BOSTON — The end came on Christmas Eve.
Last Thursday morning, an unusually mild, sunny day for late December in New England, 33-year-old Jeffrey David Mullican lost his 20-month struggle against AIDS. He died about 11:40 a.m. in a private room on the eighth floor of Massachusetts General Hospital, ravaged by a staphylococcus infection, internal bleeding and pneumonia.
The AIDS virus had also invaded his brain and rendered him delirious and incoherent much of the time. He was unable to speak, unable to focus his eyes, often unable to tell where he was or who was at his bedside.
Yet, as savage as the final hours were, the last weeks and months of his life contained more for which to be grateful and were touched with more meaning than is true for many of those who fall prey to one of humanity's most unforgiving and isolating diseases.
Death Came Swiftly
For one thing, death came to him with merciful and uncharacteristic speed; the suffering and helplessness that many AIDS patients must endure for months touched Mullican only in the last weeks of his life. Moreover, by agreeing early on to participate in a risky trial of a new drug, Mullican found a measure of satisfaction in contributing to scientists' expanding knowledge of AIDS.
As it turned out, the drug probably gave him almost a full additional year of life--a year that became an intensely painful and courageous odyssey to confronting death and attaining a new measure of peace with the living.
While he was often sick during the final months, until almost the very last Mullican remained able to exercise the independence that meant almost everything to him. He scored some small victories over the self-absorption that often blights the spirits of the desperately ill, and he found strength within himself to resolve the tensions that had developed--as they almost always do in such cases--between himself and his parents.
"The drug (azidothymidine, or AZT) changes the slope of the curve and (it) afforded much of the good time Jeff had," said Mullican's physician, Robert T. (Chip) Schooley, 38, an associate professor at Harvard University and a leading AIDS researcher.
"In some ways, it's better to have had the rapid decline like this, after the end of a good 18-month course, than have a steady decline over the whole period. Without AZT I think we would have experienced last fall what we're experiencing now. I don't have any regrets about having given him AZT. Many good things happened."
Among those good things was the development of an unusually strong bond with his family that was reinforced in this last month, beginning with his visit home at Thanksgiving.
"That was one of the things that was achieved in the more than 18 months that Jeff remained alive, and that was incredibly important," Schooley said.
Mullican deteriorated rapidly in his last weeks. The disease--as it invariably does--had taken a dreadful toll. Once a husky and vigorous six-footer, he had wasted to about 115 pounds. By the time he was hospitalized the Sunday before Christmas, he was extremely debilitated and barely able to speak.
There was the bacterial infection, staphylococcus aureus, probably caused by one of the lines used to administer intravenous medication for a previous infection. In addition, he was suffering from his fifth bout of pneumocystis carinii pneumonia, a respiratory infection that frequently afflicts AIDS patients. He was also having mild gastrointestinal bleeding from an unknown cause. He had a high fever as a result of the staph infection and--as is tragically common--he had become increasingly confused and delirious because the virus had invaded his brain.
He was able to breathe on his own, although occasionally he received oxygen from a mask attached near his bed.
At times he was quite lucid.
He knew his older sister Judy was there. It was Judy, visiting from her home in the Midwest, who had helped get him to the hospital on Sunday night. And it was Judy who stayed with him until his parents arrived, stroking his forehead, mopping his face and chest with a cool towel and helping him let go with soothing words of relaxation.
He knew his parents were on their way Wednesday and on Tuesday, 48 hours before his death, he recognized another friend who had come to visit. The visitor, one of his close friends, had adopted a baby some months before and she had sometimes sensed that Mullican was unhappy about the time the baby had taken from their friendship.
Now, however, he had moved beyond such feelings. The first thing he asked, in a barely audible voice, was: "How's the baby?"
Yet, moments later, again in the grip of dementia, he mumbled something about being on a farm. Then, weakly, he tried to raise his hands and murmured: "My fingernails are so long."
He could see but his eyes did not seem to focus. They rolled upward, staring vacantly as though reflecting his resignation and helplessness.