T his is what it was like fighting for AIDS patients' lives during the Republican '80s:
The patient was weak, near death, losing precious body weight by the day. His doctor recommended an expensive intravenous-feeding treatment in hopes of kick-starting the man's immune system.
The hospital refused.
"The attitude was 'This man's going to die, so let him die,' " Dr. Scott Hitt recalls. "I explained to the family that the procedure probably wouldn't have been any use. But I knew that the real reason was economic."
This is what it was like fighting for the attention of politicians back then:
A county official cornered Hitt and other gay activists at a public meeting to ask why an ACT UP member had spray-painted his office door.
"I remember telling him, 'You just don't get it, do you?' " says Hitt, who is not in ACT UP (AIDS Coalition to Unleash Power). "People are dying and you're not doing enough. Sure, you're spreading the word about the epidemic but you have to do more. Time is running out.' "
Today, money and promises are a little easier to come by. But Hitt's AIDS patients are still dying.
Each time he enters his Beverly Hills clinic, he finds young men and women waiting in the tiny examination rooms, their expressions a bitter blend of fear, guarded hope and resignation as they confront some unbridled, otherworldly army.
At 35, Hitt has already seen hundreds die, many of them his friends. And so the faces that crowd his mind are more than just snapshots of a perplexing medical war--they are images from a lost generation he has known and loved.
For six years, he has specialized in AIDS treatment as a partner in the Pacific Oaks Medical Group, one of the country's largest and most aggressive private health-care providers for HIV patients. Hitt sees more than 600 HIV-positive men and women, and another 250 with full-blown AIDS.
Each night, with his healing efforts done, he starts a second life as a gay activist: staging fund-raising and strategy meetings at his Hollywood Hills home, speaking his mind to benefactors and politicians, clattering at the computer keyboard, working for "The Cause."
Indeed, AIDS activists say, Hitt is an influential cog in the local gay political machine and has recently become a serious contender for an appointment to the President's AIDS Commission, a policy-making advisory group.
Along the way, though, the doctor has learned that political activism can be a tightrope walk: He was accused in 1991 of violating a patient's privacy for political purposes, and the fallout endangered his career.
Without the encouragement of friends and supporters, he might have snuffed out his own activist fire. And the loss would have been profoundly felt.
"I put Scott Hitt in the top 10 astounding figures I've known since working on national politics over 34 years," says David Mixner, a Los Angeles political consultant described by Newsweek as "the most powerful gay man in America."
"He knows what needs to be done. He's already doing it."
Eric, a studious-looking man with a shadow of shaved red hair, is struggling through the early days of AIDS, worried that a neck rash is a bad sign of things to come.
"I had this zit on my chin that turned into a hideous thing," he says with a look of boyish revulsion. "The scab fell off and it's all weird. Now, it's moved to my neck."
As Hitt examines the rash, Eric continues in a stream of consciousness: "I'm stressed out, Doctor. I just feel like there's this gunk flowing through my blood. I can't sleep at night. I have these nightmares. . . ."
And so it goes. Hitt listens to such stories a dozen times a day at his clinic. Sometimes, they turn out well. Eric's rash is not AIDS-related. And later in Hitt's office, where a poem by his lover hangs, the doctor revels in a patient's favorable test results: "Hey, that's great! That's good news! That's really good news!"
On rounds at the Immune Suppression Unit of Midway Hospital in Hollywood, where Hitt has worked in the past few years, the mood is more grave. The very worst cases lay in white-washed rooms--anonymous save for a lover's photograph pinned to a wall--men on the cusp of death.
For these patients, Hitt can only try to answer their questions, explain the newest treatments and offer heartfelt hope and good humor.
Because AIDS is a whole grab bag of conditions that may appear alone or in gangs, he often feels like a kid with one of those plastic fortune-telling eight balls. Turn it upside down and see which malady will strike next: pneumocystis carinii pneumonia, wasting syndrome, Kaposi's sarcoma. . . .
Each day, there's a new mystery.
In one baffling case, a patient inexplicably lost his ability to speak coherently during a night out with friends, his thoughts suddenly pouring out in the garbled language of sickness.
CMV retinitis also ambushes the unsuspecting.
"I've had patients who didn't even know they carried the HIV, complaining innocently of some (spots) in their eyes," Hitt says. "I'll find that half of the back of their eye is inflamed.
