Sunday, June 26, 2016

Q&A with Mark A. Jacobson

Mark A. Jacobson is the author of the new novel Sensing Light, which focuses on the early years of the AIDS crisis. He is an attending physician at San Francisco General Hospital and a professor of medicine at the University of California San Francisco, and he has specialized in HIV/AIDS. 

Q: Why did you decide to write this book, and why as a novel rather than nonfiction? 

A: I’ve always loved reading fiction and, as a young man, once dreamed of writing a novel that could move people in the way my favorite authors moved me. 

I never committed the effort for such an undertaking until 2008, after a bicycling accident left me unconscious for several hours. That experience caused a tectonic shift in attitude toward my own mortality.Instead of simply comprehending the abstract fact that I wasn’t going to live forever, I now fully believed that fact, accepted the limits on the time I have left, and reconsidered my life goals accordingly. 

I certainly didn’t want to stop taking care of patients or teaching medical students and residents in our HIV clinic (and I still don’t), but I also realized that writing any more grants or research papers wasn’t going to add substantively to the modest impact I’ve had on the practice of medicine. 

Suddenly, that youthful dream of writing a novel didn’t seem so impossible. I could imagine a story I was actually well-equipped to tell. I began gradually winding down my research commitments and developing that story.

In answer to the second part of your question, while I very much enjoy reading good non-fiction, I don’t feel a passion for writing it. 

Q: How did your own experiences as a doctor during this period help you create your three main characters?

A: I graduated from medical school and began my internship in 1981, days after the CDC reported a mysterious, fatal form of immunodeficiency in five gay men.

A few months later, I was assigned responsibility for the first patient in my hospital to be diagnosed with this disease. He was critically ill with Pneumocystis pneumonia, on a ventilator because of respiratory failure and dialysis for kidney failure. I spent many hours every day for the next month doing my best to keep him alive and ultimately failed. 

That experience and many subsequent ones led to my commitment to scientific discovery and alleviation of the suffering caused by this disease. The three protagonists of Sensing Light share a similar experience in the first part of the novel, which leads to a similar commitment on their part.

To feel the freedom I needed to write this story, I had to imagine a unique personal history and emotional logic for each character that had absolutely no basis in the lives or behavior of any of my colleagues during that time. 

However, details from my own life were fair game. I could distribute many specific challenging situations I had faced among my three protagonists. Some examples include having a patient plead with me to give him the means to end his life, a close colleague dying of AIDS, accidentally sticking myself with a needle contaminated with blood from an HIV-infected patient, and facing the fury and impossible, yet righteous, demands of AIDS activists. 

Q: The book is set in the first decade of the AIDS epidemic. Why did you decide not to continue it further into the 1990s and beyond?  

A: Sensing Light began as a short story based on my experience in November 1989, in West Berlin. I had been invited to give a talk at an international symposium on lung complications of AIDS.

Hours after my arrival, the government of East Germany collapsed, and thousands of its citizens began streaming across the unguarded wall into West Berlin. The collective mood was a heady mixture of fear over what might happen next (Would the East German army invade?) and exhilaration (The Cold War had just ended!). 

After writing this story, in which the protagonists are American doctors attending this symposium, I began working backwards, imagining these characters’ lives and interactions before the drama in Berlin occurs.  Continuing the story after Berlin, other than with a brief epilogue, would have been anti-climactic.

Q: What do you hope readers take away from the novel? 

A: Albert Camus said this so eloquently that I will defer to him.  “What we learn in a time of pestilence is that there are more things to admire in men than to despise.”

Q: What are you working on now?

A: Another novel, more ambitious in historical scope and aiming for more narrative suspense and complex character development than Sensing Light did, but employing just a single protagonist—someone with a minor role in Sensing Light as one of Kevin’s junior faculty protégés. 

I want to grow as a writer by creating empathy for a character who has a more troubled past and is more susceptible to moral compromise than any of the protagonists in Sensing Light.

Q: Anything else we should know?

A: AIDS no longer needs to be the fatal disease it was in Sensing Light.  Simply by testing everyone at risk for having HIV infection and treating those who test negative with a single antiretroviral pill daily, we can end HIV transmission and ultimately its associated illness and mortality. 

Even those already infected with HIV can have lives of normal duration and health by adhering to modern antiretroviral drug regimens, just as people with diabetes can by controlling their blood sugar with diet and medication. Treating those already infected also greatly reduces their risk of transmitting the virus!

For those interested, I have posted an update on the current global status of the HIV pandemic on my website. An excellent source for far more information about HIV/AIDS is available on the University of California SanFrancisco HIV website.

--Interview with Deborah Kalb

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