The Triangle’s health advocacy community lost one of its most outspoken voices this weekend with the death of Dr. Charlie van der Horst during a 120-mile marathon swimming race in the Hudson River. He was sixty-seven.
The world-renowned AIDS researcher and professor emeritus of medicine and infectious diseases at UNC–Chapel Hill was not content to fight for his patients in the exam room or from the lab bench. During pivotal moments of his life, van der Horst felt compelled to take a public stand for health care justice by stepping out of the clinic and into the streets.
Perhaps the most iconic act of civil disobedience during the Moral Monday protests of 2013 and 2014 belongs to van der Horst. In a well-known image, van der Horst, wearing a white coat and with his hands bound by zip ties, shoots a glance over his shoulder that showcased his wry sense of humor while Capitol police escort him out of the General Assembly.
What led the medical doctor to be arrested that day?
In a previously unpublished interview—conducted in July 2014 as part of an oral history on the Moral Monday movement—van der Horst reveals how his commitment to social justice stemmed from his early political activism, the difficulty of caring for victims of the AIDS epidemic, and his indignation with the General Assembly’s refusal to expand Medicaid.
This interview will be permanently housed at the Southern Oral History Collection for future scholarship.—Jonathan Michels
I was born in the Netherlands. I was a postwar, World War II baby, and then my family immigrated when I was two months old to the U.S.
My mother was a Holocaust survivor and she didn’t feel safe. She thought it wasn’t safe to be a Jew and be in Europe anymore after that. Didn’t have a lot of rational sense, but that was her fear, and so she really wanted to get out of town.
We moved to a town of about eighteen thousand people called Olean, New York, south of Buffalo. It was sort of this sleepy town at the northern tip of the Appalachian Mountains. Not very wealthy, surrounded by farmland, and it was a quiet place. They ended up there because my grandfather had a patent, a special patent, and he had established a small factory there to be close to the factory that made those big engines because they used his patent.
My parents were active in the Civil Rights movement. We never had Welch’s grape juice in the house or Welch’s jelly because Robert Welch was I think a founding member or big supporter of the John Birch Society, which is a right-wing organization. My parents belonged to the ACLU their first year they immigrated to the United States. My father was a member of the NAACP and raised money for the United Negro College Fund.
I remember marching with my father. My mother wouldn’t have done that because she was still sort of scarred from the Holocaust. She wouldn’t have gone out and marched. But I remember marching with my father and a black friend of mine. A big crowd of people, black and white, just marched downtown. We held signs and sang songs.
Later, I got involved in the anti-war movement. I remember getting signatures for George McGovern. I don’t remember a lot, but I got a lot of people who were supportive of it. What was shocking to me was more students didn’t get involved. They just didn’t want to.
People do a lot of talking, but they don’t—for a variety of reasons—they don’t actually walk the walk. I’m a child of a Holocaust survivor, and people who didn’t walk the walk died. But you never get change unless you put a little effort into it. It should be a little painful.
‘That Goddamned Nutcase’
After attending Andover, I applied to Harvard and I applied to Duke. I wrote this incredibly left-wing essay for Harvard. It was like this stream-of-consciousness thing about standing up for what’s right.
The admissions advisor at Andover, he couldn’t understand why I didn’t get into Harvard. I was a little disappointed because all my friends had gotten in. Now, remember this was when Nathan Pusey was president at Harvard and had called in the Cambridge police who had beaten, literally a bloody, bloody battle with the students who were occupying an office on campus.
He called up the admissions director at Harvard. He said, “I don’t understand why didn’t you take van der Horst?” He said, “Did you read his essay?” [The admissions director] said, “Have you looked at the newspaper headlines. Do you think I’m going to take that goddamned nutcase?”
I think I wrote the same essay for Duke. For them, that was a positive, despite all that. It was a culture shock [coming to Duke]. Andover was a lot of negative things. It was a lot of wealthy kids from New York City who had been in prep school all their life. Harry Steinway of Steinway pianos. The son of The New York Times owner. All these very rich and famous people, and I was this country bumpkin. I didn’t know that heir to the throne was pronounced heir or herb was pronounced herb. And I would get them mixed up in English class, and they would all laugh and tease me and things like that.
On the other hand, they were really, really smart and very outspoken. People weren’t shy about giving their opinions, and the faculty just pushed you hard and you had to write, write, write.
