Here’s to Gos Blank

His death certificate and all other medical records use the name Charles David Rich, but most people reading this will remember him as Gos Blank, because that is the name he chose to be known by.

People who knew Gos personally would probably tell you about his love of music. Gos founded a hard rock band named Nero’s Opening Act, in which he was the lead vocalist and played guitar. He also worked with other musicians and bands, at the mixing board, or album production, and he was developing a pretty fine reputation for that work.

Most of us in his Internet online community knew Gos as a vocal advocate of the AIDS dissident community; a group of people who question and challenge the mainstream theory that the so-called Human Immunodeficiency Virus (HIV) is the sole and sufficient cause of AIDS. Yes, Gos was HIV-positive, but he insisted that the available scientific evidence does not support the notion that it is a sexually transmitted pathogen, capable of causing disease. Gos believed his positive test was a “false positive,” and the result of his pre-existing illnesses.

As I write this, I am sitting in the dining room of the home of Lisa Dugger, Gos’ wife and best friend. I have been here a few days, so I could attend Gos’ memorial service, meet his family and friends, and review his medical records. I thought I knew Gos well, from our work together as moderators at the Forums at Questioning AIDS, as well the numerous telephone visits we used to have. He was a verbose writer and talker, and a significant contributor to the forums.

Gos passed away three weeks ago, on October 13, after spending two weeks in Cypress Fairbanks Medical Center in Houston, Texas, where he was admitted for abdominal pain and difficult breathing. Gos’ list of diagnoses is a long one, some of them, like Crohn’s disease, dating back to his earliest years. At Gos’ service, his mother related the family’s experience with the medical system, trying to get an accurate diagnosis of the disease.

Others who knew him from childhood, shared stories at his memorial fete last Saturday. His older brother Randy, who was 12 when Gos was born, had to give up some personal space in his bedroom to accommodate the new infant. As he tells the story, Randy discovered Gos was “confused” about what the term “uh oh” meant when he uttered those words from his crib. When Randy went over to investigate, baby Gos held out his hand and Randy received the offering, only to discover a turd in his hand.

All of those who shared stories about their friendship with Gos agreed that he was always honest; sometimes painfully honest. He was also an avid reader and consumer of information, some of it quite esoteric.

The other characteristic that every person who related a story at his service shared was Gos’ love for a good argument. He was a tenacious debater, who had an uncanny ability to recall his sources, which he could cite from memory. More than one person said something to the effect of “I never won an argument with Gos.”

I already knew this about Gos, though. He loved to engage what we called “orthodox trolls”, or “AIDS apologists” on the forums. Someone committed to the mainstream position on HIV and AIDS would come to QA to try to set us “denialists” straight about HIV and AIDS. While anyone could respond to these guys, Gos was the star performer, challenging them to a moderated, scientific debate. We even set up a special forum, with rules for presenting and challenging evidence, and called it “Toe-to-Toe”. It never got much traction, because no one was willing to debate Gos on a fair and level field.

Still, he did get a lot of action in the main forums. He relates his experience with one of these HIV=AIDS apologists, who he referred to as “Gene” in one of the books he has written:

 In November of 2007, a biologist named Gene (not his real username) entered a dissident forum of which I was a member, and began to demand whether anyone there had any scientific credentials. He seemed eager to debate with a dissident on AIDS, and since that was a fight I’d been spoiling for already, I accepted his challenge.

He agreed to accept the burden of proof for the purpose of the debate — which, to the layman, may seem unfair, but in science the burden of proof is always on those who assert a positive — if it were otherwise, then God, Santa Claus, Superman, and the Easter Bunny would all be considered to be objective scientific facts, since no one can prove that they don’t exist.

Evidence was to be discussed in five logically ordered steps: 1) Prove that HIV exists as a single, unique, exogenous retrovirus which has been cultured and isolated by scientists. 2) Prove that HIV is infectious. 3) Prove that one or more tests have been correlated to actual viral isolation, showing a high degree of specificity. 4) Establish, using the test or tests which have been validated to the standards in Step 3, that AIDS-defining symptoms are substantially more prevalent in HIV-positives than among persons with no risk for HIV, after all other potential factors (lifestyle, drug abuse, malnutrition, etc.) have been controlled out. 5) Prove that AIDS does not predate HIV infection.

