The following version of this book was used to create this study guide: McDermott, Keith.. Acqua Calda. Carroll & Graf, an imprint of Avalon Publishing Group, 2004. First Carroll & Graf edition, 2005. This story of a mid-forties gay man emerging from an experience of being deathly ill with HIV-AIDS is set in the mid-1990’s, a period in which HIV-AIDS was not yet a manageable condition and what treatments were available were often as fatal as the disease itself.

A prologue outlines Gerald’s hermit-like state of mind, and lifestyle, in the aftermath of his recent brush with death. He contemplates his participation in the clinical trial of some new HIV-AIDS medications, believing that he is either in the control group (that is: receiving sugar pills instead of the actual medication) or that the medication is doing no good. His late-night musings are interrupted by a phone call from renowned theatrical director William Weiss (Bill), with whom Gerald had worked for several years and who wants Gerald to join him in working on a project in Italy. Gerald agrees.

When he arrives in Italy, Gerald is unhappy with his accommodations and with some of the other actors, but is happy to reunite with Bill and some of the other actors with whom he Gerald who had previously worked in Bill’s creations. A particular favorite is Ariela, who teases Gerald playfully as they wait for the newer members of the company to arrive, first from Germany and later from Italy.

As Gerald settles into the routine of rehearsal, he finds himself energized by the creative process, by new acquaintances (including Mima, an Italian actress with whom he bonds over cigarettes), and the environment, warm and lushly beautiful. He is inspired by all these circumstances to go off his medications, with the almost immediate result that he begins to feel fatigued and unwell.

As rehearsals continue, with frequent interjections of frustration and high emotion from the temperamental Bill, Gerald becomes increasingly involved in the work and increasingly engaged with the newer members of the company. One night, he joins a group led by some of the Italians to a nearby mineral spring, where he enjoys a nude swim in the hot pool (the acqua calda). He also has an intimate conversation with Mima, and later receives a massage that turns sexual from Enzo, one of the Italians. They manage some time on their own for a quick round of mutual masturbation, Gerald enjoying feeling sexual for the first time in a long time and promising himself that he will tell Enzo about his HIV status before their next encounter.

Arranging that next encounter proves difficult as Bill’s demands for rehearsal time increase, Gerald’s fatigue deepens, and Enzo reveals that he has a lover who is coming to see the show. Eventually, they manage some alone time together, but it is very brief, as they both have to get back to preparations for Bill’s show.

Gerald, meanwhile, is becoming increasingly unwell, and there are questions about whether he is able to meet the rigorous requirements of the performance. Finally, in the middle of opening night stress (and after reacting negatively to a headline in an Italian newspaper promoting a “miracle” cure for HIV-AIDS), Gerald collapses, and is told to go to his hotel to rest. Instead, he climbs to the top of a nearby hill, contemplates his situation, and in a kind of ecstasy, runs back down in an attempt to make his final entrance in the performance.