AIDS Doctors: Voices from the Epidemic: An Oral History - Hardcover

Bayer, Ronald; Oppenheimer, Gerald M.

Hardcover

ISBN 10: 0195126815 ISBN 13: 9780195126815

Publisher: Oxford University Press, 2000

Synopsis

Today, AIDS has been indelibly etched in our consciousness. Yet it was less than twenty years ago that doctors confronted a sudden avalanche of strange, inexplicable, seemingly untreatable conditions that signaled the arrival of a devastating new disease. Bewildered, unprepared, and pushed to the limit of their diagnostic abilities, a select group of courageous physicians nevertheless persevered. This unique collective memoir tells their story.
Based on interviews with nearly eighty doctors whose lives and careers have centered on the AIDS epidemic from the early 1980s to the present, this candid, emotionally textured account details the palpable anxiety in the medical profession as it experienced a rapid succession of cases for which there was no clinical history. The physicians interviewed chronicle the roller coaster experiences of hope and despair, as they applied newly developed, often unsuccessful therapies. Yet these physicians who chose to embrace the challenge confronted more than just the sense of therapeutic helplessness in dealing with a disease they could not conquer. They also faced the tough choices inherent in treating a controversial, sexually and intravenously transmitted illness as many colleagues simply walked away. Many describe being gripped by a sense of mission: by the moral imperative to treat the disempowered and despised. Nearly all describe a common purpose, an esprit de corps that bound them together in a terrible yet exhilarating war against an invisible enemy.
This extraordinary oral history forms a landmark effort in the understanding of the AIDS crisis. Carefully collected and eloquently told, the doctors' narratives reveal the tenacity and unquenchable optimism that has paved the way for taming a 20th-century plague.

About this title

About the Author

Ronald Bayer teaches at the Joseph L. Mailman School of Public Health at Columbia University. Gerald Oppenheimer teaches at Brooklyn College, City University of New York.

Reviews

In the early 1980s, clinicians in urban centers became increasingly alarmed as young homosexual and bisexual men presented with a life-threatening disease that seemed related to a severe immunodeficiency. The Morbidity and Mortality Weekly Report announced cases of the disease among gay men in 1981. Reports of diseases and cancers never seen in healthy young people, including Pneumocystis carinii pneumonia, Kaposi's sarcoma, cryptococcal meningitis, and toxoplasma encephalitis, slowly entered medical publications throughout the United States.

In New York, San Francisco, and Miami, physicians initially noted that their patients were exclusively men who had sex with men, injection-drug users, and hemophiliacs. Soon, sex partners of these patients began to show up with similar diseases. Pediatricians quickly noticed a similar constellation of immunosuppression, unusual infections, and odd tumors among the very young. Often, patients died within a year. The AIDS epidemic had begun.

Despite the sharp rise in the number of deaths due to this initially mysterious illness, most physicians were hesitant to provide medical care for patients with AIDS. More astounding were those who refused outright. Many clinicians had intensely negative reactions to the sexual practices and lifestyles of these patients, and this frequently interfered with the provision of appropriate care. Indeed, during the early years, it often appeared that, with disdain and disbelief, the health care system had turned its back on the epidemic.

However, not all physicians walked away. AIDS Doctors: Voices from the Epidemic tells the moving story of doctors who have committed their professional and often their personal lives to the AIDS epidemic. The authors interviewed 76 physicians with broad experience in the field of AIDS to compile an "oral history archive" that describes the shared and unique stories of physicians who have cared for people with AIDS. In essence, the interviews and accompanying commentary weave a history of the AIDS epidemic narrated by physicians who have been immersed in it.

The book begins in 1980, with an account of the mounting anxiety shared by doctors in several U.S. cities who had begun to notice similar clinical presentations among their patients. Personal accounts of the rising number of patients with severe fungal, protozoal, and viral infections provide a sober description of the start of the epidemic. As the story of the epidemic progresses through each chapter, the doctors consider many factors as they commit themselves to working with patients with AIDS. Some chose this path because they were excited about a new disease and the prospect of publication and advancement. Gay and lesbian doctors often found themselves caring for these patients when no one else would. Still others were drawn in by their sense of social justice and a calling to care for the disenfranchised. Chapter by chapter, the many physicians who neglected to care are contrasted with the few who stepped forward. There are detailed descriptions of the struggle to provide adequate services with few resources. Personal accounts reveal that many institutions deliberately chose not to put resources into AIDS care. Often, caring for patients with AIDS involved an uphill battle against hospital administrators, colleagues, friends, and family.

In a chapter entitled "The Dark Years," physicians describe how they came to terms with the little they had to offer young patients who were dying in exceptionally high numbers. A long chapter, "Travel Agents for Death," painstakingly gives voice to doctors who were overwhelmed by the deaths of their patients and had to cope with the ambivalence of their colleagues, the health care system, and society.

The authors then turn to the early treatment era, when zidovudine first became available. During this period, excitement often alternated with fear and horror; feelings of helplessness alternated with feelings of purpose. The book ends with a short chapter about the recent era of highly active antiretroviral therapy. Considering how much space the authors devote to the dark years, more about the recent, optimistic years would have been desirable.

