Bad Blood Again: First Syphilis, Then Aids- a Whole New Game

By Richard G. Pugh

Bad Blood Again is a novel revealing for the first time investigational techniques employed by trained public health workers as theygo about managing the spread of infectious syphilis. That dedicated and often dangerous work took on a new life when the AIDS epidemic began terrifying the nation beginning in the early 1980s. Pugh weaves in his own experiences as a VD investigator and reveals in considerable detail the sexual excesses surrounding the juggernaut of AIDS in the gay community.

• Language: English
• Publisher: AuthorHouse
• Release date: Feb 4, 2009
• ISBN: 9781467046022

Richard G. Pugh

     Richard Pugh, a native Carolinian, was born in Greensboro and raised in Charleston. He graduated from the U. of South Carolina (Go Gamecocks!) with a degree in psychology and served in the U.S. Coast Guard before marrying Charlotte Ann his high school sweetheart. Pugh gained investigational experience with the U.S. Public Health Service in its Communicable Disease Control Program before entering the field of association management. Pugh served as CEO of the Coastal Carolina Tuberculosis Association, Assistant CEO of the South Carolina Medical Association, and CEO of the Nevada State Medical Association in Reno before retiring to begin his writing career.      He was appointed to the Adjunct Clinical Staff at the University of Nevada School of Medicine in Reno in 2005 and has written five books recording events in early medicine in the Silver State through oral histories of medical professionals who began their practices in mid 20th century. Capturing and publishing their life stories before they pass into history has been the main thrust of his work for the University.

Book preview

CHAPTER ONE

In the Beginning

Standing inside this bus station eyeing people wondering through and trying not to look suspicious is a challenge not everyone can pull off. I always pull it off and damn it, that’s the exciting part of my work! Many times the looks given me in bus stations or in crummy bars or in parks made me want to wear a sign saying, Hey, mind your own business! I’m just doing my job! Time after time I have had success locating people in such places, but I always felt a little alone, fearful even! Never any back up if something went wrong but then thankfully, nothing ever did!

So, what am I doing here in this low-life Lincolnton, Pennsylvania bus station on a Monday evening in early April 1983 when I could be home having a delicious Jack Daniels on the rocks, my very favorite beverage, watching TV, or having a quiet dinner with my girl friend? I sometimes wondered what it would be like to be a drug pusher, or a panhandler looking for a little change to buy some wine, maybe a private detective, or one of those socially degenerating creeps hanging out looking for whatever comes along; drugs, sex, kids, or whatever. I even imagined being an FBI or CIA agent, particularly a CIA Agent. I could picture myself being a murderer waiting to catch a quick stage out of town; or maybe a jealous husband trying to catch his wife with another man or with another woman. Those were vaguely amusing musings; I wasn’t any of those characters! I was a Venereal Disease Investigator, a VDI! I was a pecker-checking clap-cop! While I was a federal employee, I had the added advantage of being assigned to the Pennsylvania State Health Department and used that state identification at all times.

Investigators like me are responsible for working in the trenches and the bus stations every day and night doing all we can to make sure syphilis doesn’t become the embarrassment it was in the fifties and sixties when it raced through the population like Sherman went through Georgia! It’s a lofty and good goal but progress toward achieving it has been spotty and that has discouraged me more than anything. My fellow Investigators do a great job fighting a very shrewd enemy and take thousands of infected people off the streets, but without notice the feds cut back funding for the control program and the cases go back up. It’s a cycle and right now new monies have been located to reinvigorate the program and I am entirely pleased with that happening. Syphilis is as crafty as a coyote and over thousands of years has always found a way to survive. The causative agent of syphilis, the Tremonema Pallidum is indeed a worthy opponent!

How did I get involved in investigating the sex lives of people with infectious disease? Now that is a good one and it’s a story worth the telling.

I’m Douglas Leslie Given and I was raised in Charleston, South Carolina where my dad was a mechanic and I was a happy kid with never a thought of what to do with my life. I smiled my way through high school and earned a measure of popularity going out for all the sports teams and surprisingly making them. Never actually played much, however, because I didn’t have the bulk to block, the speed to run, and while I did have some height, I couldn’t master the knack of slam dunking, but I could occasionally hit the long ball and earned the spot as catcher on the baseball team. I was pretty good at that but there was this other kid just a little bit better and he beat me out for the position. Being a bench warming splinter collector really wasn’t a big deal.