Over the course of the next five months, he proved to be a gold mine of information, and he certainly proved to be a worthy and formidable adversary in a debate, but the one thing he couldn’t prove was that HIV actually exists.

This surprised even me, as I was sort of hoping that he could prove HIV’s existence, so that the debate could move on to the subject of whether or not HIV causes AIDS. After all, absence of proof is not proof of absence — it is possible for HIV to exist without conclusive, unambiguous proof that it exists. If he couldn’t prove that HIV exists, then it would mean that I’d really failed to prove anything other than that he couldn’t prove that HIV exists — which ultimately proves nothing. On the other hand, if he’d succeeded in proving the existence of HIV, then the debate could proceed on to a discussion of all the reasons other than the lack of evidence, for my suspicion that HIV is either nonexistent or at least harmless.

One thing I love about having such debates is that I always learn so much, and this debate taught me many things I’d never even considered before.

Before he died, Gos had written two volumes of his book. He wrote frankly about his life experiences; about AIDS; about AIDS questioning and dissidence. One is more than 400 pages long, while Volume 2 is nearly 200 pages. The books will be edited and published at some point in the future, which will save me some time and space here.

Even though Gos had described to me his history of chronic illness since childhood, I did not understand, nor appreciate how severely ill he has been most of his life. Friends who knew him personally described the wracking pain he experienced from his Crohn’s.

Fortunately, Gos made his wishes very clear to me while he was alive:  “If I go first, tell the truth about what happened,” he told me, and I will attempt to do so. While Gos was an amazing man, he was also human, and he was flawed. He had no choice about having to live with Crohn’s. It is obvious that disease, and other autoimmune problems run in his family.

But Gos not only rejected allopathic medicine and care, he did not, or was not financially able to embrace any kind of alternative health “care”, either. Worse yet, in my humble opinion, he had some really unhealthy habits and addictions. I can hear him howling from the other side of the veil even now, when I blame his cigarette smoking for exacerbating, if not causing his respiratory distress.  His medical records and death certificate are very confusing on this matter, and Lisa tells me that the cigarettes did help alleviate some of the worst symptoms of the Crohn’s. I don’t doubt that. Nicotine is, after all, a drug, and some of the other chemicals in mass produced cigarettes may also have some pharmaceutical properties.

He was also a sugar addict. One of the significant diagnoses in the hospital that was actually verified by culture was candida albacans—thrush—which feeds on sugar. We won’t know until the final autopsy is back whether or not this fungal infection had spread to internal organs.

Because of his previous negative experience at a large hospital in Houston, Gos refused to be transferred from Cy-Fair Medical Center, where doctors admitted they were not able to provide the level of care that they felt a patient as “complex” as Gos required. Because of his refusal, doctors at Cy-Fair wanted Gos to undergo psychiatric evaluation.

The records make clear that they were convinced that Gos’ HIV status was the cause of his illness, and they were treating him presumptively for “PCP—pneumocystis carinii pneumonia”, even though it is now known as pneumocystis jaroveci pneumonia, a mistake that drives home the point that his medical care providers there were not up-to-date on infectious diseases. Even so, a larger hospital, with more resources, would undoubtedly have made the same assumptions, once they knew that Gos had test HIV-positive. The only problem was:  all tests for PCP came back negative, though some later blood tests revealed “cocci clusters”, a bacterial infection, in his blood.

That’s not to say that Gos did not have some serious infections. In addition to the Candida albacans, he had an active cytomegalovirus infection (CMV), based on PCR tests. His Crohn’s was in full flare, and lung scans indicated pneumonia, which, according to Lisa, were nearly identical to scans performed in June, when Gos had been hospitalized at Memorial Hermann Medical Center.

Gos was given a cocktail of powerful intravenous antibiotics, including: Rocephin, Zithromax, meropenem, Bactrim, vancomycin, Cipro and Diflucan, as well as drugs intended to ease his breathing, proton pump inhibitors and narcotic pain medications, among others. Throughout his medical records, the doctors were diligent about posting comments that Gos and his family did not want them to initiate treatment with antiretroviral drugs for HIV, unless they could prove infection to their satisfaction. One doctor even deemed it appropriate to post the following note in Gos’ medical records during an evaluation the day before Gos died:

Wife reported that if the patient would pull-through by any chance and would know that human immunodeficiency virus treatment was started. He will divorce her because that is not what his wishes are.