"So, not only do I have to tell this person he's HIV positive, I have to break the news that he has full-blown AIDS. And that he is probably going to go blind."
Despite such horrific moments, Hitt retains an unflagging optimism, debunking the notion that contracting HIV signals an imminent countdown to death. Some of his patients have been healthy for a decade or more.
The Pacific Oaks Medical Group, which also has an office in Sherman Oaks, has been described as "one-stop shopping" for HIV patients. It offers an array of on-site specialists--from nutritionists to respiratory therapists--as well as chemotherapy and radiology services. Physicians' assistants help the doctors monitor hospital patients and make house calls to the sickest shut-ins.
Doctors elsewhere often look to Hitt and his colleagues for news of the latest medical options.
"This epidemic is new territory for all of us," Hitt says. "There are no guidebooks to follow."
Still, the clinic is seen as a model for managed care.
"A patient who comes to Pacific Oaks need look no further," says Dr. Howard Grossman, a New York physician who recently visited the clinic.
"They're light-years ahead of the way other doctors are treating this disease."
Hitt's goal is to see AIDS tamed, as diabetes has been, into a disease whose symptoms are largely manageable.
"I see patients with T-cells that are mildly depressed who say, 'Doctor, I'm going to die, aren't I?' And I always say, 'Where have you been living?' We are making strides in the treatment of AIDS," Hitt says. "The more progress we make, the safer it will be to say that those people just might be around long enough to see the cure."
That outlook inspires patients.
"Scott is optimistic, but he's also a realist," says Doug Halter, a 34-year-old computer software salesman from Ventura. "He tells things the way they are, but he also treats you as though you're going to live a long time.
"I really believe the reason I'm still alive today is because of Scott," says Halter, who learned he had AIDS six years ago. "But if I don't make it through this epidemic, I know that he gave me the best shot I ever could have had."
The survivors of other patients share that feeling. Some have kept in touch long after losing their loved ones.
"He was there for us--always so straightforward and optimistic," says Tommie Lee, a Mississippi mother whose son, Barry, died in early May.
"His enthusiasm kept Barry optimistic. It's good to know Barry had Dr. Hitt because we were not there all the time. I'm so grateful for that doctor, for who he is and what he stands for, from the depths of my heart."
In his will, Barry Lee bequeathed a watercolor painting of his father and brother. "I would like the original painting of Dad and Chris in my hallway to be given to Doctor Scott Hitt," he wrote. "His care and compassion for the duration of my illness was profound. I would like him to know how much this meant to me."
So there he was, 15 years old, in the front passenger seat, giving wide-eyed directions to his blind father behind the wheel of a car weaving along Pacific Coast Highway.
On this night, Bob Hitt had forced his son into service as chauffeur after his date became ill and fell asleep in the back seat.
"Scotty did all right," says his father, a retired stockbroker who lost his eyesight as a result of injuries suffered during a building collapse in the 1971 Sylmar quake.
"I did some pretty crazy things. I shocked my boy sometimes."
The son later returned the favor when his father asked him if he was gay.
"He was 23, just out of medical school," Bob Hitt says. "Scott said, 'I sure am.' I shook my head, got myself under control and we talked about it. I'm OK with it now."
He was on hand recently to watch Scott receive an award from an Oregon human rights committee for his work on gay issues. "I'm proud of my son. He's a hell of a guy. He's daring. And he's a good doctor."
For the most part, Scott Hitt grew up without his father in a Tucson mobile-home park. After his parents' divorce when he was 6, his mother remarried and had two daughters. Her only boy was a loner.
He remembers wincing when his grandmother, who lived in an adjacent trailer, would make bigoted comments about gays, about how they were destined to become mentally ill.
High school was a dual life of feigning interest in girls while knowing he was a homosexual. Early on, he thought about what obstacles he might face as a gay man. He could have become a lawyer but doubted his chances of landing a job at a top law firm. "As a doctor, I felt I could have my own practice. I knew there was a shortage of physicians and therefore, less discrimination."
At 20, he graduated from the University of Arizona--a scholastic stint paid for in part by his father. During medical school on the same campus, he began frequenting the gay bar scene, where he met his partner, Alex Koleszar.
The two have been together 14 years, moving in the late '80s to Los Angeles for Hitt's residency.