I joined the Coast Guard Six by Eight Program after high school. It was a special program involving six months of boot camp in Cape May, New Jersey followed by eight years of dreary weekly reserve meetings and two weeks training each summer. I was in one of the first of such guinea pig companies, and what a total waste of time that was! The fifty of us in my company learned absolutely everything there was to know about swabbing decks and tying knots. Granny knots were my favorite! One very good thing came out of those six months of base-ridden nonsense because several of us bottom feeding seamen recruits decided we were going back home and getting an education and vowed not to become fodder for the military.

After that six month’s misadventure, I checked into college admission requirements and learned my smiling all the way through high school didn’t prepare me one bit for a higher education, especially since I never took any algebra. My thoughts of becoming a civil engineer would be out of the question. I would need to go back to high school and take two algebra courses just to be allowed to take the college entrance exam. I did that post graduate high school math study program and passed the SAT exam amazingly big time.

I applied to The Citadel in Charleston and the University of South Carolina in Columbia and was accepted at both, but at the last minute, I decided I would not have been able to endure the freshman ‘hazing’ the Citadel was infamous for. I also had increasing thoughts about marrying my high school sweetheart which was proscribed for students at the Military College of South Carolina.

So there I was, two years out of high school and twenty years old and an engineering student at Carolina. It didn’t take long to clearly see there was absolutely nothing enjoyable or even comprehensible about those early pre-engineering courses and as a result of making that major career selection mistake, I dropped out, married to my sweetheart, worked in my dad’s auto repair shop (and hated every second of it) and re-entered school the following semester. With around the clock and calendar classes and study, including three summer sessions, I graduated in four years with a BS degree in Psychology with a wonderful and surprisingly good GPA. I enjoyed those classes and learned to answer questions with questions. Why do psych majors do that?

Due to nagging financial constraints, my wife and I had three jobs between us, there could never be wonderful college parties, or panty raids, or student protest of any kind, no fight songs on the ‘horseshoe’ or tearfully singing We Hail Thee, Carolina! at football games! It was a tough time in our lives, but we got what we came for--a SHEEPSKIN!

In the months before graduation I must have interviewed with a dozen companies and set my sights on two, even prayed I would get an offer from one of them. I really wanted to get an offer from the Central Intelligence Agency as their interviewers painted pictures of a fascinating CIA career. I also interviewed with the U. S. Public Health Service for an investigator’s position with the Communicable Disease Center. The CDC liked to hire psychology graduates and interviewed as many as they could locate. Another plus on my side was the training I was receiving each summer completing my years of reserve duty. I was a Hospitalman 3rd Class and when my CDC work took me to locations with no Navy or Coast Guard reserve units where I could attend those awful weekly meetings, I had to put in a month each summer, and usually did that tiresome time at the Coast Guard base in Charleston. I worked in the base infirmary and on tugs, actually they were buoy tenders but euphemistically called Coast Guard Cutters where I took histories and did physicals, gave shots, and drew blood for testing. I also treated lots of things. Once or twice I gave a shot for this or that privately contracted disease and never killed anyone and I think that impressed the CDC interviewers I was medically inclined and had never killed anyone!

While waiting for a call from the CIA, I accepted the position offered by CDC. Good Call! A day or two later the CIA, referred to as THE COMPANY, sent me a telegram thanking me for my interest, telling me of several outstanding qualities exhibited in my interviews and wishing me well with whatever it was I decided to do with my life, but offering me no job! I still think I could have been a fine spy!

The years that followed as an investigator, a Field Epidemiologist as we were called were a whirlwind of interesting assignments but were tough on my family. The training was great and the camaraderie with the other investigators was outstanding. I got transferred three times in seven years, but those were the best years imaginable. We had a son while I was in school and my wife tried very hard to be supportive of my work, but she began to drift away, slowly at first then faster and faster. Her dislike of my work exploded one night when I brought blood samples home after a night of case finding and put them in the refrigerator uncomfortably close to our son’s baby formula. Not smart, but also inconsequential as there has never been any evidence--Oh, never mind! We divorced within two years after graduating from school; and we still keep in touch but are not buds. She had been working on her degree in counseling while I was chasing syphilis in Pennsylvania and took a fine job at USC back in Columbia and married her live-in boyfriend who adopted my son straight away. That sequence of events surprised me a good bit and I’m not quite sure why.

