I remember that summer night like it was yesterday…
It was early July, 1994. I had just finished medical school and was starting the first week of my internship at Saint Vincent’s Hospital in Greenwich Village, NYC. Before I got there I hadn’t fully grasped what I was in for. I was training in one of the country’s HIV/AIDS epicenters, a community, and a hospital, where a vicious disease was bringing death everywhere you looked. 80-90% of those admitted to the 700 bed facility were by people with AIDS, a neighborhood.
It was my first night on call and my pager was buzzing- It was the first time I’d respond as a newly minted doctor…A nurse from a floor I was covering explained that a patient under my care was having difficulty breathing. I could sense her urgency over the phone as she pressed me for an answer.
“What do you want me to give him, doctor?”
I wasn’t sure how to respond ,so I asked the nurse about his blood pressure.
“Normal”, I was told.
How was his heart rate ?
“ Rapid but regular.”
How did he appear…clinically?
“ He’s alert, knows where he is. It’s just that he’s feeling short of breath, and he’s breathing fast”.
“His oxygen level?”
“It’s low at 75%. “
I asked her to start him on oxygen and told her I’d be there in a moment.
The nurse told me to hurry. Following protocol, I asked her about the patients primary care doctor
“It’s Dr L.” she said. “He was here a half hour ago.”
“Great.” I responded. With a bit of luck he would still be in the hospital.
Having called and arranged to meet Dr L. at the nurses’ station, I found myself with a moment to go over the patient’s chart. He was 26, with no past medical history. He’d been in seemingly good health until the week before when he’d been hospitalized for headaches. These were due to an unusual fungal infection, a form of meningitis usually only seen in the immune suppressed. The patient had been tested for HIV the day before and had learned just a few hours ago that he was HIV positive. He’d been responding well to the anti-fungal medicine, but earlier that evening came down with a dry cough, reporting to his nurse that he felt short of breath. It was all there, textbook, something eerily similar to what would be reported of the patient next to him, or the man across the hall, or the one who’d died a couple of days earlier in the same bed as the patient I was about to go in and see.
Still buried in the patient’s chart, I heard for the first time a voice I would come to depend upon.
“Are you the new intern I was just talking to?”
I looked up and nodded yes.
“Well, let’s go see the patient together”, said doctor L., his affected theatricality at first catching me off balance. Dr L flew down the hall in front of me. I had to break almost into a jog just to catch up to him. We walked so fast together down the hall that night that I could feel the cool septic hospital breeze on my face. It blew through my hair. “Runway Doctors”, he commented, the camp in Dr L’s voice marching in rhythm to a pronounced sashay. I was and wasn’t sure of what I was seeing.
I introduced myself to the patient as we entered his room. He was a young man , pale, thin as rail, with curly red hair and bright blue eyes. His cheeks were sunken and his temples a little hollow. It was a look I’d come to recognize on many different faces. He asked us what was causing him to feel so sick.
“We’ll try to get some answers for you, I explained”, Dr L and I ordering a portable chest x-ray, a sputum analysis, some blood work. By night’s end we’d diagnose him with PCP Pneumonia, another opportunistic infection.
“What’s going on?” the patient wanted to know. “ How can this be happening to me?” He was as unprepared as most young men would be for life threatening illness. The questions weren’t questions really. They were a way to stretch towards some kind of recognition. .
After we treated him with new medications that night, I sat at his bedside, held his hand until he drifted off to sleep. I was any more than he was for the enormity of what of what was all around us. In medical school I had spent years learning about illnesses and how to treat them, but what do you do when there is no good treatment?
In the middle of my first night on call, I thought to myself how fortunate I’d been not be alone, to have had a senior doctor present at my side for that first encounter. I was also comforted that my first professional experience was with a doctor as eccentric as Dr L and with someone a little gay, or maybe more than a little gay, just like me. A month so after that Dr L called me to tell me that the patient from my first night on call had died from “overwhelming infection”. It was a phrase we’d use so as not to have to describe what we were actually looking at.
The young man with the read hear and piercing blue eyes was my first patient but not , unfortunately, the first death I had to confront in my early weeks at St Vincent’s. I wish I could say I learned how handle the loses, or at least that I was able to make a discernable difference. That would come eventually, much later, along with so many things – hope, resilience, survival. But that was years away from what my patients faced that summer or what I woke up to each day as I headed off to work.
I always tried like doctor L to walk just a bit faster than was proper, to hurry through the hospital doors. I learned to find a smile out of nowhere. And my patients ….frightened, angry, generous , bewildered… there is no rising above sometimes, just passing through a thing, to the other side or not. I’m grateful for those who are here, now, for whom and with whom I am still walking just a little bit faster, and with a little more swing to my step than is entirely respectable. I wish there could have been more of us.