At Duke, it was a lot of Southern boys who were quiet. They were smart, but they were quiet. They didn’t participate, so if you were in a small group, it was no one talked. At one point, I had this wonderful history professor. He was a European history teacher named Harold Parker. After the first three weeks or something like that, he took me aside and he said, “Mr. van der Horst, I really enjoy the conversations we’re having in class with me. But you know, there’s eight other people there. I want you to do me a favor and count to ten before you open your mouth.”
No one else would say anything. Then my senior year, and people were not—it was much better than it is now, where 60 percent of the men and women are in fraternities and sororities.
Oh god, they kept trying to recruit me. The Jews wanted me, and the Jewish fraternity and the jocks, I was a varsity swimmer. They wanted me in the jock fraternity. And the prep school kids wanted me in the prep school fraternity. And I just wanted none of them. It was just nauseating. I just was so against it.
I was an old-fashioned intellectual. I worked in the library six days a week until it closed. I was also a jock. I was on the swim team. I just loved it, but I didn’t have a lot of friends until I was writing the history honors thesis and I met all these wonderful people.
So then I went to Harvard. The joke about Harvard is that there are three major religions at Harvard Medical School. Orthodox, conservative, and reformed. So I had not been raised as a Jew, but I was finding an increasing affinity for Judaism. I felt like I had instantly thirty-two friends. They were people who got it. They went into medicine for the same reasons I did. They were politically active. They were snarky. We raised holy hell.
There’s a very famous surgeon, and he used to do grand rounds. And they’d bring a patient there. You don’t do that anymore. But in those days, they’d actually bring the patient, and so Franny Moore brought the patient and sort of exposed the patient because the patient was just a piece of flesh. It wasn’t a human being. And this [female student] who was like a Madame LaFarge kind of character—she was from, I think, Jamaica—and she would just sit there knitting the whole time in class. She was older. She was like forty and a mother already. And she stood up in the middle of the grand rounds and just dressed down this faculty member as if he was a three-year-old.
The pharmaceutical industry, they gave us free stethoscopes, and we would send them away to doctors in the West Indies.
So we were very, very feisty. This was a very conservative medical school. People did not protest at Harvard Medical School. No way.
‘We Went on Strike’
I wanted to see what public medicine was like, so I did a rotation at Boston City Hospital, which was no longer a Harvard teaching hospital. So Harvard hospitals at the time, they’re all private hospitals. It may still be true. So I did it at Boston City Hospital, which is a public hospital. I really enjoyed that. So when we looked at our residency, our residency was a little complicated because by then Laura and I were involved. We weren’t engaged yet. So we sort of lied and said we were engaged so we could match together. And we ended up going to New York.
It was very hard. We worked so hard for three years, every third night. You slept in the hospital. So you’d be on, you’d go in at seven a.m. in the morning, like, on a Monday. And you’d go home at seven p.m. on Tuesday. And then you’d get up the next morning at seven a.m. and you’d work just the day and get out at seven p.m. and then—. So that would be Wednesday and then start all over again Thursday, seven a.m. going until Friday night at seven p.m. or about that. But there were no set hours. You left when the work was done.
We had to push our patients to X-ray. There weren’t enough staff. If they needed emergency antibiotics, we had to run to the pharmacy to get them and hand them to the nurse to hang. All the blood, we drew ourselves, and all the lines, we started ourselves. And we ran the blood up to the lab.
I learned an enormous amount of medicine. It was very, very, very good, but we went on strike.
It was actually the longest physician strike in U.S. history. I think we went on strike in 1981, as I recall. And the issue was that we said the hospital was not hiring enough staff to take care of the volume of patients.
They were admitting people, critically ill people, to waiting rooms that didn’t even have proper plugs in them. So when they had a cardiac arrest, you had to just like move the bed to a different place so you could plug in the crash cart because they weren’t battery-powered then. You needed a plug so you could shock the patient. It was just ridiculous.
They were putting us in a position where we would admit a sixty-year-old with cardiogenic shock due to massive heart attack to the coronary care unit, and then we’d have to kick them out two days later because we had a forty-five-year-old with the same thing. So they were having people who’d been physicians for twelve months having to make these life-and-death decisions. It was just intolerable. We thought it was harming the patients. The patients were dying because of this. And so we went out on strike.
We ended up getting busted in the end. Everyone got a FedEx that says if you don’t show up to work tomorrow, you’re fired. Not only will you be fired, but we’ll make sure you can’t get boarded in your specialty or whatever.
The medical establishment is not very liberal. How many doctors do you see joining me on the picket lines?
