"I jes' followed the trail, pardnuh," fake-drawls Hunter Hammill, M.D., flashing the good humor that helps him connect with patients, raise their spirits and urge treatment compliance -- which he calls a desperate need among a population often low on self-esteem and short on care.
Perhaps the cards were always shuffled towards medicine, OB-GYN and Texas for young Hunter. His father was a prominent neurosurgeon; his mother raised eight children. As a small child, he wanted to be a white-hatted cowboy hero. For grammar school show-and-tell, he produced a lifelike anatomy kit of a pregnant woman. While majoring in biology at Boston College in preparation for medical school at Columbia, he studied languages, acing Spanish.
An internship rotation changed his mind about OB-GYN. It allowed him the chance to interact with patients and it offered unique challenges. Noticing the number of fevers and infections afflicting his patients, he pursued studies and research in gynecological infectious diseases in Los Angeles in the early '80s. There, he encountered the first wave of HIV.
At first, Dr. Hammill was at the sidelines of the epidemic as an OB-GYN because many thought that the disease wouldn't affect women. "Unfortunately, they were wrong," he says.
In his private practice at Associates in Infectious Diseases and Gynecology and at two outreach centers he founded in Houston for the uninsured, Dr. Hammill's caseload includes 300 HIV/AIDS patients at any one time.
He also treats about 100 pregnant women a year infected with HIV -- and with remarkable results. Adopting the philosophy, "if the mother does poorly, the baby does poorly," Dr. Hammill ignored criticism for employing AZT (Retrovir) in pregnancy, using HAART therapy and offering vaginal deliveries, developing a treatment protocol that consistently produces a mother-to-baby HIV transmission rate of less than one percent. "The best in the world," says a colleague.
That same tough-mindedness has led Dr. Hammill to endure bumping through jungles with bodyguards and run-ins with the Mexican army to bring HIV treatment to other countries. At home, he loudly calls for universal medical access for patients and decent pay for caregivers to defeat HIV. "Make it a national priority and fund it like a war, because we are still losing the battle," he growls, like the last defender of the Alamo from Jersey.
How long have you been practicing?
How has your work changed in that time?
HIV/AIDS did not exist; we had wards of patients instead of computers and no CTs or MRIs.
What's the best thing about your job?
Seeing the patient smile in the morning on rounds when they feel better.
What's the worst thing about your job?
Insurance companies and bureaucrats.
What have been your greatest successes in your work? Greatest failures?
The greatest success is every time any individual does well. The greatest failure is not communicating well to patients who give up, and also not taking enough time to write more about my work.
What is the biggest challenge you face as a clinician?
The hardest thing often is to get patients to comply. Many suffer from very low self-esteem from poverty, lack of education and the stigma of the disease. But as dysfunctional as some patients can be, the system caring for them is more dysfunctional. Just one example: In Texas, women have to get a doctor-signed certificate that states they are pregnant just to get Medicaid coverage. Without it, they could be in labor, and the clerk would still say no!
What do you think is the biggest risk factor for HIV?
The biggest risk factor for HIV is lack of self-esteem in children that leads to high-risk behavior. Yet another issue is the lack of education.
What single change would you like to see in HIV care?
I would like to see universal access for patients and appropriate reimbursement for caregivers. Make it a national priority and fund it like a war, because we are still losing the battle. It will accomplish acceptance in our society as a disease to be treated as other medical illnesses.
What education or counsel do you provide newly diagnosed patients?
I tell newly diagnosed patients that HIV is a chronic disease and not a death sentence, that life goes on, and that they still can raise their children and go to work. An eclipse does not destroy the sun.
What about patients who are about to begin treatment?
I tell them dosages, schedules, side effects and to call me with any questions. I must be accessible to work with them on compliance, and I try to do that all the time.
If you were infected with HIV today, at what T-cell count would you begin treatment?
What treatment regimen would you choose if you had to begin treatment today? Explain.
Combivir and Viracept, because I give it to my pregnant patients and they seem to do well.
What's the key to a great healthcare provider/patient relationship?
Three things: trust, availability and communication.
How do you feel about patients who take a proactive role in their own treatment?
It's encouraging because it suggests if they are involved they are more likely to stick to their treatment regimen. I have a number of patients who obviously have asked around or read up about treatments. You can tell by the questions they ask and the way they answer your questions.
Who was your all-time favorite patient and why?
An obese HIV-positive diabetic who was pregnant and kept bringing "tres leches cakes," and her smile to me when her glucose was too high.
The patient with AIDS who said to me she wanted to live long enough to have her baby. After her baby was born very premature and was in the nursery doing well, the mother asked, "Is my baby sleeping?" and then said, "It's time for me to sleep." She passed peacefully and her child is now 10 years old and free of HIV.