Despite all the drugs, Gos’ condition worsened to the point that doctors advised intubation—inserting a tube to deliver oxygen directly into his lungs—and Gos was so desperate for relief from oxygen deprivation that he consented. It would prove to be the last decision he would be able to make for himself. The tube was inserted on the evening of 10/11.  By morning, doctors were advising that Gos be sedated to prevent him from trying to remove the tube or IVs, apparently a common enough procedure for patients in this state. Gos never regained full consciousness again. In hindsight, I believe this was the day that Gos began dying.

I was still in Kansas City, and the messages I was receiving at this point from Lisa were confusing and contradictory. I realize now that is because she was getting distinctly different messages from different doctors. Some were telling her that the intubation was a temporary measure to help stabilize Gos until the antibiotics cleared the presumed infections, and that they expected him to recover. A few hours later, someone else told her his condition was too critical, and she and the family should prepare for the worst.

Dr.  Rajendra G Pandya, MD, was so concerned that he noted no fewer than six times in Gos’ medical records that “the family refuses empirical treatment.” It does not take long to discern that Cy-Fair and its staff simply did not know what to do with Gos. Their assumptions about PCP proved to be wrong.  They were trying to treat the wrong infection. By the time they realized this, it was too late to make changes in his treatment.

According to the preliminary autopsy, Gos “died as a result of multiple pulmonary conditions including bronchopneumonia, centrilobular emphysema, and probable diffuse alveolar damage (Adult Respiratory Distress Syndrome).”  Despite Cy-Fair doctors mentioning “HIV” 51 times and “PCP” 19 times in the 556-pages of medical records, the immediate cause of death on the death certificate was: “bronchopneumonia and centrilobular emphysema”, and an underlying cause of: “probable Adult Respiratory Distress Syndrome (ARDS).

There is no mention of “HIV” or “AIDS” in either the preliminary autopsy, or the death certificate, though the final autopsy report has not yet been released and may contain new information.  The other piece of information missing from the hospital’s records is the so-called “viral load” results, though the records make it clear that the test was ordered and drawn. Gos’ CD4 count (another surrogate marker commonly tracked in AIDS patients) was only 5 a couple of days before Gos died.

No one really expected definitive answers from the autopsy, and indeed, few who knew him well consider his passing as completely unexpected. The doctors got one thing very right:  Gos’ illnesses were very complex; multifactorial and complicated. Even if the immediate infection had been arrested, and Gos had been able to regain consciousness, there is little likelihood he would have been able to continue to live much longer. He told me more than once on the phone that he never expected to grow old, and the conversations often turned to what he wanted to happen after he died.

He would scoff at me when I urged him to quit smoking, and had a well-prepared response that defended his choice to continue to do so. I’m more than amazed that even in death, Gos won yet another argument. Field #27 on the Texas death certificate is the question: “Did tobacco use contribute to death?”  The answer checked is “No”!  I honestly cannot believe my eyes.

Gos had a philosophy about bad habits, personal freedom and the inherent right of every individual to choose pleasure over societal mores. It can be found on the website of Nero’s Opening Act, in the introduction to the song RounGrounBrown, which was played at his memorial service at his request, via a spiritual medium:

Have you ever noticed that all of the things that make life worthwhile are either illegal, immoral, fattening, unholy, unhealthy, politically-incorrect, socially unacceptable, or just plain wrong?

If these things be evil, then it must be a good kind of evil…

I realize that the information I am sharing probably leaves readers with more questions than answers. My experience tells me that is almost always the case with knowledge. No matter how much we know or learn, we ultimately discover that life… and death… is a mystery.

Gos is survived by his wife, Lisa Dugger and his daughter, Libra, his mom, Faye, brother Randy, and three sisters, Connie, Christine and Sandra.

(Note:  For some reason I can’t explain, I want to post this while I am still in Houston, in Lisa and Gos’ home. Call it another step of closure for me.  I reserve the right to edit/update or correct later, but if I’ve made mistakes, I do not believe there are any that could be large enough to change the overall message or meaning of this post.  -Jonathan)