The Ultimate Unscheduled Event

This blog entry was written by Steven Natterstad, M.D. ("Dr. Steve"), Dr. Bob's husband and partner of 18 years.

Steven M. Natterstad, M.D.
Steven M. Natterstad, M.D.

The conclusion to Dr. Bob's obituary read: "In addition to his husband (Steve) and sister (Linda), Bob is survived by his parents, Jennie and Angelo Frascino ... and by many friends, colleagues and 'eyeballs' around the world." You, Dr. Bob's global online family, have suffered an immeasurable loss. He was truly a larger-than-life persona, and so he leaves a huge void in our lives. However, because of the great man he was, he also leaves us with a giant presence, one that will continue to guide, reassure, educate and empower all of us.

The only way I have been able to navigate a post-Bob world is through constant "postings" to my own personal "life expert." There have literally been thousands since Bob died. Bob has assured me that he has read them all, and answered as many as would be immortally possible. I highly recommend that you continue to consult your physician expert, Dr. Bob. In a very literal sense, he lives on in the 30,000 posts in his two forums, as well as in this blog.

But Dr. Bob is much more than all these bytes traversing cyberspace. Eleven years of Dr. Bob's presence on (and present he was!) have taught you all a great deal about living in and navigating a world with HIV. The answers to your questions, the reassurance you seek and Bob's twisted sense of humor will always be there for you. Just ask him. I do.

The title of Bob's blog, "Life, Love, Sex, HIV and Other Unscheduled Events," provides the perfect chapter headings for a final blog entry.

Chapter 1: Life

Bob knew how to live. He truly lived each moment as if it, perhaps, would be the last. And if it were to be so, he could always honestly say that he was still the "luckiest guy on the planet," that he had lived an amazing and fabulous life, and that he had no regrets. Nada. Zilch. Zero. Bupkis!

He truly loved his life. He loved that he and I were able to get married on Halloween in 2008, when it was legal in California; he loved playing the piano and listening to classical music; he loved his career in medicine; he loved his work on the Oberlin Board of Trustees; and he loved being Dr. Bob to all of you here at Very few people can truly say that they have enjoyed their life as much as Bob did.

Bob always gave generously, whether to me, his family, his friends, his foundation, Oberlin College or you, his readers. Isn't that alone the definition of a life well lived?

He answered as many of your questions as was humanly possible and, as he sometimes wrote, he did indeed read every question submitted. I do not exaggerate when I tell you that, on average, he devoted five to six hours per day to reading and answering your questions. As his travel companion, I often witnessed him spending every hour of a flight, including those interminable 14-hour ones to faraway places like Australia, churning out Dr. Bob-certified responses. And all the while, he listened to his beloved classical piano music, or his "tunes," as he would call them.

Chapter 2: Love

Bob and I met over 20 years ago when I joined the multispecialty medical group in Sunnyvale, California, where Bob had been an allergist, immunologist and HIV specialist for nearly a decade. We became friends literally at the bedsides of a tragically large number of HIV-positive patients. As an internist, I focused on the in-patient care while Bob handled the out-patient visits and treatment. Our skill sets complimented each other perfectly.

We soon discovered other common interests, including classical piano. I remember one particular conversation during which we "talked piano" for hours. Afterward I thought to myself: If only Bob were a woman, we would be a perfect match. You might say I was a bit late in arriving to the party. As our friendship grew, I shared with Bob my string of disastrous failures with women. Bob, always eager to offer a sound piece of advice, told me to "date within my own species." Somehow, nearly 18 years ago, Jupiter finally aligned with Mars and we fell in love. Ironically, the anniversary of our upgrading from friends to lovers is December 1, World AIDS Day.

Chapter 3: Sex

I suppose it would be more than fair to say that Bob did not pull any punches when he wrote about sex. In the Book of Dr. Bob, life without sex was, well, unimaginable. To live a fulfilling life as a human being meant to be sexual, no matter poz, neg, indeterminate, gay, straight, bi-curious or whatever.

Bob was commonly asked: "Can magnetic relationships really work and be sexually satisfying?" He responded: "From personal experience, I can assure you the answer is absofrickinlutely! I have been in a magnetic relationship with my lawfully wedded husband Steve (Dr. Steve, the expert in's Tratamientos forum) for almost 18 years and counting! I am HIV positive; he is negative . . . I can assure you HIV has not inhibited our toe-curling, own-name-forgetting, wake-the-neighbors bouts of passion nor our happily-every-after existence." And now you get to hear it from the "lawfully wedded husband": You have my assurance (and that of our neighbors) that Dr. Bob spoke the truth!

