The Story of an Influential AIDS Doctor Working in the Deep South

arts_books1-1_42.jpgIt was a typical day in late May 1982. The last blooms still hung onto the azaleas. In Charleston, tourists, like fireflies at night, has descended on the Holy City for the start of the sixth annual Spoleto Festival of the Arts. But Dr. Robert Ball Jr. had more on his mind than symphony orchestras and classical music performances. As he prepared to see patients at his infectious disease clinic in Charleston's West Ashley neighborhood, his phone rang. A family practice physician called seeking an infectious disease consultation for a desperately ill patient.

As an infectious disease specialist, Dr. Ball had grown accustomed to such pleas for help, doctors referring strange cases of tropical diseases to him for care. In less than a decade of medical practice he had developed the reputation of being something of a storm chaser of the infectious diseases that surfaced in the Low Country of South Carolina, an area characterized by viciously hot and humid summers, extensive marshes, and, of course, mosquitoes.

The physician on the other end of the phone line had admitted his patient to St. Francis Xavier Hospital for observation. He was at a loss to determine what ailed the young white man. Without hesitation, Dr. Ball promised to see the patient that day. It was a short drive from his office to the hospital, which had been founded by the Sisters of Charity of Our Lady of Mercy in 1882. When Dr. Ball walked into the private hospital room, he saw a patient who looked to be in his late teens or early twenties. He quickly learned that for several weeks the patient had been suffering from high fevers and swollen lymph nodes. A chicken pox-like rash covered his entire body. Lesions pockmarked his frame, with open, raw sores draining clear fluid. Herpes-like lesions covered his genitals and perineum, the area between his scrotum and anus. On close examination, Ball also noticed that the man had thrush, a yeast infection of the mouth that doctors would later associate closely with being HIV positive.

The young man's swollen lymph nodes signaled trouble. His herpes clearly had been contracted sexually; another disease might have been lurking inside him for several years before trashing his immune system. The symptoms had become too obvious to ignore. Whatever the reason, his health was deteriorating rapidly. "It was the worst case of genital herpes I had ever seen," Dr. Ball says. "Normally, genital herpes doesn't spread throughout your body. In his case, it did."

Thankfully, Dr. Ball determined, the patient didn't have the pneumocystis carinii pneumonia (PCP) or the cancers that physicians had quickly discovered were common among people with AIDS. Of more immediate concern was his extremely low white blood cell count. "There were a number of other lab abnormalities that indicated a systemic infection that was probably viral," Dr. Ball recalls, speaking with an even, genteel southern inflection that could have come straight out of a Pat Conroy novel.

In addition to his private practice, Dr. Ball also taught at the Medical University of South Carolina (MUSC), his alma mater, and knew the lab staff of the huge facility. After he examined the patient, he immediately ordered additional blood tests and further analysis of the man's white blood cells. When the patient's MUSC lab tests came back a week later, they showed an extremely low number of what are now called CD4 lymphocytes. Back then they were called OKT3 lymphocytes. Having low CD4 cell numbers increases the risk of opportunistic infections, leaving an individual as vulnerable as a battleship floating on the high seas without guns. Simple pneumonia could be as lethal as the bubonic plague. Troubled by the initial test results, Dr. Ball ordered more tests. As he awaited the results, he ran through all the possibilities. Little did he know that fateful doctor-patient encounter in St. Francis Hospital on that spring day would turn his comfortable, white, middle-class world upside down, change the course of his professional and personal life, and shake long-held political and spiritual beliefs, transforming him from a white southern Barry Goldwater conservative to that rarest of species, a white southern progressive.

* * *

Robert Ball's links to Charleston and the Low Country are as deep and as storied as the region itself. His ancestors first settled on the land when South Carolina was still a colony, more than 320 years ago. The pages of the telephone book are peppered with Balls. He served as president of the Society of First Families of South Carolina, a genealogical organization that documents and celebrates the history of the earliest colonial settlers.

Young Robert grew up in the West Ashley section of Charleston. He played football in high school but was never great at it. His passion was books. He spent hours locked away in his bedroom devouring science books. After high school, unlike many South Carolina blue bloods, he didn't head west for the University of South Carolina in Columbia or even Clemson upstate. Robert remained closer to home. He drove less than half an hour to the College of Charleston, where he studied biology and chemistry. To no one's surprise, he wanted to be a doctor.

In college, Robert, an avid boater, helped form the school's first sailing team. He dabbled in Republican politics and a lot of campus life. His old college yearbooks showed that Robert also was involved with at least four campus organizations each year. He led a Charleston chapter of the John Birch Society, a group that was founded in 1958 by former candy industry executive Robert Welsh, who spouted an ultraconservative brand of pseudo-Christian anticommunism, nationalism, and antiglobalism. John Birch Society members called for the repeal of the federal income tax on constitutional grounds, sought the abolition of the Federal Reserve and the United Nations, and viewed the civil rights movement as the vanguard of a communist plot. In 1964, like most other John Birch Society members, Ball supported Barry Goldwater. The conservative Arizona senator had lost to Nixon in the 1960 Republican primaries but prevailed against moderates Governor Nelson A. Rockefeller of New York and Governor William Scranton of Pennsylvania before being trounced by the incumbent president, Lyndon Johnson, in 1964.

