The AIDS epidemic and its depiction through Medical Literature

The AIDS epidemic crossed the physical borders of the United States of America in 1969.  This entrance into American society affected not only the health of the citizens, but, its presence led to social, cultural, and political movements that have been analyzed and criticized to this day.  Because of the varying ways in which the disease was perceived, received, and resolved, a mixture of medical literature has been produced.  Each selection of this literature may addresses a different underlying topic listed above, but almost all of them describe the horrid results of this infectious and deadly virus.  Most of this literature was written during beginning years of the outbreak of AIDS, but what one must realize is that it is still thriving and killing within the world’s community today.

Throughout my life, AIDS has been an established disease and aspect of civilization and society.  During late Elementary and Middle School years, the science behind the AIDS virus is explained and described so that we as students can understand what it is and how its transmission can be prevented.  Throughout high school and college, I learned of initiatives and organizations that are working diligently on preventing the spread of this disease within the United States and throughout the world.  During my freshman year of college, I took a class entitled On the Verge of Infectious Disease, with Professor Dr. Jeff Mayne.  This class addressed issues such as the spread of infectious diseases and the biology behind some of the world’s greatest, and most terrible epidemics.  It was in this class that I learned of the origination of HIV and AIDS.  So when I read this literature of the disease after knowing the biological and historical roots, it is interesting to compare all of these perspectives to which I have been exposed, especially the diseases influence and effect on American society.

When the Auto Immune Deficiency Syndrome, AIDS, was recognized in the United States, it was had not titled or referred to as AIDS.  Rather it was a “gay cancer” because the disease was mainly present within the gay community.  Because of its association with the gay community, it later became know as a “Gay Related Immune Deficiency.”  The emergence of the AIDS epidemic within the gay community led to a change in the way the gay community was perceived and received within society.  During this time, there was already a stigma and a negative associated with the gay community, especially within particular areas of the United States.  The presence of this highly transferrable and public disease within the community probably only hindered the perception of the gay community among others who were opposed to this lifestyle, even within the medical field. 

Abraham Verghese writes in his work “From My Own Country” about the first case of AIDS reached Johnson City, Tennessee.  In this story, the patient, a gay man originally from Johnson City and who had gone to New York to live, was coming back to Tennessee to visit his family.  During his trip home, the physical symptoms of the AIDS virus begin to present themselves, and by the time he got back home, he was admitted straight into the emergency room.  During his time in the hospital, he was treated as an average patient, even though his symptoms were quite severe and he required special attention, until it was determined that he had AIDS.  After this discovery that he was a gay man from New York and Johnson City’s first AIDS patient, everything changed.  A nurse in the work told the narrator of the story, Ray the doctor, that “the young man’s room took on a special aura.”  What is more, there was a intense prejudice toward the patient.  “Some of the veteran ICU nurses, perhaps because this case broke through their I’ve seen-it-all-and-more-honey attitudes, astonished me with their indignation.  In their opinion, this homo-sex-shual” with AIDS clearly had not right to expect to be taken care of in our state-of-the-art, computerized ICU.”  This quote represents the ethical dilemma that took place in Johnson City, Tennessee.  The quality of the treatment of a patient was lessened because of the lifestyle that he led and because he had an incurable disease that was viewed with an abhorred stigma and disregard.

Abraham Verghese wrote about the personal and ethical issues that arose simultaneously with the spread of this disease.  Another author, Randy Shilts, wrote “And the Band Plays On” where he blames the Reagan Administration for not supporting research that would aid in finding a treatment or cure for AIDS.  He writes, “People died while the Reagan administration officials ignored pleas from government scientists and did not allocate adequate funding for AIDS research until the epidemic had already spread throughout the country.” He also criticizes the gay community leaders because they, “played politics with the disease, putting political dogma ahead of the preservation of human life.”  Shilts addressed many frustrations that arose during the initial years of the epidemic and he concludes that these major forces were indifferent to the situation and did very little for its resolve. 

The AIDS epidemic led to the creation of a wide assortment of medical literature from varying perspectives.  The literature that has already been referenced deals with more of the effects of the disease within a hospital and the reaction of a medical staff, in Verghese’s work, and Shilt’s describes how the invasion of the epidemic was, or was not, handled by the American Society.  Still, other work such as Elispeth Ritchie’s “On the Ward” provides the reader with an image of the blunt reality of life as a doctor who is working with patients with HIV and AIDS.  She writes about three patients with AIDS that she cares for.  One man was a gay man.  Another patient, a black man had received AIDS from a bad blood transfusion. Her third patient is a woman.  She writes about each patient and expresses her interpretations of their situations through her writing.  She writes of the black man.  “He is still attractive and personable, if thin.  This morning he told me how nice I looked.  I replaced his feeding tube; his throat hurts too much to swallow.  We are doctor and patient.  Two years ago I would have hoped that he would ask me out.  I tell myself severely that it is no good crying for him.  He has five sisters who will weep.  I have other patients to care for.” 

