Magic and the AIDS breakthrough

Magic Johnson, the famed basketball star, is telling the story of his HIV infection which caused him to retire from the NBA in 1991 when he was at the top of his game.  That was a time when HIV (human immunodeficiency virus) infection was a medical time bomb which could rapidly progress to AIDS (acquired immunodeficiency syndrome).  AIDS killed patients by causing an exotic infection.  The disorder was devastating homosexual men, hemophiliacs, heroin addicts and Haitians. Haiti at that time was a gay man playground where the infection was transmitted by gay intercourse. Heroin addicts were infected by sharing contaminated needles. In this 4H Club, patients with hemophilia were innocent bystanders who got AIDS from blood clotting factors derived by pooling together the blood of many donors. Blood donations were not checked for HIV when no one knew what this was. The tennis star and humanitarian, Arthur Ashe died of AIDS following transfusions for open heart surgery in 1993.  

That was a time when apparently healthy gay men came to the hospital complaining of recent onset of  shortness of breath. The diagnosis of an AIDS defining infection was usually prompt but often within 48-72 hours, the patient was dead!  This horror was a risk in about 20 percent of patients on medical services in select hospitals in the late 1980’s when the infection spread by sexual transmission to the heterosexual community.  AIDS was a modern day plague.

Medical science mobilized quickly. Laboratories in France and the United States took credit in identifying the virus so that diagnostic testing could be done to determine who was infected. The blood supply again became safe. The human immune response to infection had to be unraveled. Contrary to the belief that the immune system did not respond appropriately to HIV, medical science showed that the human immune system realized that HIV represented the fight of its life. Immune cells threw all that they had into the battle, but the virus was destroying a key cell in the front live, the CD4 lymphocyte. A dwindling number of CD4 lymphocytes indicated that the virus would soon claim another life.

I attended a basic science medical conference in 1995 and AIDS was expectantly a big part of the program. A drug discovery  administrator from Merck, showed a lecture slide  which looked like a card from the Rorschach  test used by psychologists to analyze a patient’s personality. The picture of the  symmetrical glob was not from the Rorschach test but was the  electron shadow of the critical protease enzyme of  HIV needed to replicate the virus. To most of us in the audience, this met nothing, but to a drug discovery scientist, the symmetry of the protein, indicated that an inhibiter could be developed which could  fit into the enzyme structure and neutralize its function. The first protease inhibiter to fight AID was  put on the market in 1996. Within six months, the number of patients with AIDS in the hospital was obviously reduced. Our remarkable immune system, needed a little help from the protease inhibiters to slow down the proliferation of the virus. That allowed the immune system with the further help of older antiviral drugs to significantly destroy the virus load and restore  CD4 cells to normal levels.

Magic Johnson retired thinking he would be faced with the dismal consequences of HIV progressing to AIDS. He was likely one of the first patients to receive protease inhibiters. A deadly disease was converted to a chronic controlled disorder. He has remained healthy and he has prospered. American medicine faces much criticism from politicians, patients and physicians about cost and especially drug cost.  But there were no better university, governmental and industry laboratories in the world with the biomedical expertise to respond to the clinical crisis of AIDS. These labs discovered the viral cause of AIDS and the pharmaceutical industry discovered and developed the drugs to treat it in about 10 years.  Magic Johnson was lucky that protease inhibiters came along just at the right time.    

Surviving sudden death in New York City

On a warm June night in New York City, I had an acute cardiac arrest on the sidewalk across from the Staten Island ferry.  I had lived well that evening walking across the Brooklyn Bridge to join my wife and daughter for dinner and helping a sick woman in a subway as we returned to Manhattan.  I lived the next twelve days of my life in an induced coma with intervals of wide delirium. During my rehabilitation, I asked my wife and family a thousand questions about how I survived.

