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Harvard Medical School and Brigham and Women’s Hospital lost one of their best teachers this week.<\/p>\nHarvard Medical School and Brigham and Women’s Hospital lost one of their best teachers this week.<\/p>\n
No, it wasn’t a distinguished professor or astute clinician.<\/p>\n
It was one of my long-term patients, who had given himself selflessly to teach dozens of medical students, residents, and (especially) ID fellows over the nearly 30 years I’d known him. Let’s call him Tony. Boy, are we going to miss him.<\/p>\n
He worked in a fancy haircutting salon in Boston, where he was highly popular. We first met in the hospital room of his longtime boyfriend in the early 1990s, a grim time for HIV disease. His partner was dying of aggressive lymphoma; I was consulted on the case because of persistent fevers, but there was little we could do.<\/p>\n
When our brilliant and perceptive social worker realized that Tony — clearly a kind and friendly man — would soon be alone, she reached out to him.<\/p>\n
“How are you<\/em> doing?” she asked.<\/p>\n “Not so well,” Tony said. “My test is positive too. And I hate<\/em> my doctor.”<\/p>\n Yes, that could have been a red flag for a difficult patient. But it turns out Tony’s doctor really wasn’t a good match — he was highly judgmental about the fact that Tony had HIV. “He spends more time telling me not to spread it to others than he does trying to help me. I can’t stand the guy.”<\/p>\n So I became his doctor. Over the next few years, Tony’s CD4 cell count fell, he suffered several HIV-related complications, and required admission to the hospital a few times — but through it all he remained cheerful and unfailingly nice. When able, he continued to work full time at the salon, sometimes walking over to the Ritz-Carlton to blow dry a fancy person’s hair before an important event.<\/p>\n “It’s important to them!” he’d say, proud of being in demand. “Plus the money is great.”<\/p>\n Tony had a humble background — he was born in another country, raised in a “rat-infested” (his words) apartment by immigrant parents who didn’t speak English, and he never attended college.<\/p>\n No matter. He got along with everyone<\/em> — not just the fancy ladies (it was mostly ladies) at the Ritz, but also our aforementioned social worker, our front-desk staff, our nurses, and most notably, our ID fellows.<\/p>\n Over the next 29 years, he must have seen at least a dozen different fellows as they went through their fellowships. He treated each one of them like his primary ID\/HIV doctor, never once acting as if they (as trainees) were just “pretend doctors” waiting for the “real” doctor (me) to show up. You can’t imagine how important and empowering that attitude is for doctors in training.<\/p>\n Plus, he agreed to speak at Harvard Medical School classes several times a year, sharing his stories about what it means to live with HIV in the United States. In these sessions, he generously offered his unedited views on American medicine, never sparing certain doctors he’d met with lousy bedside manner.<\/p>\n “He treated me like I was his next down payment on his Cape house,” he said about one particularly aggressive surgeon. “Cha-ching!”<\/p>\n Nope, he wasn’t shy. But what great teachable moments for these young doctors-in-training.<\/p>\n Why do some patients embrace this role in our teaching hospitals? What is it about their personality, and makeup, that gives them the generosity of spirit to help train clinicians? And conversely, why do some people go to a teaching hospital and resent, ignore, or avoid\u00a0the students, residents, and fellows, treating them as an inconvenience? Don’t they know what the word “teaching” in “teaching hospital” means?<\/p>\n Although I don’t know the answer to these questions, I can assure you that we physicians are exceedingly grateful to the former group for their taking on this very important role — something I told Tony repeatedly over the many years I knew him.<\/p>\n One of the privileges of being an HIV specialist all this time, of course, is witnessing the transformation of this previously fatal disease into one that’s treatable. Tony faithfully took combination antiretroviral therapy as soon as it became available in 1996, and it saved him from dying of HIV. His virus has been under control since then.<\/p>\n Not dying of HIV means that regular diseases of aging start to take their toll, and these did not spare Tony, in particular because he was a lifelong smoker — severe osteoporosis, arthritis, COPD — and innumerable aches and pains plagued him. When he started to lose weight earlier this year (he was already rail thin) a workup quickly established he had pancreatic cancer. “It’s the cancer that gives cancer a bad name,” one Dana-Farber doctor memorably told me.<\/p>\n It was only a couple of months from his diagnosis to his death this past week. He was surrounded by his family, friends, and most importantly, his current partner.<\/p>\n When I mentioned just how grateful I was for all the generous teaching Tony had done over the years, his partner shared that he drank his morning coffee each day always<\/em> from the same mug.<\/p>\n “It’s a Harvard Medical School mug,” he said. “Has<\/em> to be that mug.”<\/p>\n Makes sense.<\/p>\n And not bad for a guy who never went to college.<\/p>\n","protected":false},"excerpt":{"rendered":" Harvard Medical School and Brigham and Women’s Hospital lost one of their best teachers this week. No, it wasn’t a distinguished professor or astute clinician. It was one of my long-term patients, who had given himself selflessly to teach dozens of medical students, residents, and (especially) ID fellows over the nearly 30 years I’d known […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,6,8],"tags":[],"class_list":["post-10217","post","type-post","status-publish","format-standard","hentry","category-health-care","category-medical-education","category-patient-care"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/10217","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=10217"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/10217\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=10217"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=10217"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=10217"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}