She also writes of her concern for her own personal health. “I am glad that I am married and tested negative twice.  If I were single, would I insist on a blood test before sleeping with a man? I hate to sound so pessimistic when friends grill me at a cocktail party—but I don’t want my friends to die that kind of death.”  This work by Ritchie is unlike some of the other works that have been mentioned.  The purposes of Stilt’s and Verghese’s works are to inform and persuade the reader to see the flaws in society whether those societies be the American society or the society within a hospital as in Verghese’s work.  Conversely, the purpose of Ritchie’s work is simply to provide a perspective and share thoughts and the reality of the situation. 

Because of the nature of the AIDS disease and its prevalence, even today, throughout the world, medical literature regarding this issue is widely produced and read.  By reading the literature previously described, and other literature pertaining AIDS, I feel that I better understand some of the societal concerns and happenings that weren’t necessarily addressed in my freshmen seminar class that was biologically based.  This literature personalizes and humanizes the disease.  Reading about a doctor’s interpretations of the disease through her patients, from seeing how a conservative, southern culture affects the treatment of a patient wtih the disease, to identifying some of the large-scale, governmental and societal issues that affected the progress in treatment and prevention of the spread of the disease provide me with a much more in-depth and well rounded perspective of the disease. While this literature addresses issues, concerns, and presents a variety of perspectives about this controversial and highly volatile disease, its existence is important to remind people that this disease has not been conquered and the lives of people are threatened daily.

Lee Goatley

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A Doctor’s Life

Can you imagine what it would be like to wake up every morning understanding that the health and welfare of people is a tangible reality instead of a foreign concept?  After years of hard work, dedication to the medical field, and learning everything from the anatomy of the human body to the microorganisms that cause so much infection and disease, a select few earn the title of medical doctor.  The attainment of this title comes with the privilege of applying knowledge and expertise to abide by the guidelines of the Hippocratic Oath and “experience the joy of healing those who may seek my help” (Lasagna 1964).  

For those of us who do not have a medical doctorate, it is difficult to grasp the idea of having the power to heal, or the ability to interpret the symptoms a patient is communicating and reading lab reports to conclude what ailment may be intruding upon a patient’s health.  Still, even though those of us without this degree do not have this same understanding, is that liberating in and of itself?  Is it burdening to always have the health of other people upon your conscience? William Carlos Williams writes in “The Practice” that “It’s the humdrum, day-in, day-put, everyday work that is the real satisfaction of the practice of medicine; the million and a half patients a man has seen on his daily visits over a forty-year period of weekdays and Sundays that make up his life.” 

As a reader of this prose, I infer that Williams is explaining that his work is a satisfying burden(my italics)because his work has “always absorbed him.” The monotony of each day which entails doing the same things makes the physician seem like he is a prisoner to his work.

If you think about the day in the life of a general practice physician, it may go something like this:

1. Wake-up in the morning to a pager/cell phone ringing with information about one patient or the other.

2. Go into the office to see/treat 40 patients with hundreds of different symptoms and ailments.

3. Go to the hospital/nursing home to do rounds  

4. Consult with other doctors about patients that were seen that day

5. Go home and think about the cases/patients that were seen today

This lifestyle definitely is not ordinary.  Williams writes, “Time after time I have gone into my office in the evening feeling as if I couldn’t keep my eyes open a moment longer.  I would start out on my morning calls after only a few hours of sleep, sit in front of some house waiting to get the courage to climb the steps and push the front-door bell. But once I saw the patient all that would disappear.”  

I ponder the thought, if the lifestyle of a physician is imprisoning, what redeems this vocation as one that some of the world’s brightest and most caring people choose to do? I feel that the act and art of healing other humans legitimizes the medical field and to be an active participant in the healing process.  The smallest improvements of a patient can stimulate great joy and the feeling of achievement and good.  Before taking this Medical Literature class I had never really comprehended the reality of experiencing words.  This is probably because we do not generally think of experiencing words, rather we experience life and put it into words.  In Williams, The Practice, he writes,

“The physician enjoys a wonderful opportunity actually to witness the words being born. Their actual colors and shapes are laid before him carrying their tiny burdens which he is privileged to take into his care with unspoiled newness. He may see the difficulty with which they have been born and what they are destined to do.  No one else is present but the speaker and ourselves, we have been the words’ very parents.  Nothing is more moving.” 

