My 20 Years on the Front Lines

In my farewell as a regular columnist for HIV Plus, I'd like to share some insights and experiences of my two decades of growing up as a doctor and as a man on the front lines of the AIDS epidemic. I was 23 when I met my first person dying of AIDS complications. It was 1983, and I was a newly minted medical student at the University of Pennsylvania School of Medicine. My first clinical assignment was simple and straightforward'my classmates and I were sent out to the hospital wards in our short white coats with stethoscopes (which we had no idea how to use yet) draped carefully around our necks to interview hospitalized patients about their medical histories. I found myself standing outside an isolation room that housed one of Philadelphia's earliest AIDS patients. His skin was covered with purple-red Kaposi's sarcoma lesions, and he was very pale. I gently knocked on his door. Puzzled by my unfamiliar young face, he motioned me inside. The room smelled of disinfectant solution that couldn't quite mask the faint odor of diarrhea. I introduced myself to him as a medical student and told him I was learning how to take a medical history and asked for his permission to sit and chat for a while. His face brightened. 'You're the first person brave enough to do that today,' he said. I asked him why, since it was well after 2 p.m. 'Nobody except my doctor dares to come in,' he replied. In my own naively direct way, I asked him how he became infected with HIV. Surprisingly, he smiled as he told me of his 1970s glory days dancing and sexing the night away at places in New York City I'd never heard of. He concluded that, since AIDS was assumed in 1983 to be a gay sexually transmitted disease, he'd gotten it from one of his many hundreds of sex partners. There was no anger or bitterness in his voice as he acknowledged that he was dying. When I asked about friends and family to support him, he said he had no one but his cats at home. He saw that I was visibly upset by this. 'I've had a fabulous life, really,' he implored. I was touched by his courage, grace, dignity, and humor while facing certain death all alone. I was also taken aback that the world was treating him like a leper. Meals were slipped under his door instead of being delivered to his bedside. Even his doctors (my superiors) admitted to me that they believed 'these gay guys brought this on themselves''the old 'divine retribution for sinners' argument. I was appalled and offended. How could educated physicians that I was supposed to look up to and learn the art and science of medicine from be so ignorant? It was one of those epiphany moments when you figure out what you are supposed to do here on earth. I reasoned that since the medical establishment seemed to fear the disease and the patients, then somebody who really cared should step up to the plate. I had yet to make my specialty choice as a doctor, but this sweet, funny, discarded man cemented my decision. I have never regretted it. I've witnessed unfathomable suffering and incalculable grief as well as astonishing compassion and unexpected bravery. AIDS radically reordered my youthful priorities. It catalyzed my maturation process and helped to turn me into a decent, sensitive, and loving man far earlier than my personal developmental process would have suggested. For that I am eternally grateful. As for the future, I remain more optimistic than most. Even though new HIV infections are rising domestically and are exploding in the third world, I still have hope. On the horizon I see better, less toxic drugs and novel immune-boosting therapies. I am confident that we will eventually develop an effective preventive vaccine that will one day stem the tide of the AIDS pandemic in the developing world. And believe it or not, I still have faith in a cure. If the past two decades are any indicator, then miracles like a cure can't be impossible. I've learned that nothing really is. Cohan is an attending physician and the managing director of Pacific Oaks Medical Group , one of the nation's largest practices devoted to HIV care, located in Beverly Hills, Calif.