Part I
by Gerald S. Feldman
Four months ago, when Dr. Anthony Fauci stepped out onto the stage at New York City’s 92nd Street Y the audience rose to a standing ovation. Clamorous, unrestrained, heartfelt.
What was this acclaim and affection for?
Was it for his fifty year tenure at the NIH (National Institutes of Health) in which he was the director, for forty three of NIAID (National Institute of Allergy and Infectious Diseases)? Or for being a constant and vital force at home and around the world against such highly contagious diseases as HIV/AIDS, SARS, and Ebola? Or was it for his most recent role as a leading member of the US President’s Corona Virus Task Force?
Considering the level of commitment to being well informed by any 92Y audience the answer was certain to be “all of the above.” And probably more.
And so Dr. Fauci stood patiently waiting… and waiting… and waiting… until, when their ardor had sufficiently quieted (though not diminished) he took a seat opposite his interlocutor, Lawrence O’Donnell. MSNBC’s anchor for the political news and opinion program, The Last Word.
The occasion was the publication two days earlier of Dr. Fauci’s memoir On Call: A Doctor’s Journey in Public Service. No doubt it was a story we wanted to hear – to sit and listen and learn of the experiences, the trials and lessons that fate and happenstance advantaged in forging the life and career of one we looked to with gratitude and admiration.
But there was something more urgent. There was the story we needed to hear.
Our story.
To revive the memory of the journey from which we’d all just recently arrived home and safe. And recall the many who had fallen along the way. Of how the path we’d trod together had divided into two. From one scored by the milestones of experience and wisdom and the skills of science – that with vigilance and unity we might have arrived sooner, and safer, with a greater survival of human treasure to triumph over a deadly plague – and inexplicably fork into a second path. Without compass: roundabout, deceptive and vague. A detour onto a wasted plain, over which we were told that simply believing in the mirages ahead would make them real and bring salvation within our grasp.
We needed to hear it told and told again.
Compulsively. Obsessively. In the hope that perhaps just one more telling could resolve all questions, and salve our fears for the future. To tell it simply and distill its meaning, nothing short of the epic could be its proper construction. (Because, in reality, for those of us who’d witnessed and lived through it to the end, the heightened suspense, drama and extreme outcomes of the epic were closer to the truth than any other narrative form could express.) And though epic in weight and scope and consequence, revealing its essence might still be elusive unless stripped even further to its barest human elements – to a melodramatic struggle of combatants. Hero and nemesis, protagonist and antagonist, who were also natural foils. And coincidence or no, our story had been cast from the start with just such a pair. Two men, locked in conflict, who just happened to be each the other’s opposite in every way.
And, of course we knew, when it registered that here in the flesh sat the protagonist to our story – its pathfinder and captain, Dr. Anthony Fauci.
So, it was Lawrence O’Donnell who launched the first salvo when he turned to the audience and asked: «How many lives has Dr. Fauci saved?»
One by one, shouted answers were peremptorily waved away by the MSNBC anchor.
«Too low… too low.… no, more… higher.»
Until O’Donnell slowly articulated the answer to his own question: «Twenty-five million.»
Some of us knew but refrained from shouting it out (because of misdirected, but understandable incredulity) that the “twenty five million” figure O’Donnell referenced was the international estimate of lives saved by the global PEPFAR initiative (the US President’s Emergency Program for AIDS Relief), for which Dr. Fauci had been a prime architect and overseer since its inception by president George W. Bush in 2003.
O’Donnell then paused, pointing to himself.
«He saved my life.»
And singling out random audience members, «He saved yours… and yours… and yours.»
More applause, sighs and nodding heads as a secular communion enfolded this otherwise stoic brigade of surviving New Yorkers. Recalling when we were the rampart at the center that stood fast against an invisible invader who arrived suddenly and in force: fearlessly subtle and deadly elusive. Leaving in its wake a ruin of images. Indelibly stamped.