A few years ago, on a tour of the Sistine Chapel, Hitt turned suddenly to his lover and said, "Will you marry me?"
The answer was yes.
"I was so happy," recalls Koleszar, a painter and computer consultant. "It couldn't have been more romantic. I was waiting for the lightning bolt to strike."
A moneyed crowd is doing the social shake-and-bake at a recent Beverly Hills benefit for AIDS Project Los Angeles.
As the three-piece band plays before the displays of Armani and Calvin Klein suits at Neiman Marcus, half a dozen male models with piercing eyes and pouty looks sashay along a makeshift runway.
The audience stands in silent rapture.
There is one man, however, with his back to the entertainment. Hitt is lost in conversation with James Loyce Jr., executive director of APLA.
A slender man with deeply set eyes, the doctor is as ubiquitous at such events as the miniature quiches--leaning into the ear of some listener, showing the flag of political interest.
Indeed, keeping pace with him is like following some driven head of state. There are such functions as the annual Los Angeles Gay & Lesbian Pride Celebration; Hitt was among its official honorees this year. And he meets regularly with fellow members of APLA, the Gay and Lesbian Victory Fund and Access Now for Gay and Lesbian Equality (ANGLE).
ANGLE convenes monthly at the contemporary one-story house Hitt and Koleszar share in the Hollywood Hills. In a living room decorated with leather furniture, modern art and paintings by Koleszar, high-profile gay men and lesbians--attorneys, aspiring politicians, business owners and movie people--talk and laugh, gently ribbing each other.
When the meeting comes to order, matters turn serious, centering on spreading the activist spirit to college campuses and on the status of several political races.
Hitt sits at the center of the group and the conversation. He looks alert, despite having delivered a late-night speech the previous day at a political fund-raiser. In the weeks and months before that, he helped coordinate door-to-door campaign blitzes, fund-raising efforts, and he personally made vote-getting trips to Sacramento and Washington.
During the last presidential campaign, Hitt's home was also the scene of informal round-table discussions between the local gay lobby and each Democratic candidate.
Bill Clinton, he says, represented hope.
In a 1992 campaign speech at the Palace Hotel in Los Angeles, the then-Arkansas governor had proclaimed the gay and lesbian cause as one of basic human rights. Hitt and others had worked hard to sell $100 tickets to the event, meeting resistance from gays who viewed Clinton as a "redneck conservative Democrat."
The activists videotaped the speech and sent copies to gay groups nationwide.
"The speech was the first time Clinton found a cause," Hitt says. "The next day's headline in the Washington Post read, 'Clinton Finds a Voice.' "
The gay community had found a voice as well.
In the last five years, local groups have raised more than $100 million for The Cause, activists say. And the Clinton Administration, Hitt says, has already spent more than $1 billion on AIDS research than its predecessor.
But there have also been disappointments, such as the President's compromise on gays in the military and his failure to overturn the ban on HIV-positive immigrants entering the country.
Hitt has no time for setbacks.
"AIDS is the Holocaust of our generation," he says. "Soon, the toll from the disease will exceed the number of Americans who have died in all of our wars combined. How many people in their 30s know a hundred friends who have died?"
Gays, he says, are waging the last civil rights struggle.
"There are lots of evil people out there who . . . believe that AIDS is retribution for an evil lifestyle and that being gay is against nature's laws. There is so much discrimination. . . ."
Along the way, Hitt has learned some bitter lessons about mixing medicine and politics.
He became the focus in 1991 of a controversy surrounding doctor-patient confidentiality when he telephoned a colleague's patient--a man sick with AIDS--in hopes of eliciting support for Bob Burke, a candidate for the state Assembly from Silver Lake.
The patient accused Hitt of breaching medical ethics by using his influence to acquire the man's name for political purposes. Hitt acknowledges that the man's name was on a list of Silver Lake residents provided by a doctor friend. But he insists that he did not know the man was gay or had AIDS.
Rejecting an apology from Hitt, the patient appeared on TV's "Larry King Live" to air his grievances.
The state Board of Medical Quality Insurance investigated and eventually cleared Hitt of any wrongdoing, but the dispute nearly damaged his medical and political reputations, the doctor says.
When his patients called to ask for an explanation, Hitt was able to ease their concerns. Still, he was angry: How could his best intentions have gone so wrong? And was it all worth it?
