is going blind from the AIDS virus. In another is a corporate executive in his 30s who is so frightened of losing his job that he refuses to use his company insurance and bears the full cost of his weekly chemotherapy himself. Later this afternoon Shipman will see a straight but promiscuous high school teacher, 40, in for a blood test; a classical musician, 26, with a persistent cough; a 21-year-old waiter showing the first signs of the disease; a heterosexual chauffeur who has lost 90 lbs. following an AIDS-related lung infection and a 34-year-old truck driver with advanced Kaposi's sarcoma lesions. "There have been times when I've cried in Shipman's arms," he says, "and he has comforted me."
It was Shipman's own childhood fear of death, he says, that originally turned him toward medicine. "Most people don't become doctors to get the enormous satisfaction of healing," he says. "They do it because they are pathologically frightened of dying and they think that acquiring some great mystical knowledge will prevent their own mortality." Born in Chillicothe, Mo., Ship-man spent much of his youth moving around the Midwest with his parents and younger sister. His mother was a nurse; his father sold farm machinery and was transferred frequently. At 10, young Greg had already chosen his career when his best friend died of a congenital disorder. "It upset me a great deal," says Shipman, "and even now I feel the loss." That same year his family settled in Minneapolis, and he began working summers as a hospital volunteer until he graduated—magna cum laude—from the University of Minnesota.
Shipman entered the university's medical school intending to specialize in hand surgery ("I was extremely interested in the intricate composition of the veins, arteries, tendons and nerves") but soon became fascinated by internal medicine. He was particularly moved by the courage and appreciation shown by cancer patients. "Even when there was little you could do for them," he says, "you always felt that you were two human beings tied together at a particular moment, and both of you were better for it." That sentiment has been rekindled by Shipman's AIDS victims.
The patient in room 307 at Edge-water Hospital, a 48-year-old accountant whom Shipman has been treating for six months, has just arrived by ambulance. His body is covered with purple lesions; his breathing comes in gasps. His lover stands helplessly, as a nurse, cocooned in sterile mask, gown and gloves, whisks in and out of the room before Shipman arrives and clasps the man's blotched hand. The patient, now sedated with methadone, has previously signed a DNR (Do Not Resuscitate) form instructing the hospital staff not to keep him alive by extraordinary means. Shipman calls for oxygen and a softer mattress. Then he sits at the man's side and speaks calmly: "So you understand that if your heart stops, we're going to let it go." The dying man understands. He clutches Shipman's hand and whispers, "I want to thank you for everything you have done for me." Forty hours later the man is dead.
Seeing so much death has not diminished Shipman's lingering fear of it. "That's something very private that no one can teach you how to do," he observes. Each loss hits hard, but Shipman deals with his anguish alone. He never goes to funerals; instead, he stays home and listens to Mozart. "Thoughts of people come back to me," he admits. "The grieving doesn't go away."
Most wrenching, of course, is the loss of close friends. Shipman can count 15, most of whom he has treated. "There are times when you think about the fact that you have been spared," he says. "I have done the same things they have done, and yet they are now just somebody's memories. Deep in my heart there is a gnawing sadness that it had to happen to them." In September 1986, a lover he had not spoken to in nearly three years came down with the disease and called Shipman. "It was very upsetting," he says, "because he was asking to be forgiven for everything in the past and begging me to take care of him. It wasn't necessary for him to apologize." The man died four months later of a viral infection. Shipman has not been tested for the AIDS virus because, he says, "I presume I know what the results would be."
"I worry about him," says Kathy Mathews. "I told him if he gets sick, I can't work here. I don't want to watch him die." Says Shipman: "Occasionally I am concerned about my own health. That cough, is that it? That spot, is that it? Sometimes you get very macabre and feed your face because of the myth that people who put on weight can't possibly have AIDS."
While AIDS causes Shipman anxiety at times, it seldom provokes him to rage against fate. "You can't get angry at a disease," he says. "No one is guaranteed threescore and ten. I'm 36. Even in the best of all possible worlds, I've seen more than half of what I'm going to see. Last year was the first time I began to marvel at things I've always taken for granted: a sunrise over Lake Michigan, the smell of spring lilacs, the crispness in the fall air. When you imagine you may not see these things again, you become more intense."
At day's end, Shipman retreats to a 100-year-old two-story brownstone. His last live-in relationship ended two years ago, a casualty of his commitment to work. Last month his current lover, Jeffrey Wallace, 33, an administrator for an insurance broker, moved in. Shipman has begun vacationing in Paris—one escape from the withering routine of his 70-hour week on the job. Pinball is another release. "When I'm worried about a lot of things, I can get mesmerized by that little silver ball," he says. "And pinball is kind to you; it always lets you win a game."
In addition to maintaining his practice, Shipman serves as medical director at the Howard Brown Memorial Clinic, a not-for-profit community center for the treatment of sexually transmitted diseases. There he spends evenings seeing walk-in patients who cannot afford a private physician. When Shipman is not ministering to the victims of AIDS, he is a tireless advocate on their behalf, writing letters to legislators, making speeches, giving interviews. "Ronald Reagan has put AIDS in the closet," he says. "Instead of being embarrassed by it, he should face the problem and encourage legislators to make it a law that people who are infected will not be denied housing and insurance. The President's AIDS commission has made recommendations, and the White House has done everything to backtrack. History will deal with him in terms of how ineffectual he has been in leading the country on this issue."
He is equally disparaging of the controversial declarations of Masters and Johnson that the virus is rampant in the heterosexual community. "It is a shame that they have sacrificed their 25 years of scientific research integrity for the sake of screaming headlines." He appreciates the progress that has been made in discovering the nature of AIDS, but he is realistic in assessing the chances of finding a cure. "We have come a long way," he says. "In 1981 we knew we had an epidemic; in '83 we knew it was a virus; in '85 we had a test for it; the same year we mapped out its genetic structure. But when it comes to a vaccine, you're talking about getting bacteria to jump through a hoop. That takes years."
Until then, Shipman is committed to his noble struggle. "What is most depressing," he says, "is that the bureaucrats have made this catastrophic illness a political issue rather than a medical issue by allowing social stigmatization to continue, instead of saying, 'This is the world's most pressing health-care issue, and we, the American people, are going to solve it.' Time is ticking," says Ship-man, "and it is winning."