A cholesterol deposit within the wall of the blood vessel which nourishes the right side of my heart, suddenly broke off of its base immediately after I climbed the stairs coming up from the subway.  The turbulence in that blood vessel set off a chain reaction causing blood flow to slow throughout my heart because I also had other multiple blockages.  My heart suddenly lacked oxygen and could not generate its life sustaining and rhythmic electrical charge which excites each heart beat.  The heart was too weak to push oxygen dissolve in my blood to my brain. I lost consciousness. My wife’s scream for help brought an African American to my side who was a medic and Sergeant in the United States Army. His powerful hands methodically pushed on my breast bone which propelled blood out of my heart and up into my brain. His effort accounts for the fact that I am still the same person I was before all this happen.

The Sergeant’s wife called 911.  In about four minutes two New York City firemen were there. They cut my shirt up the middle and applied the paddles of a defibrillator to my chest.  The devise discharged three increasingly powerful jolts of electricity. With the third shock, my upper body jerked violently for an instant and then I lay motionless.   One of the firemen put his fingers into my groin, searching for a deep pulse as a sign of life.  The signal from the paddles showed a straight line and my wife thought I was gone. But deep in the cells of my heart the flow of sodium ions in tiny channels disrupted by the  loss of oxygen, had been restored by the shocks.  As electricity flows in a wire, an ionic signal mysteriously developed in the specialized circuitry of my heart and instantaneously electrified my heart muscle. The heart reacted like a hand suddenly becoming a quenched fist.  The blood in my heart chambers rushed out into my brain, lungs and abdomen. The fireman’s finger tips finally detected an impulse. The wondrous electromechanical pumping action of my heart had resumed and preserved my life.

I was transferred to the Columbia Presbyterian Medical Center where I was cooled to the low nineties. Low temperature retards heart and brain damage. I required a pulsating balloon inserted into my aorta to augment my heart’s pumping.    I developed a vicious pneumonia requiring two antibiotics. A respirator was necessary to aide my breathing. I had to be kept deeply sedated because when I was allowed to become awake I was a delirious wide man who pulled out the tube in my wind pipe connected to the respirator. My family was advised that I required open heart surgery to bypass multiple coronary artery blockages. Considering my general condition, they worried that I would not recover from surgery.

 My wife and daughter studied their iPad at my bedside looking for a patient in a similar crisis. They found the names of three cardiology groups who had treated patients like me without open heart surgery. These groups inserted multiple tiny springs called stents into the left main coronary artery which is a blood vessel so critical to the heart’s circulation,that only open heart surgery was done to repair it.   Stents are usually threaded into the heart’s blood vessels from the same blood vessel in the groin which signaled that I was alive to the firemen.  The cardiologists who were pioneering risky stent operations were in Seoul and Milan but a name in the third group was familiar. He was in New York City!

Dr. Michael Collins had performed my cardiac catheterization to define my multiple coronary artery blockages.  He had recommended open heart surgery.   He advised my family that I could die if he made an error trying to insert multiple stents into the left main coronary artery and the blood vessels downstream. However, my family sensed that he was capable and confident and asked him to do the procedure.  In the time my wife and I were married, 41 years earlier to the day, five stents were positioned and sprung open in my main coronary arteries.  My heart’s pumping power increased by one hundred percent that afternoon. I was taken off the respirator in five days as I regained consciousness.

Seven months later, Dr. Collins and I met again in the heart catheterization room to determine if the repaired blood vessels had remained patent. He and I looked at the images of my coronary arteries on the computer screen as the dye he injected rushed unobstructed into the big pumping muscles of my heart.  Michael Collins stood back one step from the table. “I really had a good day the last time we were here.”  I have seen two grandchildren enter my life since my collapse. I have resumed caring for hundreds of patients.  When I close my eyes to sleep each night, I think of my days in coma, unaware of the vigilant family at my bedside. I recall the pain in my ribs and the burn marks on my chest when I became aware of my survival and I think of the men, the system and the science which have  given me my continuing gift of  life.