So here I was, hanging out at a dingy bus station doing the job I loved. Sometimes I felt like I did stand out somehow even though my training told me never to do that. Investigators were never to draw attention to themselves and that was just the way our bosses wanted it. End of discussion! We were to wear dark suits, no pin stripped suits or fancy silk ties, and white shirts were the major part of our uniform! There would be no facial hair of any kind! On a lark after a fishing trip one summer I began raising a mustache and my boss, Big Jim, immediately told me to lose it, just lose it!

I was just a shade over six feet tall with thinning but still dark brown hair and a slowly receding hairline. My father and two brothers were well on their way to MPB and eventually would be completely bald as they kept finding lots of hair on their pillows. I sometimes thought my height and, yes, my outstanding good looks as my wife assured me in the early part of our marriage might have been intimidating to hapless VD suspects but it also added a measure of effective professionalism to my work over the years.

It was always a thrill when I was successful in locating a contact in a bus station, a bar, or on the street and I was thrilled when my suspect tonight showed up! A bit of luck! Yep, that’s him! No doubt about it! It’s Bert all right a tall black man maybe a little taller than me even. He has a small but noticeable keloid scar across the left side of his face and is wearing a snap-brim hat and a tan windbreaker; now I make my move!

I don’t make contact until he is in the middle of the waiting room and I watch him momentarily scan the people sitting there. I approached him asking directly:

Bert, how’s it going? in my most serious tone. Were I ever approached in a similar situation with a question like that I might just suspect the questioner was gay. That question made me think of the line ‘issued’ to us in syphilis case-finding school. Our instructor told us if we were ever solicited by a homosexual an effective and disarming response we might use was, Listen, dude, you work your own side of the street--this side is mine! Thankfully I never had to use that line and wouldn’t have anyway!

VD investigators are mostly in urban areas because that is where the disease is but they can occasionally be out in rural areas as well. VDIs seldom if ever run into each other doing casework. Now, wouldn’t that be hoot! I could see myself approaching a suspect asking, Excuse me! You’re Jerome, aren’t you? I’m from the health department and I need to talk to you! If he were another investigator it would be followed by a lot of good-natured laughter then followed by swapping stories over a beer someplace.

Bert stepped back two steps and replied, Pretty good. What’s up with you?

I’m with the health department and I have to talk with you. Can we go some place for a minute and I’ll explain what‘s up.

What in the hell is this? If you’re from the health department let’s see some ID! I expected that and had my photo ID card in my hand. He studied it a little and said, Let’s go over there by the newspaper rack.

I noticed he had a slight limp, which was another of the identification points given to me by the patient who named him as a contact earlier today.

What’s going on, what you want with me? He asked leaning against the rack.

Here is where things could go very wrong if not done by the book. "My name is Doug Given and I’m an investigator for the health department. Your name has been given to me as someone who has come in contact with a person diagnosed with a communicable disease. You’ve heard of syphilis haven’t you sometimes called bad blood? The person who gave me your name thought enough of you to see that you were contacted and checked out. I’m not saying there is anything wrong, but my information is that you have been exposed."

Who gave my name, I haven’t been exposed to no bad blood or anything else, now leave me alone! He brushed past me but stopped a short distance away asking, Gave my name, huh?

Yes, I have a good description, that scar on your face, a slight limp, a good dresser, a cool hat, drives a yellow mustang with racing stripes, it’s the right fit. I even have your name. They call you Bert, don’t they?

Yeh, sometimes. How’d you say you got my name? His voice was getting stronger.

Those were good questions and I had to be careful here because the information obtained in my interview with the infected patient was drop dead confidential otherwise the contact-tracing part of my work would fall on its ass. I promised the patient confidentiality and it wouldn’t work to let anything slip out.

Bert, that’s not the importing thing right now, what’s really important, is for you to get checked out and get that done as quick as possible. I’m working on a chain of infectious syphilis in town and I’m locating people who very well could have the disease and spreading it without knowing it. Not everyone who comes in contact with syphilis gets it, but everyone who comes in contact with it has to be located and examined. You have a sore someplace on you body right now, don’t you? I could see what looked like more than a fever blister on his upper lip and that was no surprise at all. Pointing to it I asked, How long have you had that?