Two years later, after he graduated from the College of Charleston, Ball followed a path he seemed genetically bred to pursue. He drove across town and enrolled at what was then the Medical College of South Carolina, an institution whose desks, chairs, and labs were stained with the sweat of his forebears. Ball is descended from a line of physicians seven generations deep. His great-grandfather was a doctor; a number of great-uncles were too. One uncle was a physician; another, Benjamin M. Martin, was chief radiology technician at MUSC for over two decades. Both grandfathers were doctors, and his paternal grandfather, Dr. James Austin Ball, was the medical school's first professor of infectious diseases, then called tropical medicine, at the turn of the century. His maternal grandfather, Dr. Thomas Hutson Martin, graduated from the College of Medicine in 1919 at age 19 before launching a long and distinguished career as a physician and surgeon in Charleston. Dr. Martin was a longtime member of the Charleston County Board of Health and an assistant professor of surgery at the medical school. He retired from practicing medicine in 1951. Later, Ball would donate Dr. Martin's class ring to the medical school's Waring Historical Library.

The oldest medical school in the Deep South, the Medical College of South Carolina was founded in 1824 and kept its name largely intact for 145 years. But by the time Ball donned his cap and gown to accept his medical degree in 1970, the college had been renamed the Medical University of South Carolina. He helped put himself through medical school by working days as an anatomy instructor and nights in the MUSC microbiology lab. For his medical internship, he drove 470 miles west on Interstate 20 to the University of Alabama-Birmingham, which was located in a city that had come to symbolize southern white resistance to the struggle for black civil rights. But less known at the time was that its hospital was a vital training ground for infectious disease specialists. Later it would be home to several pioneers in the fight against HIV and AIDS.

Ball began his medical internship, now called a residency, in Birmingham the same year George Wallace returned in triumph to the governor's mansion for a second four-year term. Wallace was still a rabid segregationist who opposed equal rights for people of color. The young Ball admired Wallace's uncompromising segregationist anti-civil rights platform. That was before his epiphany; that was before AIDS, before he saw firsthand the machinery of white privilege and southern prejudice, once reserved exclusively for people of color, unleashed on white gay men with a deadly, demoralizing new sickness.

Wallace and his politics of derision appealed to Ball at his deepest core. On holidays he drove east to Charleston, proudly showing off the Wallace bumper stickers on his car. Those stickers multiplied as Wallace ran again for the presidency in 1972 after his failed bid in 1968.

Parents, classmates, and friends weren't surprised by Ball's affinity for Goldwater and Wallace. Like most well-off southern white men, Ball grew up in a very politically conservative family, even though their hometown, Charleston, was becoming increasingly liberal. His family was Republican, the kind who scoffed at northeastern Republican moderates. Ball, still a fervent anticommunist, spent years licking his wounds after Senator Goldwater's 1964 defeat at the hands of LBJ.

That decisive election was to have a direct impact on Ball's fate. After his re-election, Johnson escalated America's involvement in Vietnam. For the next six years, rural southern boys and inner city kids in their teens and early twenties were drafted and shipped, weapons in hand, to the jungles of Southeast Asia. Ball's medical internship only delayed the inevitable. The draft board gave him permission to finish his training. Sooner or later the army would beckon. As the war in Vietnam dragged on, even white boys of privilege couldn't avoid doing their share in the increasingly unpopular war. The summer Americans first heard about the Pentagon Papers, when protestors in Washington tried to bring the federal government to its knees, Ball, now at the end of his internship in Birmingham, received the long-feared letter -- a direct order to report to the draft board in Charleston. Days later, he walked into the draft board office in Charleston and swore his allegiance to defend the country. He was lucky. The army wanted to send him as an orthopedic surgeon to the combat zone in Vietnam, where American GIs needed able surgeons to repair the damage wrought by Vietcong booby traps. But his skills did not lie in the operating room. "You want me with a pen in my hand, not a scalpel," he joked years later. "No wonder we were losing over there."

Ball spent his two-year tour of duty working as medical director of the emergency department at the massive William Beaumont Army Medical Center complex in El Paso, Texas, which serves neighboring Fort Bliss. By the time he was honorably discharged in 1973, the end was in sight for the U.S. military involvement in Vietnam, but the country had just begun a spiral toward another prolonged political crisis -- Watergate.

Ball returned home as expected to Charleston, where for the next two years he pursued an internal medicine residency, followed by a 24-month infectious diseases and immunology fellowship at his alma mater, MUSC. Ball was hardwired not just to study medicine but also to hunt infectious diseases, just like his paternal grandfather, Dr. Ball, who in the early 1900s taught dermatology and tropical diseases. Graveyards in the South are filled with children and young people victimized by smallpox, yellow fever, and cholera. Sexually transmitted diseases, especially syphilis and gonorrhea, ran rampant through the poor sectors, especially the black population. While he was serving in the army, Ball contracted viral meningitis, a relatively common but rarely serious infection of the fluid in the spinal cord and surrounding the brain. Viral meningitis and other infectious diseases fascinated Ball. After he was discharged from the military, he hoped to pursue a specialty that offered the daily challenge of trying to cure people with the new and exciting antibiotics being introduced daily rather than deal with terminal conditions like cancer. But the good Lord had other ideas.

His long journey to becoming a physician complete, Ball opened a private practice in the West Ashley section of Charleston in 1977. Jimmy Carter had been elected to the White House a year earlier. America was still struggling to rediscover its self-confidence. While he built his fledgling practice, Ball taught part time at MUSC, honoring his family legacy.

While Dr. Ball taught infectious diseases, elsewhere in the massive MUSC complex a high-cheekboned black woman, Annie Mae Pegram, cheerfully endured the pricks and prods from physicians testing new cancer drugs. It's unlikely that their paths ever crossed, but fate conspired to ensure that AIDS, the disease that dominated Dr. Ball's private and public medical career, would also shape the life and cause the early death of Annie Mae's youngest daughter, Carolyn.

TEMPLATEReadMoreBookExcerpts.jpg Excerpted from Andrew J. Skerritt's Ashamed to Die: Silence, Denial, and the AIDS Epidemic in the South (Lawrence Hill Books)