Of the masked and frightened passerby. Faceless. Ghostlike – as I was to her. And the emergency room driveways, steam rising from their banks of refrigerated morgue trucks.
And of sounds.
From these inverted catacombs. The incessant and ghastly groaning of outboard compressors, circulating the chill that delayed corruption of their grim galleries. Of the 7:PM ritual of cheering, shouting, bell ringing, horn blowing, pot and pan rattling. Bunkered and cloistered behind brick, steel, glass and plasterboard. Honoring the nearby hospital staffs – from Lenox Hill and Mount Sinai, at their dinner breaks or changes of shift.
They’d saved us too. Many with the sacrifice of their own health – even their own lives.
At the same time, in another place, jeers not cheers would have greeted Dr. Fauci. And chants of “Lock him up!” would have surely followed. Because in the interval between the violent end of one presidential administration, while the plague still reigned, and its being brought under submission in the next, a movement had grown, despite all real evidence to the contrary, to find Fauci guilty of criminal malfeasance in his response to Covid-19, making him liable for the toll of unnecessary deaths – even of being personally liable for its creation.
But with philosophical detachment Fauci related that such vilification was not new to him. That much earlier in his career, thirty five years earlier to be exact, he’d faced virtually identical attacks by an aggrieved contingent. And his response then, was how he’d made his bones.
February 1989. The AIDS crisis a decade in and the US death toll at its peak. With Fauci in his fifth year as head of NIAID, directing the federal implementation of clinical research and treatment for AIDS patients. Protesters from the activist group ACT UP! (AIDS Coalition to Unleash Power) – enraged at the lack of government progress (and seeming interest) in its response to AIDS while they were rapidly dying – gathered around Fauci’s office at NIH. Fauci was their target, the face of the government response. Shouts of “murderer” who should face jail and execution for conducting useless trials of poisonous, ineffective drugs that only increased their agony and ensured death. Worse, they accused him of being a shill for his cronies, the drug companies, whose profits soared the more ineffective drugs they produced and marketed.
But Fauci surprised them.
Contrary to expectations, Fauci did not reflexively defend his institution’s position. Because he’d continued his work as a clinician at the NIH hospital, while directing NIAID, he treated AIDS patients daily, developing personal relationships with some, and experienced the constant frustration, tragedy and grief of being unable to save even one. He reflected that the rigid protocols they’d been following were not helping (that the cruel delays they introduced were actually hurting the chances of many who might gain a little more time, perhaps even to survive until more effective treatments, or ultimate cures, were found. “If I were in their shoes, I’d do the same thing.” Fauci admitted.
He invited ACT UP! members – including their passionate leader and founder Larry Kramer – into his office to discuss how he and the bureaucracy could do better and if they could work together. This resulted a “parallel track” collaboration strategy, that included patient treatment with drugs still in trial stages, while continuing with traditional rounds of approval through strict clinical trials. The result was a vast acceleration of the discovery of effective treatments that saved lives.
Some time after meeting with ACTUP, speaking at San Francisco’s town hall, Fauci solidified his position – alienating the FDA because he opposed its authority to impose strict protocols that would deny patients the right to risk treatments that held hope of delaying or possibly preventing AIDS’ inevitable outcome. And he announced the new policy at NIAID of following the “parallel track” strategy he’d developed with patients.
At a government hearing that followed, Larry Kramer, who was in attendance shouted: «Tony, I have called you a murderer in the past, but you are now my hero.»
Fauci spoke of the close friendships he’d developed with the AIDS activist community with whom he partnered back in 1989. Thirty years later, while Larry Kramer lay dying at the age of 84 – having reached a full and productive life he’d have surely been denied had he not engaged with Fauci – had a brief phone conversation with his friend. He said to Fauci, «I love you Tony» and Fauci replied,«I love you too.»