Willams says that nothing is more moving than to experience words such as being born.  Other words that are experience by doctors are being healed, recovering, receiving help.  Are these the experiences that outweigh the “vocational imprisonment” of being a doctor? Probably so.  I cannot say that I have personally experience the words “being born” as a doctor has, but it is an intriguing thought that if I choose to follow a path in the medical field could one day, the thought may one day materialize into that experience.  Personally, the potential for that experience is exciting and thought-provoking.  I want to experience words.  

Simultaneously, I think literally of the William’s written words.  This beautiful explanation of how physicians can experience words really inspired me to evaluate the ability for language and words to be so perfectly formulated and placed together to convey an idea as simple, yet as complex as the one above.  This is what doctors do.  They formulate appropriate ways to address, console, and inform patients.  That is the art of words.  That is literature.  Doctors are both Sherlock Holmes and Sir Arthur Conan Doyle.  

At the end of the day as doctors reflect upon the lives, they have played multiple roles in their vocations.  They have empathized with patients in every shape, form, and condition.  They have established relationships with their patients whether the care that was given to the patient is reciprocated from the patient back to the physician.  All the while they fought to remember the essence of who they are because so much of their time was focused on everyone but themselves. 

-Lee Goatley

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Medical Literature: Does it have a purpose?

What is the purpose of medical literature? Is its purpose the same as the vocations of the authors who write these compositions, to provide medical guidance and direction? Is it to inform? Or is its purpose merely to provide an outlet for the people who function as the healers, curers, nurturers of our world to allow their thoughts, reflections, anxieties, experiences, and emotions to become ever-so-slightly tangible. 

If Hippocrates were to answer these posed questions, he would resolutely declare that the purpose of medical literature is to educate and inform.  Hippocrates, known as the father of Western medicine, essentially began what we call modern medicine.  In the 4th and 5th century B.C. when he lived, the process of healing was an art, not a science.  He laid the foundation for the progression of science into the future.  Hippocrates founded the Hippocratic School of Medicine in Greece which facilitated the study of science rather than of art.  During this era, the documentation of medical findings was imperative in order to inform others who were beginning to understand the value of science and medicine.  The literature was used to provide references and compile breakthrough information so that it could be developed to heal on a scientific level.  The philosophical perspectives and abstract methods in which the healing process had been enveloped could be overturned.  In the Tradition in Medicine segment of the Hippocratic writings, the necessities for medicine to become a science are explained.  One explanation is the following, “…the rest of science will be discovered if anyone who is clever enough is versed in the observations of the past and makes these the starting point of his researches.”   This excerpt describes the importance of using references and previous research to understand the past findings of the medical sciences, while emphasizing the ignorance of someone of refuses to utlize those resources for future research because without a scientific knowledge based on the past, the future experimentation and learning is devoid of meaning, merely a deception.

While Hippocrates may utilize the medium of writing as a way to educate others, Defoe, writer of The Journal of the Plague, creates medical literature as a method to inform others of the reality of a situation that most are not able to relate.  In Defoe’s novel, instead of simply writing a factorial composition describing life during the time of the Bubonic Plague, he chooses to insert a dimension of fiction by creating a narrator who guides the reader through his experience during the Plague.  By incorporation this aspect of fiction, the reader is able to understand the thoughts, understandings, and emotions of the narrator.  The narrator, in a way, is a liaison between the audience and every person affected by the Plague because we are able to understand the rational used in order to survive.  The narrator had to decide whether to leave his parish to go to an area which was not affected by the Plague and give up his business, which was all he had and a testament to all of his hard work, or to stay and risk his life to die.   There was also his constant thinking of religion, God, and God’s will.  When the narrator’s one opportunity for him to leave fell through, he understood that as God’s will that he was to remain in the area and not leave.  Ultimately, The Journal of the Plague, is an informational work of fiction which allows the audience to become more knowledgeable about the dire reality of the Bubonic Plague and how life was during that time.  

Still, are there more purposes for medical literature? William Carlos Williams essay, The Practice, demonstrates that writing is just an aspect of his vocation that is just as important as the physical practicing of medicine.  He writes, “…they are two parts of a whole, that it is not two jobs at all, that one rests the man when the other fatigues him.”  While the practice of medicine is physically fatiguing to Williams, the art of writing is rejuvenating.  When he writes, there is no other purpose for him but to write, to attempt to put into words what he experiences in his day-to-day life as a physician.  Williams also writes that the craft of writing is premium only during a few rare moments in life every couple hundred of years when these words can be formulated into a “few gifted sentences,” to form a poem.

In conclusion, does Medical Literature have one distinct purpose? The answer, no, but in general, medical literature the creation of a tangible work that regardless of specific purposes can reach future generations to give insight and exist for someone who may want to read medical literature for any of its purposes described above or for the many other purposes in which medical literature is written.

Lee Goatley

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