Edward's Lesson

HIV -- what was HIV? I had not even begun to address my own sexuality, much less given any thought to treating this disease, when I began searching for a residency program. In the late 1980s, there was limited HIV education in my medical school. The rural state of Kentucky did not have people with HIV -- or so I was told.

My residency interviews took me to the University of California in San Francisco and Bronx Lebanon Hospital in New York. At one point during each of my interview trips, I was pulled aside by a resident in training, and privately told that I would only see HIV-positive patients if I chose to attend their program. Having never been exposed to patients with HIV in medical school and having some fear about the epidemic, I purposely ranked those residency programs at the bottom of my list. Baylor College of Medicine was my first choice.

Ironically, after arriving in Houston to attend Baylor in 1989, HIV fell into my lap during my experience at Ben Taub Hospital, and while covering the practice of a mentor of mine, Dr. Susan Miller. She took me under her wing and groomed me for what has become the most important and life-changing part of my medical career, treating HIV-positive individuals.

My very first HIV-positive patient, Edward, for whose care I was solely responsible, was taking ddI powder as monotherapy in an expanded access program. Ed seemed to visit my office on a regular basis, often with no specific medical problems. He and I would just sit and talk, and I grew very fond of him. He helped me grasp the simple notion of how important it is to be present during an examination: physically, mentally, and emotionally. Upon Edward's death, his family asked me to deliver the eulogy at his funeral. This puzzled me because I was only his physician. Although I declined the family's request, Ed's funeral was the one and only funeral that I have ever attended for a person under my care. I learned a lot about my mortality from that experience, which led me to make the decision to celebrate with patients during their lifetime on earth, rather than after they are gone. Later, Edward's family told me that he had visited my office so frequently because I had been the only person in his life that would "touch" him (during an examination), and we always ended the visit with a hug. And really, all I'd done was listen to him!

Since then, I have been blessed as the HIV component of my practice has grown more than I could have ever imagined. I am thankful for referrals from physicians and patients, but I am especially humbled by referrals from my patients. I am grateful that I can participate in research, allowing me to continue learning new and better ways to treat the people who have entrusted me with their care. As the face of HIV has changed and patients have multiple treatment options available, I have been blessed with long-term patient-doctor relationships.

The blessings that I receive each and every day from my patients are what keep me showing up for work. I feel I get more from my patient's office visits than they may receive from me. I often learn from my patients, and I feel part of my job is to empower them to live their lives to the fullest. I continue to practice what I learned was so important to Edward -- end an office visit with a hug. I have also learned that sometimes all I have to do is listen -- without judging.

Ironically, I feel that I am the one who receives healing from each patient encounter and, as long as patients continue to show up, I will continue to give everything I have to give. I am the one who wins at the end of each day.

Shannon Schrader is an HIV-treating physician. He is director of The Schrader Clinic.