Fauci’s demonstrated empathy was nurtured early, and he spoke of when as a teen he’d been accepted to Regis High School, a private Jesuit school for boys on Manhattan’s Upper East Side. Endowed by a trust, the school offered a tuition free education of the highest quality to applicants who had demonstrated exceptional academic motivation and achievement.
On the drive to his appearance before us that night, Fauci noted that they’d passed Regis, on Madison Avenue and 84th Street, just blocks from the Y. «I loved that school,» he recalled, adding that he hadn’t even minded the three subway lines he had to take to get there from his parents’ apartment in Brooklyn. But it wasn’t just the quality of the curriculum he admired.
“Men for Others” he reflected was the school’s motto. Anachronistic in today’s language the Jesuit maxim was addressed to male students in the all boys high school by the Society of Jesus consisting exclusively of men. (Today, in coeducational Jesuit schools the phrase is heard as “men and women for others,” or simply “people for others.”) To the theme of service to others, the Jesuits added the corollary “precision of thought and economy of expression.”
A skilled communicator, Fauci easily made clear that the value of “precision of thought and economy of expression” when applied to “service to others” in his field of clinical research in public health (or any other such endeavor) resulted in a “multiplier effect.” And he described the tremendous satisfaction he got using much the same effort as in diagnosing and treating single patients, that when applied with the more exacting tools of clinical research and development, could achieve discoveries and treatments affecting thousands or more lives for the better.
«But,» O’Donnell interjected, admitting that though he too had been educated at Catholic parochial schools, where the nuns and priests, like the Jesuits, tried to inspire the students with the Christian ideal of selfless service «neither I, nor others,» of his peers, followed that path. Requiring Fauci to elaborate and explain that what made him particularly responsive was that what the Jesuits taught was a continuation, reinforcement and refinement of the same ideals he’d grown up with. And particularly taught to value at the kitchen table discussion with his parents (both college educated first generation Italian-Americans) from early childhood in Bensonhurst, Brooklyn. Values his parents put into practice with the family’s move to a new house in Dyker Heights (just blocks from Bensonhurst). There his pharmacist father opened a drug store on the ground floor and the family lived in the two bedroom apartment above.
The “Fauci Pharmacy” was not just a drugstore. At a time when neighbors often could not afford to see a doctor – and if they could, were just as likely unable to afford to fill their prescriptions – Stephen Fauci became their physician, psychiatrist, and counselor. He filled their prescriptions and allowed them credit if they couldn’t pay. Many never did. Fauci recalled that often when his father came upstairs for his forty-five minute dinner break, he would discuss his customers’ cases at the table with the family. And just as often was interrupted by someone downstairs needing his help.
Fauci smiled, admitting that his father was «a great pharmacist but a poor businessman,» and their finances were always at risk. But they were happy. Both parents fulfilled their priority of service to others. Fauci loved his father and he obviously emulated him. It was a natural progression from being raised in a family in which care of others was the highest calling, later reinforced by his high school training with the Jesuits to becoming a doctor specializing in medical research (in which a discovery could be a multiplier) to the director of a public service medical institution.
Fauci served seven presidents. While I have (mostly) avoided nuance and subtlety, ambiguity, compromise and deference – any qualifiers that might soften a narrative of melodramatic contrasts, there is one exception that proves the rule. Because, all things considered, it highlights an even greater contrast to the antagonist in our story, who will be introduced in part two of this report.
Surprisingly (or not) it was Fauci’s reminiscence of serving under George W. Bush, who despite a record of serious missteps and tragic controversy (about which I needn’t elaborate), was the one who sent Fauci to West Africa to establish PEPFAR (widely acknowledged as the most successful effort to fight a single disease in world history) with these words, «Whether you live or die shouldn’t depend on where you were born.» To which Fauci added with obvious emotion, «This was an example of what the immense power of the presidency, coupled with true leadership, could accomplish for the good.»
Friday, October 25, 2024
On the cover: Anthony Fauci on April 16, 2020 – from White House Coronavirus Update Briefing. Public Domain
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