The struggle of these doctors to care for the sick and dying often meant professional and personal isolation. As a physician devoted to AIDS care for many years, I found parts of my own story in the stories of others. All these stories about isolation, battles with administrators, the lack of time with family, and desperation born of the numbers of dead and dying patients need to be heard. Physicians with years of experience in caring for patients with the human immunodeficiency virus will particularly identify with this book; those new to the field should find it inspiring and informative. The book should also enjoy a general readership, since the lay public can relate to the human stories that detail the failings and triumphs of the health care system in relation to AIDS. The book is more than informative and moving -- it is a testament to the devotion of physicians to the sick.

Marla Gold, M.D.
Copyright © 2001 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

A detailed oral history of the first decades of the AIDS epidemic, told from the vantage point of the treating physician.Meticulous interviews with 74 doctors form the core of this lengthy narrative. Beginning with the events of the late '70s and early '80s, the doctors in these pages describe the sudden advent of the mysterious disease that presented itself, in various urban centers, as an immunologic deficit coupled with rampaging, exotic infections. Many physicians' professional lives paralleled the emergence of AIDS medicine in the US: as recently minted residents when the first cases of AIDS appeared, many perceived AIDS both as a clinical opportunity (allowing them to engage in groundbreaking scientific research) and a professional coup (gaining them early entrée into the lime-lit medical demimonde of cutting-edge medicine). Startlingly candid, more than a few physicians here express their passion for cowboy medicine--as well as their pride in publishing journal articles, receiving coveted speakers' invitations, and achieving the crowns of professional stature (such as tenured professorships and government appointments, historically reserved for more senior physicians). The intellectual and emotional conflicts raised by the nearly constant stream of AIDS deaths (until the advent of antiretroviral cocktails in the last half of the 1990s) devastated and sobered a generation of physicians taught that treatment leads to cure. Technical gaffes in the storytelling (such as describing the death of an AIDS physician, yet quoting her extensively in subsequent chapters) may confuse and distract the reader, but the eloquence and candor of many of the doctors quoted outweigh a certain lack of editorial finesse.A cold and revealing history of an American archetype, sure to appeal to readers whose lives have been affected by AIDS, and it might do well as required reading in medical school. -- Copyright © 2000 Kirkus Associates, LP. All rights reserved.

Longtime collaborators Bayer (of Columbia University's School of Public Health) and Oppenheimer (of Brooklyn College) team up again to deliver a solid, largely anecdotal account of the AIDS epidemic through the eyes of the doctors who have witnessed it. Organized into a chronological narrative, this collective oral historyAbased on interviews with 75 gay and straight physiciansAsurveys the central medical and social issues of each era of the epidemic. From the early 1980s, when gay males with suppressed immune systems suddenly began dying of Pneumocystis carinii pneumonia, to the more recent years marked by treatment breakthroughs, Bayer and Oppenheimer (who together coedited Confronting Drug Policy: Illicit Drugs in a Free Society) showcase the physicians' words. Interviewees describe how frustrated they were initially at not being able to help their relatively young patients, and how anxious they were before they knew how the disease was transmitted, about their own safety and the safety of the gay community. As the book moves on to consider the years during which the epidemic widened to include drug users, some of the doctor-participants candidly admit that they did not feel the same degree of concern for that population. Interviewees then recall extraordinarily committed medical colleagues who tried to give patients emotional comfort as a palliative treatment and the networks they eventually created to support one another. Through the physician's experiences, Bayer and Oppenheimer trace the emergence of drug therapies and attendant controversies, as well as the treatment "partnerships" doctors eventually began creating with patients who demanded the newest drugs, whether or not they were legal or proven effective. Filled with stories, this account will be of interest to medical historians, physicians and AIDS activists. (July)
Copyright 2000 Reed Business Information, Inc.

This emotionally charged oral history looks at the collective memories of 75 doctors who have been active in the treatment of AIDS patients since the earliest years of the epidemic and illustrates how the disease has affected their lives and careers. Although Bayer (Blood Feuds: AIDS, Blood, and the Politics of Medical Disaster) and Oppenheimer (Confronting Drug Policy: Illicit Drugs in a Free Society) purposely sought out doctors with diverse backgrounds and beliefs, the recollections are often strikingly similar. The book begins with an in-depth description of the early years of confusion, frustration, fear, and rejection and then proceeds to a discussion of the coping strategies that the doctors developed as they constantly confronted death. The latter part of the book provides opinions on clinical drug trials and the pros and cons of current treatments. A glossary of AIDS-related medical terms and brief biographies of the physicians are included. While Abraham Verghese's My Own Country (LJ 4/1/99) and Peter Selwyn's Surviving the Fall (LJ 3/1/98) offer one doctor's perspective, this book is impressive because it ranges widely over the experiences of so many physicians. Often brutally honest and always riveting, it is highly recommended for all libraries.DTina Neville, Univ. of South Florida Lib., St. Petersburg
Copyright 2000 Reed Business Information, Inc.

Edition details

• Publisher: Oxford University Press
• Publication date: 2000
• Language: English
• ISBN 10: 0195126815
• ISBN 13: 9780195126815
• Binding: Hardcover
• Edition number: 1
• Number of pages: 320