Valley Doctor’s Life Is Changed by AIDS Fight : Deaths of Friends, Patients Do Not Stop Man Who Co-Diagnosed Illness

It was at a Halloween night dinner with five friends in 1980 that Dr. Joel D. Weisman first spoke openly about the strangely stubborn infections appearing in his gay male patients.

For more than two years he and his partner, Dr. Gene Rogolsky, had been seeing an unusually high number of intestinal parasite cases and routine illnesses that returned mysteriously again and again. And now it appeared that some patients’ immune systems had collapsed.

Little did Weisman know that his patients’ stories would become part of one of the greatest medical horror stories of the 20th Century: the plague of AIDS. Even worse, he could not have predicted that 7 1/2 years later, of the friends at that dinner, he would be the only one who had not died of the disease.

“On some level it’s depressing” to know so many people who have died, Weisman said recently. “It brings us all back to earth. It makes you deal with your own mortality.”

His Life Changed

The life of Weisman, considered by colleagues to be one of the nation’s leading acquired immune deficiency syndrome physicians, has been dramatically altered, personally and professionally, by the disease.

A well-established Sherman Oaks general practitioner who kept his homosexuality private, Weisman had been content to quietly provide compassionate and competent medical care. But events thrust him into the spotlight.

After 1981, when Weisman and UCLA’s Dr. Michael Gottlieb wrote the first published report diagnosing the immune system collapse as a new disease, he became a medical pioneer, a health educator, a leader for gay civil rights and a lobbyist for greater research spending and social services.

“We were all asked to do things we were not trained for,” Weisman said. “All of a sudden it was important to have these political skills.”

He appeared frequently on local and national television, as the first co-chairman of the board of the AIDS Project Los Angeles, to argue for more funds and services. And he became something of a celebrity, his smooth-skinned ruddy face, blue eyes and silvery gray hair recognized even when he tried to escape for quiet weekends at his Ventura beach house.

Meanwhile, with the disease striking down some of his closest friends as well as his longtime patients, Weisman had to re-evaluate his personal definition of medical success.

“It’s made me look at issues of death and dying in a different way,” said Weisman, 45. “What makes somebody a good physician in this situation? Is it just winning? Keeping people alive? If I looked at every death as a defeat, I would not be able to continue.”

But continue he has. In recent years he has spent more time fighting medical battles, treating more patients and conducting clinical research, while others have stepped forward to bear the public burden of fighting for funds and services.

Weisman, Rogolsky and two other general practitioners who have joined the practice have cared for about 1,000 of the 4,546 AIDS patients in Los Angeles County, including most of the cases in the San Fernando Valley. Deaths now total 2,844.

Even more patients infected with the human immunodeficiency virus--who may develop AIDS--or suffering from AIDS-related complex, or ARC, also come to the office on Van Nuys Boulevard. Such cases now make up about 50% of the practice, and the percentage is growing.

Weisman said he now judges medical care by whether it increases the quality, not only the longevity, of patients’ lives. He talks about protecting patients, and helping them retain their dignity and pride despite the disease’s devastations. Early on in the epidemic, when hysteria caused some medical personnel to treat patients like pariahs, Weisman and his partners became ombudsmen for patients’ rights.

He recalls that many people feared contracting the disease from casual contact. With his mother, Sylvia Weisman, working in his office, he had a powerful rebuttal to such fears.

“Do you think I would let my mother work here if I thought she could get the disease?” he would say.

Although he once contracted hepatitis B from an accidental puncture with an infected needle, he said he does not fear becoming infected with AIDS. AIDS, he said, is far more difficult to contract.

Weisman teamed up with Rogolsky in 1975 after three years in private practice in Carteret, N.J., his hometown. He had wanted to become a doctor since he was introduced to medicine by a family friend, a pathologist who took the 7-year-old Weisman to his laboratory.

The son of a high school principal and a veteran teacher, Weisman was always a good student and was quite popular, his mother said.

He graduated from Upsala College in East Orange, N.J., with a degree in biochemistry and then studied at the University of Health Sciences in Kansas City and Normandy Osteopathic Hospital in St. Louis.

When he was young, Weisman spent summers in Los Angeles with his grandmother. When he grew up he wanted to return. A city person who loves theater and the symphony, he nonetheless also enjoys getting away on weekends to the beach or mountains.

By 1980, Weisman and Rogolsky had a well-established practice that included substantial numbers of gay men. From the first, when it was clear that something mysterious was happening, they advised patients to change their sexual behavior.

The position was controversial because the gay community saw sexual freedom as a civil rights issue. It also was delicate because Weisman feared the reaction from heterosexuals.

“I realized it would have an effect on the way heterosexuals viewed homosexuals . . . but I worried that ignorance meant people would die,” Weisman said. When a case had been made for the sexual transmission of the disease, he thought it was the responsibility of the gay community and the government to disseminate the information.

“But I couldn’t even make some of my friends listen and they’re dead now and that’s disconcerting,” he said.

Weisman’s voice catches and he looks down. But then he goes on with his thought. Although some of his responses seem practiced, from the many interviews he has given over the years, he also lets his emotions show through.

Friends say he has become more solemn over the years, but he still laughs easily and makes others feel relaxed in his presence.

Weisman said he believes some gay men left his practice because he and Rogolsky were adamant in their position. He said some non-gay patients also left the practice, driven by fear as the number of AIDS patients in the office increased.

Weisman’s companion since 1982, who asked not to be named, said those years were difficult.

“There was this period when it was obvious that the practice was changing from a variety of people with broken arms and sore throats . . . to death and dying,” he said. “And Joel had the foresight to see that it wasn’t going to stop and was going to get much, much worse. That was a terrible time for him.”

