If youre old enough, some of what youve lived through has managed to become history. I went to medical school and surgical training during the AIDS epidemic. As I try to understand that time, I tell stories about it. Here is one of them.
I was a surgery resident working in a trauma center in Baltimore. Our hospital was full of people shot and stabbed and beaten with baseball bats. One quarter of the people in our ER had HIV, though when we saw them in emergencies, we didnt know who did and who didnt. What we believed was that HIV was a disease with no real treatment, a disease that would progress to AIDS and then relentlessly to death.
One day when I was working, EMTs brought in a man whod been stabbed in the chest. He was dead without a measurable blood pressure but he was just barely dead. The EMTs said hed still had a pulse when they pulled up to the door of the ER.
Guys like this are people we can save. We can open their chests and find the wound inside. We can stop the bleeding, massage the heart and then shock it back to beating. A surgeon with quick hands can yank a third of these patients back to the present. As residents, of course, we wanted to be that surgeon.
On that day I was not the deft savior. My patient died and I cut myself as I opened his chest which, predictably, was full of blood.
I didnt stop working on him when I cut myself. We were trying to save his life. And what would have been the point of abandoning ship because I cut myself? The exposure had already happened. His blood and whatever was in it were already in my hand wound.
My team and I kept working until hed been dead too long to get him back. Then I went to the locker room and examined my hand. I had a small slice of a wound. I cleaned it out with bathroom soap and covered it with a Band-Aid. I didnt tell anyone.
I didnt tell because I was embarrassed. Id cut myself. It was my fault, my error. Were supposed to cut other people. What kind of surgeon cuts herself?
I also didnt tell because I was terrified to even talk about it. Our hospitals were full of AIDS patients young people dying awful deaths from bizarre infections that we could barely treat. Id taken care of hundreds of them and I didnt want to be one. I didnt want to think about it. I didnt want to talk with some doctor about it. I wanted to pretend it hadnt happened. So thats what I did.
I went on to a research rotation, stopped operating, stopped donating blood. I hid.
It ate at me, though, and a couple of months later, I went to an HIV clinic at a hospital I didnt work in. I was anonymously tested for HIV. When the nurse who didnt know my name told me I didnt have it, I cried.
Over the years, Ive told this story to students and residents to try to communicate what it was like to train in the time of AIDS. Ive wanted to capture what a scary time it was both for patients and doctors, how consumed we were by caring for people with AIDS, how anxious we surgeons were about being exposed to HIV, how frightened and sad we were as we watched people die who were often younger than we were.
My point has also been to tell a story of medical progress. Ive wanted my trainees to be amazed, awed by the advances which have turned American HIV into a chronic disease instead of a death sentence. And, truthfully, Ive wanted them also to feel lucky to be living now, and to be training in the U.S. where these advances have changed the lives of both patients and doctors.
Just as generations of historians uncover new meanings in old events, Ive realized recently theres something more to this story besides AIDS and the glory of medical progress.
What is also there, glaringly, is how the fear of illness and death can make sane people crazy. When I thought I might get AIDS, I became irrational. I looked normal on the outside. I paid my bills. I went to work. I interacted regularly with smart physicians doing AIDS research. Still, though, I was consumed by a fearful fatalism: Id either get AIDS or I wouldnt. Id either die or I wouldnt. Nothing to do, I thought, but keep busy and try to take my mind off it.
Often we see patients who are just like I was. They come in with giant cancers that surely didnt arise this week, or advanced infection that should have been treated weeks before. We shake our heads and wonder why they havent come in earlier, but truly if I want to understand them, to comprehend their denial and fear, I have no further to look than my own past.
Sickness is terrifying. Caring for patients demands that we recognize that. After all, we can only treat them if they come to us, and acknowledging their experience is one way to keep them coming through the door.