On the one hand, it was exhilarating but also exhausting. I felt proud of things like that, and then I ended up, I got blackballed from what I was going to do for fellowship. The associate chair of medicine, who was also chief of cardiology, had written this wonderful letter of recommendation for a fellowship of infectious diseases. Then when I went on strike, he just personally felt so betrayed that he wrote secretly another letter and sent it to all the fellowship programs.
He said he wanted to withdraw my previous letter, and I was a danger to patients. So very strong. I was devastated, and I didn’t know what the hell I was going to do. I consulted a lawyer, who said you could probably sue, but you would never, ever be able to succeed professionally if you did that. So his recommendation was just to let it slide. So I did. And the telling thing is the folks at UNC just ripped it up.
I didn’t like the plumbing specialties. They just seemed sort of boring. Cardiac cathing, pulmonary, GI, colonoscopy. They just seemed sort of boring. It was more semi-surgical and not very intellectual. So I liked thinking about the whole body. They’re also just focused on like just one organ or something like that. And I liked internal medicine. So if I was going to do a specialty, then I wanted to think about the whole body.
So I said well, I’ll go into infectious diseases. And this was 1981, mind you. And I’ll just take care of little old ladies with pneumonia and make them better.
And I loved viruses, the symmetry of viruses. They’re just very pretty, elegant. The way they look, these spiked knobs. I mean, you’ve seen the electron micrographs of—3D micrographs of influenza and HIV. They’re very pretty looking.
So I thought it would be fun to do [infectious disease]. Then what happened in June of 1981? Do you remember? That’s when the first HIV/AIDS cases were recognized.
I started taking care of some HIV patients. In fact, the AIDS house in Durham is called the Blevins House, named after Nat Blevins, who was my patient. I took care of him right from the very beginning.
[HIV/AIDS] was a huge problem then because no one wanted to take care of the patients. Fear of contagion, fear of this whole idea that they were gay and just afraid of them. It was a terrible time. It was just physically draining. It was like being a resident again. I was always in and out of the hospital, and we set up a ward. We set up a clinic. We were the only hospital from Miami to New York that had a dedicated HIV ward. Almost all of the patients passed.
Most of [my] political activity had to do about AIDS issues. Usually discrimination issues. We had a lieutenant governor, Jim Gardner was his name, and he was trying to do testing of food service workers, and health care workers and teachers, and then wanted to fire them all. It was a huge issue that we beat that off, and so that didn’t happen. That was sort of the limit of my political activism in that arena.
‘I Was Pissed Off’
I held a big rally for the Affordable Care Act before it was passed here at the hospital, got all the press involved. That was very successful. I had written a couple of editorials on why [the Affordable Care Act] needed to be passed, and then it got passed. Then [Republican legislators] were making all these pronouncements that they weren’t going to expand Medicaid.
I got involved [in Moral Mondays], particularly about Medicaid expansion. I was pissed off. It was going to harm my patients.
I can’t tell you how awful it is to be put in place to make a diagnosis of a very difficult issue and then not to be able to treat it because they don’t have health insurance. It’s such a terrible feeling. It goes back like when we went on strike—when here I have the skillset, but for want of an aide or a plug in a room that works, I can’t save this person’s life.
I didn’t know about Reverend Barber at all. I went to Raleigh and talked with a couple of other people, including Perri Morgan.
That was in February and then they passed the law that [banned Medicaid expansion]. I opened up the paper and saw that Perri had gotten arrested, and I said, well, shit. If she’s doing this, I need to start doing this stuff. The next Monday, that’s when I met Reverend Barber.
I thought I wanted to protest. I didn’t know that I wanted to be arrested. I don’t think I made a foregone conclusion. It just sort of happened.
That picture became a sort of symbol for doctors being unhappy with not expanding Medicaid. In the white coat, in handcuffs—that sort of woke up a bunch of people I think.
The North Carolina Board of Medical Examiners launched an investigation, which they do for anybody, any physician who’s arrested, and then said it was not an issue. The hospital, I decided to notify risk management, and they also said they didn’t think it had anything to do with my ability to practice medicine. The, and I know the hospital and the dean have been getting pressure from someone in, or more than one person in either the governor’s office or the legislature’s leadership to do something about me, and they haven’t done anything.
People have quietly come up to me and said they were glad. They admired that I had done it. I’ve got a lot of positive press and interviews, and people stop me in grocery stores, and it’s a little bit because I wear the white coat now.
It’s a potent symbol, and I was doing it for my patients.
Jonathan Michels is a freelance journalist. As a board member of Health Care for All NC, he advocated for a Medicare for All health care system along with van der Horst.