What made the time difficult was the same thing that makes Weisman a good doctor, friends and colleagues said.

“He is a dedicated, caring, compassionate human being . . . and he brings those qualities into the care he gives,” said Rogolsky. “You are getting in there and wrestling with the angel, and the angel frequently wins. But you can’t divorce yourself from it, and you can’t stop caring.” Although Weisman, like most doctors battling AIDS, has gone through depressions, friends said he has recovered his enthusiasm.

This has come, in part, from the discovery of new treatments, such as aerosol pentamidine and the antiviral drug AZT, that seem to extend patients’ lives.

And the practice has continued to grow. It now includes four general practitioners, a social worker and a physician’s assistant. Soon to be added are an internist, an immunologist/allergist and an oncologist.

Weisman and his partners have established what colleagues readily acknowledge is a model for how private physicians should handle AIDS cases.

They treat patients with standard drugs but also conduct clinical trials, allowing patients to receive both while visiting a single office. The practice also maintains a close relationship with the AIDS unit at Sherman Oaks Community Hospital, works closely with researchers at USC and UCLA, and provides patients with counseling and other psychological support.

Area doctors knowledgeable about AIDS say Weisman’s practice is one of about 10 that serve most of the privately treated AIDS cases in Los Angeles County. Most of the private practices had a large gay male clientele before the epidemic and have grown to handle the demand.

But with the number of AIDS cases expected to mushroom to between 30,000 and 35,000 in the county by 1992, some doctors worry that those practices will be unable to expand quickly enough. Already emerging are stories of patients forced to choose between a doctor providing inadequate, uninterested care and a long wait for an appointment with an AIDS specialist.

“The vast majority of physicians are trying to stay uninvolved in this epidemic,” said Dr. Neil Schram, former chairman of the Los Angeles City-County Task Force on AIDS. “With Joel, people are going from all over the county to seek him out, because they feel correctly that the average physician is not willing or able to deal with AIDS.”

Efforts are under way in Sacramento to require doctors to learn more about AIDS to keep their licenses, and some doctors believe that soon every primary care physician will be treating AIDS cases as routinely as diabetes or heart disease. The issue of who should care for AIDS patients, however, is likely to become a tricky ethical and professional debate.

The American Medical Assn. has taken the position that a doctor is ethically required to provide “competent, compassionate treatment” to AIDS patients if he or she is able to do so.

But Weisman and Dr. Michael Gottlieb, UCLA’s pioneering AIDS clinician, say treatment of the disease almost has become a medical sub-specialty, because the virus manifests itself in so many ways. In addition, AIDS patients frequently require psychological as well as physical treatments.

“There’s no doubt that we need more people who do this . . . but it’s not just more bodies to take care of patients,” Weisman said.

“Theoretically, I believe that no doctor should be allowed to refuse to treat an AIDS patient. But if it’s someone who doesn’t want to do it or isn’t skilled in it, the patient loses.”

Weisman said the state or federal government can encourage more doctors to treat AIDS patients by making it less of a hardship to do so. He said the state’s Medi-Cal insurance system, which pays for the care of the poor, should be simpler and pay competitive rates for AIDS treatment. Despite the inherent difficulties of a large AIDS caseload--the inevitability of patients’ deaths, the reaction of non-AIDS patients, the need to stay current with the rapidly changing information--Weisman and his partners have been indefatigable.

“I’ve never made any kind of request of Joel that he has turned me down,” said Dr. Martin Finn, medical director of the AIDS program for the Los Angeles County Department of Health Services. “It’s the consistency of Joel that is so impressive. I sometimes get a little bit concerned about how he maintains for himself.”

Finn said Weisman has been busy on many fronts ever since the beginning.

Such activities have included serving as the first co-chairman of the AIDS Project Los Angeles; being a founding member of the board of the American Foundation for AIDS Research; serving on the state’s AIDS task force; setting up a separate medical group to run clinical drug tests; and helping to found the AIDS unit at Sherman Oaks Community Hospital, the first private AIDS unit in the country.

Gottlieb and others cited Weisman for his courage in taking the risk of being publicly associated with AIDS from the very early days of the disease.

“We just didn’t know which way this was going to go,” Gottlieb said. “There was considerable paranoia among the early AIDS workers, with respect to the implications for our careers. It was our misfortune to become involved with an unpopular cause.”

‘Out There Alone’

One of Weisman’s longtime friends is Matt Redman, one of the founders and the current president of AIDS Project Los Angeles. When the organization was formed in 1982 few community leaders were willing to participate.

But Weisman “jumped in immediately,” Redman said. “He became our first strong, public leader and he really legitimized what we were doing. That was a very courageous step because he was out there alone.”

Seizing leadership in that way was uncharacteristic, Weisman said.

“My preference in life was to be a good physician, have a large practice and have a good quality of life,” he said. “I never had any great desire to be a leader. I wanted to sort of fade into the fabric. . . . I would have gladly passed the mantle to someone else. But there was not anyone . . . who wanted this as a full-time project.”

Weisman is proud of the 18 months he co-chaired the APLA board, before becoming exhausted and stepping down. He still works at least 60 hours a week and serves on a variety of local, state and national boards.

“My stock in trade, what makes me who I am, is that I really like the people I treat,” Weisman said. “In and around AIDS, where the losses continue to mount, you not only have to go in and establish a relationship, but then the doctor is faced with the fact that he’s almost certain to lose that relationship.

“On a lot of levels, the difficulty is not with the medicine, but with the interpersonal relationships, because we’re asked to be more than what we are.”