"The question came up repeatedly, 'What are you doing this for?' and I asked myself, 'Well, why was I?' I tried my best to do good and somebody misinterpreted my efforts. I spent a week trying to decide if it was all worth it."
Friends eager to keep him in the fight for gay rights ultimately made the difference. "They were convincing," he says. "They made me realize such things come with the turf."
In rare moments when Hitt isn't busy with medicine or politics, taking long drives in his new Mercedes 500SL convertible or romping with his yellow Labrador named Austin, he's throwing parties.
On an overcast Saturday in June, a string of beach balls bob over the pool and Jacuzzi for his fourth annual Gay Pride Pool Party. "Damn, I'm going to miss this year's party," an out-of-town gay activist had said days earlier about the event.
Koleszar and Hitt play the perfect hosts, each entertaining different groups of guests, throwing each other the occasional glance.
The couple has come a long way since 1992, when Koleszar was struggling with a substance-abuse problem that surfaced, they both say, after the AIDS deaths of several close friends--and at a time when Hitt was putting long hours into The Cause.
"I had let certain things take over my life," Hitt recalls. "That presidential campaign became my life, like a coach watching a football game. Only it was a lot longer. Each night, we'd watch news reports as if they were footage of the big game, seeing how the other side reacted to our play.
"I just had this fantasy of Alex and I doing everything together. I pulled him into something that had become my dream. It took its toll."
Hitt eventually noticed that something was wrong. Koleszar was withdrawn, irritable, distracted. He was hooked on alcohol and sedatives.
"One night I just confronted him," Hitt recalls. "I said 'Alex, either you're having a nervous breakdown or it's drugs. It has to be one or the other.' "
Koleszar remembers that night as the most emotional of his life.
"He asked me, 'What is it that I can do at this point?' " he says. "Scott told me that, for the first time in his life, he felt powerless."
But he did persuade Koleszar to get into a treatment program. And in a show of support, he curbed his own moderate drinking for several months and cut back on his political schedule. He stopped asking Koleszar to accompany him to every dinner and event. When he went alone, he came home by 9 p.m. Now, when Hitt manages political meetings at the house, Koleszar often slips off to an Alcoholics Anonymous meeting.
"A lot of people see Scott as an enigma, as some sort of machine that goes nonstop, that's too afraid or doesn't know how to turn itself off," Koleszar says. "And Scott does keep his personal side close to his chest, even with his lover. Our relationship is going on 14 years now, and sometimes he's even guarded with me.
"It's taken me a long time to see certain sides of Scott. It's like he's almost afraid to stop at any point. Because if he did, and acknowledged the emotionally volatile issues around him, seeing his friends die on a daily basis, it would be too much for him."
And so Hitt remains Out There, taking half a dozen red-eye trips to Washington each year to press the political flesh and always feeling guilty when a patient calls while he's away.
He is a doctor first and foremost, he says.
Hitt wants to keep his promise to be there for those who are estranged from their families and have survived their lovers, for those left to die alone.
"It's a nightmare," he says, "that I want to prevent."
Still, he cherishes the living-large moments, such as the night he and Koleszar attended a White House party thrown by the Clintons. Hand in hand, they walked through the East Gate, announcing themselves to the stern-faced Marines as "Mr. and Mr."
Sitting in his home office, surrounded by pictures of himself and Koleszar with various politicians, Hitt stops briefly to point out his favorite.
"That one," he says, pointing to a framed snapshot of himself and Koleszar together--each smiling, arms wrapped around shoulders. "That one right there."
Russell Scott Hitt
Native?: No. Raised in Tucson, lives in Hollywood Hills.
Family: His partner for 13 years, Alex Koleszar.
Passion: Fighting AIDS, as a physician and an activist.
On the challenge of treating AIDS patients: "This epidemic is new territory for all of us. There are no guidebooks to follow."
On the mounting loss of life: "Soon, the toll from the disease will exceed the number of Americans who have died in all of our wars combined. How many people in their 30s know a hundred friends who have died?"
On succumbing to demands of politics: "That (1992) presidential campaign became my life, like a coach watching a football game. Only it was a lot longer. Each night, we'd watch news reports as if they were footage of the big game, seeing how the other side reacted to our play."