That’s nothing, a little cold sore that’s about gone, I put some salve on it and it’s going away. Nothing wrong with me and there is no use in my being examined or anything. I’m fine; I gotta go!

Do yourself a favor, Bert. What’s to be lost here? It’s not up to you to tell if you’ve been infected, although that little sore is a pretty good indication something’s going on. You’ve seen it. I see it! Now let a doctor see it! Maybe its nothing but if it does turn out to be syphilis it can be quickly and easily treated. Finally I got through to him!

What do you want me to do?

I want you to see your own doctor or you can go to the clinic on Five Points Drive. It was seldom if ever I had to use the third option in my bag because it was a harsh one. That choice involved a bench warrant, arrest, jail, and forced examination, treatment, and interview, all in accordance with communicable disease quarantine laws on the books everywhere. While I did have to offer that less-than-subtle choice once in my career, the patient acquiesced as soon as it was ‘splained’ to him.

The exam and blood test at the clinic are free, Bert, and only take a few minutes. The doctor will need to see you in the morning at eight sharp. I’ll be there and we can talk and I can answer all your questions, but I will need a little information right now. How do you spell your last name?

I didn’t know his last name. I would have to finesse it. The person who rolled on Bert didn’t have a clue what his last name was and handling this wrong could be a surefire a deal-breaker. If the last name turned out to be ‘Smith’ or ‘Jones’ or any of a dozen other simple names the contact would know I had nothing on him and could walk. I hated it when contacts looked back at me and said B-R-O-W-N like I was some kind of f-ing moron!

He said Bowes and spelled it out for me. Super! I’m home free! Bert Bowes! I then got his phone number, address, and where he worked and re-affirmed I’d see him in the morning. I told him I sometimes drew a blood sample when I talk to people in the field but I trusted him to come to the clinic as promised. He was not ready to go just yet and wanted a little more information about the disease so we went to his car (I didn’t want him in mine!) and I gave him a good but brief essay on it. When it was time for him to head out I handed him an appointment slip for 8:00 AM at the clinic. He didn’t thank me outright but I could tell he knew I meant him no harm and he offered his hand and I found some excuse not to shake it. Investigators don’t shake hands with known patients or exposed contacts; he drove off in his Mustang after I got his license tag number.

There was one more stop I had hoped to make but it began to rain, possibly snow a little and I retired to my hotel room to relax. I did some reflecting on the events of the day and got a feeling of real satisfaction. That satisfaction was measurably enhanced by two ounces of my favorite delicious beverage…Jack Daniels Sour Mash Tennessee Sippin’ Whiskey! I had been getting quite a few of those good feelings recently and this one began to grow at the clinic when I got the call at the Greensburg clinic this morning. Dr. John Harvey had diagnosed the first case of primary syphilis seen in his home town in three or four years. Syphilis is a mostly a large city disease and in my experience the casework required to find out where patients get it and where they spread it demands special handling in small communities like Lincolnton. People talk and the ugly syphilis word spreads. Sometimes the local newspaper gets wind of it and reporters try to chase the story along side investigators and this just might happen here.

"Doug, I’ve got a case for you. A young man came in saying he had some problems ‘down there’ and on examination I located a chancre about the size of pencil eraser just behind the head of his penis. I got a slide and looked at it under the scope. The first slide had too much blood on it and it dried out really fast, so I got another one and it was just right. Bingo! There was the Founder of the Syphilis Eradication Program the Treponema Pallidum twisting a mile a minute! In one field alone there were twenty or thirty spirochetes. I diagnosed him as a case of primary syphilis, an S-10, and the nurse has taken his blood and already given him his 2.4 and he’s waiting for you to talk with him. Do you still plan to go with me to the nursing student meeting tonight? I’ll make reservations at the hotel for you. How soon can you get here?"

My calendar is clear this morning and yes, make reservations for a couple of nights since I have some other work to do while there; I’ll be right over, see you within the next forty-five minutes. The trip actually took about thirty minutes and went by very quickly as I thought about the 2.4 numbers Dr. Harvey was referencing. It was 2.4 million units of buttermilk thick penicillin administered via a prepackaged syringe with this large, incredibly large needle, which had already been jammed into this kid’s ass muscle, the gluteus maximus. I’ve seen a hundred of these injections and done a few myself and know just where to put that needle and how far to jam it and I always felt that pain right along with the patient. No, not really!

