It is a fall afternoon at the City of Angels Hospice, a three-bedroom house on a quiet corner in Hollywood where fear is conquered and death embraced, the last home this year of more than 30 people.
A Santa Ana wind cools the living room through an open front door. On a leather sofa, a gaunt, 23-year-old man with AIDS lies wrapped in blankets. He has been moved from his bedroom to the couch to watch television and eat lunch, but he has fallen asleep. He is very still--only the rising and falling of his chest betray the life remaining in him. In three weeks, the breaths will stop.
By the dining room table, Tom Ringled and a fellow staff member, Jim Rayl, are wrestling with a Sparkletts water bottle labeled "Pennies for AIDS." It has been filled by patrons of a gay bar. Ringled and Rayl are trying to coax out the coins.
The man on the couch stirs, and Ringled walks over and touches his forehead. He props the man up with pillows to make him more comfortable, turns on the TV to a sports channel and brings in a lunch tray.
Ringled is giving palliative care. He will feed, dress and bathe the man, be his best friend, hold his hand and become a surrogate family. He will give the dying man drugs for pain. However, there are no crash carts, no IVs, no high-tech boxes with blinking lights or beeping monitors. Of course, Ringled will not prevent the man from dying.
Hospice workers like Ringled try to dispel two myths: that they are saints and that their work is depressing. He said they are normal people blessed with extraordinary, uplifting jobs. If anything, staff and volunteers in hospices become addicted to their work. They develop close friendships with patients and have difficulty leaving them at the end of the work day. After months of suffering and illness, he says, death is welcomed as the end of suffering.
Ringled, 35, has a special empathy for his patients, because he has acquired immune deficiency syndrome.
He moved to Los Angeles 12 years ago, ending 20 years of frustration over hiding his homosexuality. He knew as a boy that he was gay.
"When I was 6 years old, I knew it. I remember an uncle of mine whom I thought was very handsome and I was so totally attracted to, and I knew nothing about sex."
He dated girls in high school, lived with a woman when he was in his early 20s and fathered a child. "We got along terrific. It was fine. But all the time, I was only doing this for the rest of the world," he said.
When he was 23, he headed west. He had his first homosexual relationship two years later. It was about the same time that doctors noticed that gay men were dying in unusual numbers of a previously unrecognized disease. Ringled didn't know he was endangering his life. "Ten years ago, when probably we were all infected, we never heard about it," he said.
He started a business installing hardwood floors and settled into a relationship with one man. When his lover's parents became terminally ill, he cared for them and found the work rewarding. After taking a course at a vocational nursing school, he started caring for AIDS patients in their homes.
By early 1988, Ringled was the manager of Hughes House, a five-bed hospice in West Los Angeles. But in May, he was forced to take sick leave because he had a stomach virus linked to AIDS.
The phone rings and is answered elsewhere by the hospice director, Mary Nalick, 45. She is working in her makeshift office in one of four garages in an apartment building behind the hospice. In the other three garages, she collects donations for the regular garage sale that raises about half of each month's $13,000 in expense money. The rest of the budget comes from fund-raising efforts, like the Sparkletts water bottle, and patients' insurance.
The hospice property was bought last year for $220,000 with a grant from a foundation established by junk-bond financier Michael Milken. After being renovated by volunteer workers, it opened in December, 1988. Nalick has managed to stay about two months ahead of the bill collector since.
There is room for five patients, but since the average patient dies within three weeks, there are frequent vacancies. On this particular day, there are four patients in the hospice, and they are all sleeping. There is a kitchen and two bathrooms, one for patients and another for staff. The living room has leather sofas on hardwood floors and a big-screen TV.
Ringled explains that AIDS tends to be a drawn-out, accelerating disease. He is typical in that although he learned that he was infected with the human immunodeficiency virus probably between six and 10 years ago, he did not have any symptoms until recently. His experience treating AIDS patients has taught him that, once AIDS becomes active, "you get one virus, you get over it, and a couple of months later you get another one and another one, until you get weaker and weaker.
"All of a sudden you have pneumonia, you have skin cancer, you have chronic diarrhea, you have vomiting, all happening at once." Today, he is strong enough to work three days a week at City of Angels. "I'm totally addicted to the job," he said. "I couldn't stop if I wanted to."
Anger keeps him going, he said.
"I get angry. I'm hurt at how we all handle this as a race of people. How can we let people get this sick and do nothing?
"The biggest problem is loneliness. If you can give them a pill for anything, that would be the one pill I'd want.
"On a day that somebody dies, it hurts. I'm not going to say it doesn't. I think what hurts worse is now I refuse to go to funerals or wakes or anything, because when I go there I see 75, 80 people there, and for six months he was in my care, and I don't know these people. That's when I get angry."
Ringled and Rayl finish emptying the Sparkletts bottle, and the patient on the couch awakens. Ringled helps him back to bed. He keeps up a friendly banter as they smoke and play cards.
Some patients walk into the City of Angels. Some are carried. Some are transferred from hospitals after long bouts with chemotherapy. Some have dementia, others are alert.
Some have lost everything: their families, friends, jobs, homes, insurance, bank accounts, credit and possessions. Others enter hospices simply because they believe it is the best place to die.
"After a while, they realize, 'My God, I'm around people that are just like me,' " Ringled said. "All of a sudden, race doesn't matter or what kind of house you live in. None of that matters anymore. You're you, and I'm me. How can we help each other?"
Ringled finishes the card game and leaves to check another patient in the back bedroom. There he helps the patient move out to the dining room for lunch. The second patient eats a few bites and says he is in pain. Ringled and Rayl are standing on either side of him and reach out in support. They help him back to bed, and Ringled massages the man's legs.
Ringled has cared for more than 40 terminally ill patients. "Burnout is a problem," he said. "I think that's what happened to me, why I got sick in May. I didn't know where to draw the line, that I don't have to be responsible for that man's loneliness or that man's pain. I was putting in 16-hour days eight days a week."
Treating terminally ill patients has helped him overcome his own fear of death.
"When you see somebody who's been sick for so long and in so much pain finally out of that pain, death is anything but ugly," he said.
"We're born, and we die. Hopefully, we can do some good in between. I don't want to die, but at the same time, it's only because I want to do more here. I'm not afraid of it anymore. I just realize that it's just as natural as growing hair. It just happens to you.
"I've seen so many people die, and I see that it's just rest. You know these people just stop. Not so terrible."