Chapter 4: HIV

Dr. Bob was one of the first physicians to treat HIV-infected patients in the early '80s. He subsequently founded two medical clinics devoted to the comprehensive and compassionate care of HIV-positive people. As primary investigator for several HIV clinical trials, he published articles on evolving new treatments and quality of life issues for people living with the virus in such journals as International Journal of STD and AIDS, Western Journal of Medicine, Journal of AIDS, and Blood. He also served as Associate Clinical Professor of Medicine, Division of Immunology, Rheumatology, and Allergy, at Stanford University Medical Center for 18 years. He was a certified member of the American Academy of HIV Medicine. In May 2002, as part of the International AIDS Candlelight Vigil in San Francisco, Dr. Bob accepted the Bobbi Campbell AIDS Hero Award for which he received personal letters of acknowledgement and congratulations from both Governor Gray Davis and Mayor Willie Brown.

Bob crossed the line from physician to patient when an occupational exposure resulted in his testing HIV positive. In early 1996, when his health began to fail, he gave up his HIV/AIDS medical practice and turned his efforts to HIV education and to fundraising. In his words, "I could now speak with the knowledge and authority of a physician, but with the eyes and heart and soul of a patient."

That same year, he and I planted the seed for what would become The Robert James Frascino AIDS Foundation by performing a piano concert benefitting HIV/AIDS at our home in Los Altos, California. Due to its overwhelming success, we founded the Concerted Effort HIV/AIDS benefit concert series through which we performed classical and popular piano concerts throughout California. To date we have raised over $1,500,000 for crucial HIV/AIDS services worldwide, ranging from hospice care in Los Angeles to a clean needle-exchange program in Washington, D.C., to the provision of anti-HIV medication to HIV-positive pregnant women in Africa, thereby helping to prevent transmission of the virus to their newborns.

Concerted Effort 2011, which would have been the 17th in the series, was scheduled to take place at the Mountain View Center for the Performing Arts on Sunday, September 18, the day following Bob's death.

Chapter 5: The Unscheduled Event

At a rehearsal for Concerted Effort on the evening of Friday, September 16, Dr. Bob was in rarer than ever form. He was, ironically, the "life" of the party. We were practicing an absurdly crazy piano piece that had been our signature finale for several years. Picture this: four pianists, eight hands, 40 fingers flying, all at one keyboard, and all on one piano bench. Bob's staging for this year's rendition included neon-lit sunglasses, pages of music flying uncontrollably off the music stand, snapping pictures of us with his iPhone, and taking advantage of several bars of rests in his part of the music to either race around the piano or to stand up and file his nails while the rest of us played fast and furiously. It was classic Bob.

During our post-rehearsal dinner, Bob got the chills. The fevers continued intermittently through the night and into Saturday morning, but Tylenol, Advil, blankets and our holding each other tightly brought relief. In between fevers, we discussed plans for the upcoming Concerted Effort on Sunday, engaged in our typical pillow talk, and yes, even played a little. We both believed this was nothing more than a typical speed bump for Bob, perhaps the flu, which he would ultimately get over.

Saturday morning came, and in spite of continuing fevers, Bob insisted that the "show" scheduled for the following day must go on! He was adamant. He felt certain that either he would recover sufficiently by the next day or that I and the other pianists could carry the show without him. That was our last conversation about Concerted Effort 2011. The decision was made: The concert was on and plans moved forward.

John Lennon once said: "Life is what happens to you while you're busy making other plans." On Saturday Bob developed low-back pain that became increasingly severe and untouchable by any pain medications we had in the house. There was no choice left but to go to the emergency room. Linda, Bob's sister from New Jersey, who was thankfully in town for the concert, arrived to be with Bob and me. Bob began showing signs of an overwhelming system-wide infection known in medical jargon as "sepsis": His blood pressure was low, and his lungs were having difficulty getting oxygen to his vital organs.

Bob eventually required mechanical ventilation. But before that would happen, in typical Bob fashion, he took charge of the situation and told the doctors that he first wanted to speak with me. He reminded me that he would not be able to speak once he was on the ventilator. So we shared our love for each other one last time and gave each other a kiss. Linda was also able to tell her brother Bob that she loved him.

In spite of excellent and aggressive medical care and Bob's fighting like the true warrior that he was until the end, a very malicious, unrelenting and fast-acting bacterial foe overtook him. He spent only 2 ½ hours in the emergency room. It was dramatic, to say the very least. It was very Bob.

How did this happen to our Bob? Bob took meticulous care of himself. His anti-HIV medical regimen kept his viral load undetectable and his CD4 count and percentage stable at relatively good levels. However, Bob, who was an immunologist after all, reminded us regularly that one doesn't live with this virus for decades without developing some "holes" or vulnerabilities in the immune system, even when the CD4 count is relatively well preserved. Bob was around for the introduction of HAART (highly active antiretroviral therapy) in 1996. As a result, he LIVED for 15 more glorious years. He was not, tragically, around for the cure. He planned to be, as he often wrote in his posts and blog entries. But life happened; an unscheduled event occurred: Bob died.

I believe I hear a collective heart-rending "OUCHAMAGOUCHA" reverberating through cyberspace.

Sending you all lots of Dr. Bob-certified good-luck/good-health karma. (He bequeathed it all to me in his will.)

Dr. Steve

Get in touch with the Robert James Frascino AIDS Foundation, or read's official remembrance page for Dr. Bob.