John Harvey was a well-trained general practitioner with quite a history. He was well trained general practitioner and had retired from a distinguished medical career that included being a military physician and a patient seeing GP in western Pennsylvania. I was looking forward to visiting with him a few minutes before interviewing his patient but soon as I got there the intercom squawked, Long distance call for Mr. Doug Given! and I took my leave after telling him I was proud of him and that he was continuing his talents as a rather good ‘pecker-checker!’ I asked the nurse to show the patient to the interview room while I took the call.

Hey, Doug this is Karl, glad I caught you. What are you doing in Lincolnton? I thought you were going to be in Johnstown today, at least that’s what’s on your agenda this week and that’s what I always rely on. I called over to the clinic in Johnstown and they said you weren’t scheduled to be there this week. Then I called the Greensburg clinic and they told me where you were. Don’t do that to me again!

I got a call at the clinic this morning from Dr. Harvey here in Lincolnton telling me he had a fresh case of syphilis for me and could I get over there ASAP. He also wants me to go with him to talk to a group of nurses this evening. You have to remember those weekly calendars don’t mean crap, Karl, and are no more than guess work and you shouldn’t put any stock in them. They are another one of the meaningless reports you insist on. You ought to know that by now, Karl, and stop losing sleep over that sort of thing will you?

Doug, please let me know where you are from now on. I just wanted to know when you might get your monthly expense and activity reports in. They’re overdue right now you know. Will you drop them in the mail this afternoon? Will you do that for me?

I let a long moment lapse before telling him that was just not going to happen and I knew those damned reports were overdue and I’d send them after I got a handle on what’s going on here in Lincolnton, but not to look for them before the end of next week which was still well within the absolute deadline insisted on by Karl.

Hey, this new patient is waiting for me in the interview room right now and those reports are the last thing on my mind right now. One more thing, Karl, I have a positive blood test report from a private physician here in town I will need to spend some time on today so keep your shirt on, will you?

Karl was the number two boss at the home office, he was the Assistant State Director of the Communicable Disease Control Program and was a GS-12 grade bean-counting, pencil-pushing, anal retentive, dumber-than-a-box-of-anvils, pain in the ass! All the investigators avoided Karl whenever possible but he worked in such a serpentine manner it was seldom possible to avoid him. I never met an investigator who had respect for him and that went double for my friend Buddy Riley. Buddy always found a way to disrespect him in often subtle but cruel ways that would only become apparent to Karl later in the day and once figured out would piss him off and really make his blood boil.

Tear ‘em up in Lincolnton, Doug, the syphilis morbidity report this month looks good. At last count we had seventy cases and our numbers are higher than our six-month’s average and what ever you pull out of Lincolnton might make it a record month. See you at the staff conference in May. Now remember, don’t forget to get those reports to me. Those reports are very important you know!

After telling him where I was staying tonight, I hung up. One of these days, I’m going to punch that prick in his big kraut nose! He doesn’t listen. The first time I ever saw him was at a staff meeting where he made a colossal ass of himself. After he was introduced as the new Assistant Director the first thing he did was ask to see our state identification cards. The eight of us passed them up to him and he immediately noted with a twinkle in his eye and a grin that most of us had not signed the backside of our cards. Big f-ing deal we all thought, but he didn’t think that way and immediately gave us an assignment:

I want each one of you who has not signed the back of this card to write 100 times, he paused, and then added: I must remember to sign my identification card!

We all got a good chuckle at that and laughed it off! This new guy has a sense of humor and just maybe he’s alright. That was dashed when he said it again a few minutes later and this time with no eye-twinkle or grin. This dope was serious! With that the big boss quickly moved the meeting agenda and we heard no more of it until the session was over for the day. Karl came to each of us repeating he wanted the ‘sentences’ on his desk before the conference was over.

After a brief huddle the scofflaws in terms not uncertain told him one by one we were trained federal employees and how dare he treat us like schoolboys and not ever bring that subject up again! If he insisted on that silly-assed punishment those sentences would be accompanied by our resignations and we were prepared to go ‘way over his head’ by filing a formal complaint against him and it was bound to make him look like a simpleton jerk. The big boss backed us up on when Karl went to him after the meeting complaining we were acting in a very insubordinate manner! It’s funny how