Going to the funeral of a pregnant teenager at 20 weeks gestation who died from PCP 9pneumocystis carinii pneumonia). It's always hard to go to the funeral of a pregnant woman. She died when her life was doubly precious. And the family thanked me for helping her live as long as she did.
What is the most important/memorable/useful thing you have learned from your patients?
To live even when things about me are depressive and chaotic.
If you weren't a clinician, what would you do?
I would paint in the morning -- Matisse-like paintings -- and cook in the evenings, near the sea. Cooking can be shared with friends, and painting is pure escape and relaxation.
Who would you like to dedicate this award to?
To my patients, and to my children, whose father was not at home enough.
Where did you grow up?
I was born in Georgia, stayed there one month, high school in New Jersey, college in Boston and med school in New York.
I was frequently kept after school by the nuns in grammar school. I liked to talk a lot and laugh a lot, so that would get me in trouble. Then there was the "visible man" episode. They're anatomy kits, clear plastic replicas of the human body so you can see the organs and so forth, and they came in different versions. Anyway, for show-and-tell in the third or fourth grade, my mom, who raised eight children, gave me one depicting a pregnant woman. The nuns sent me right home!
I ran hurdles in high school on the track team, because they didn't need a 140-pound football player. I had a renaissance education in college in the '60s at Boston College. It was a time of great upheaval, politically and socially. People were searching for meaning, and it was kind of natural to explore things outside your major. So, not only did I take my science courses, but also I studied Spanish, Italian and even Chinese. And I learned a lot about the cultures, which greatly broadened my worldview.
What did you want to be when you were a kid?
A cowboy hero like Hopalong Cassidy and then, when I realized there wasn't a lot of open range or horses in northern New Jersey, a physician.
What kind of work did your parents do?
My mother, Frances Mary, raised 8 children and graduated from college in her 60s with her youngest daughter. My father, James, was a military physician and then one of the foremost neurologists of the country. He advised me to go into a field of medicine where I could do procedures.
When did you decide on medical school? What was your major in college?
In 7th grade, and my major was in biology, linguistics and Chinese. When I started medical school, I swore I wouldn't go into ob-gyn (perhaps a reaction to the visible man incident?). Or psychiatry. Now I'm kind of doing both. OB -- especially with the HIV-affected -- is one of those fields where all the physical, emotional and societal issues, relationship issues, access to care, the whole gamut, are accentuated.
What made you decide to go into HIV care?
Doing rotations in the different disciplines as a resident, I decided I definitely wanted to see patients. And I discovered I enjoyed ob-gyn. When I was an ob-gyn resident, my patients had fevers and infections, I then did a modified infectious diseases fellowship after my ob-gyn residency, mainly with anaerobic bacteria working with Dr. Sidney Fingold, a wonderful physician at UCLA Wadsworth VA Hospital. So I was sort of cultured to go into HIV care.
Who were the most influential people in your life, professionally and personally?
My parents who checked my report card; my five sisters who worry and love me; Dr. Sidney Fingold, who took a lost gynecologist into his infectious diseases program; my children, who try to understand me; my partners, Phillip Pinell, Mauritzio Maccato and Sebastian Faro; and my patients whom I see every day.
What do you do in your spare time?
I try to pace down, rest or sleep. Sometimes I use my spare time doing my paintings or sometimes attempting to cook. I also make excellent biscotti and unscotti.
What about your family?
I have a new wife, two wonderful kids -- one in law school and one now in law practice (they chose the other side). One cockatiel, one miniature Pekinese (this came along with the new wife) and one dog from the pound in Montana.
Where do you live? What kind of community is it?
I just moved into a fixer-upper house in Texas. I'm from New Jersey, and there is no good pizza in Texas.
If you could live anyplace, where would you choose?
Hawaii, Montana, southern California.
What's the best vacation you ever had?
Who says I take vacations?
What's the biggest adventure you ever had?
When stopped by the Mexican army when visiting the Taraumaras Indians in Chihuahua, Mexico, on an HIV and sexually transmitted disease outreach mission. Or traveling with bodyguards to see the indigenous Garifunas community in Honduras who were affected by HIV/AIDS. I became aware of them because there is a significant Honduran population in Texas. The husband of one of my early Honduran patients died and I discovered that his death certificate had to read tuberculosis as cause of death, not HIV, or Honduras would not allow his body to be shipped home for burial. There's still so much stigma about HIV/AIDS.
What's currently on your bedside table for reading? What book would you say has had the most impact on you?
A great book, The Cry and the Covenant by Morton Thompson, a 1949 best-selling biography of Ignatz Semmelweis, who discovered that hand washing and antiseptic prevented most maternal deaths.
What kind of music do you like to listen to? What album do you listen to the most?
Reggae, doo-wop, Steppenwolf, Louis Prima. Listen most to Vivaldi's Four Seasons.
Anything else you would like people reading this to know about you?
I'm not grumpy on rounds! I'm very passionate in what I do. I just want everything to be right for my patients.