Always willing to go the extra step for her patients, Mary Lynn even delivers meals to critically ill, homebound patients on her way home from work. "I don't feel sorry for my patients," she says, "but I sympathize, let them know that I care, that it isn't just a job to me." Many of the patients she cares for are indigent, which only makes her work feel more rewarding. "Being poor, out of work, no medical insurance, sometimes no place to live are common in our setting", she says. "If I can ease some of their fears and barriers and have my patients trust me, that is an accomplishment I am very proud of." She's not the only one -- her patients agree wholeheartedly, and that's why she's received an HIV Leadership Award.
What is the best part about your job?
I enjoy the patients -- they've become like a family for me. I know when they are beating around the bush, so we can talk straight about their problems. Also, I feel respect from the professional community.
Can you tell us a little more about what your patients are like?
The majority of patients we see are uninsured. About 5% have Medicare or Medicaid. We have 65% to 70% black males, 30% to 35% white males and 20% to 25% females, with the majority being African American. About 75% of our males are gay or bisexual.
In the gay white population, we have a lot of methamphetamine use. This is a huge problem, because it is such an addictive drug and people can have sex for days and with anybody. For people with low self-esteem, it makes them feel like "King Kong."
Some of our addicts, those that are currently using and those in recovery, sometimes have an entitlement attitude. Sometimes that is hard to deal with, but I have to realize what their problem is and not let them manipulate me into doing what they want right that minute. I have had to learn boundaries; sometimes it's much easier to give them what they want, when they want it. In the long run, though, I am doing myself an injustice. I have really worked on this and find I feel much better when making them do it the "right way" -- it could be making an appointment or just waiting their turn.
But in general, we also have hard-working folks who are not insured and so grateful to have a place to come to, and are very appreciative of our services.
Some of our patients are fresh out of jail or prison. Some come from other states without making plans before coming here. We have to explain that all states are not uniform in their Ryan White HIV programs; some states have more money than others. I remember telling one patient that she would be better off going back to New York, because she [wanted] housing, food, furniture, transportation and medications -- all right then. This is [an example of] a time when I used my "direct approach" -- no beating around the bush.
Are the people you care for "typical" compared to the average HIV-positive person in the U.S. South? What are their most pressing concerns?
I believe the people we see in our clinic are typical of the urban HIV patients in the South. The majority are African American. We're seeing more heterosexual women and some men that are on the "down low." Most of our folks are concerned with housing issues, food and just plain survival. We spend a lot of time talking about compliance issues for HIV medications, and the importance of keeping lab and medical appointments. We always talk about safe sex and safer sexual practices. Our clinic is big on "harm reduction."
At present we are one of 15 sites in the United States that has a grant to do a "Prevention for Positives" program. All clinicians have been trained in talking about prevention and how and when to refer to the prevention specialist. (I am an old-timer at this and have somewhat of a fatalistic attitude: I'm not real sure you can change someone's behavior, unless they want to change.) Most of our patients come from the urban areas, simply because this is where we are located.
How do patients come to your clinic?
Our AIDS patients go to our Infectious Disease Clinic in downtown Atlanta where they get more extensive treatment, due to their T cells being below 200. They have more access to the county hospital. We are an early intervention clinic, and are not open after hours or on weekends or holidays.
Most of our patients are referred by word of mouth from other patients. Most of the private docs in the community are aware of our clinic. Many of the private docs I know, and they know they can call on me when their patients lose their insurance or may need temporary assistance with their medications. When someone asks me to do something, I do it immediately -- that is my nature. The HIV community knows they can count on me.
What is the biggest challenge you face as an HIV nurse?
The biggest challenge I face as an HIV nurse is the bureaucracy, because the people who make the decisions don't understand what's it's like to be in the trenches. At the present time funding is a little tight; it wasn't this bad a year and a half ago. We provide many indigent care services -- primary care, dental, pharmacy, lab work, mental health; our patients are able to come to one place for all of this. Specialty care is hard to coordinate; referring patients to the county hospital doesn't always work smoothly. I'm busier with not only the medical care, but with mental care of my patients.
There are many [other] challenges at work. I want things done right, and patience is not my strong suit! Working in a health department certainly has its moments. We have to get real creative with how things are done for our patients, since money seems to always be an issue here. One of the biggest frustrations is trying to get outside health care for our patients that do not have Medicare or Medicaid. For example: CT scans, MRIs, eye care, glasses, dentures, etc. With the way our "great" United States treats the uninsured, some people do not get the medical care they need.
How have you managed to stay energized and motivated after 12 years of providing HIV care?
My average work week is 40 hours. Having been at the health department going on 16 years, I have many sick hours and annual leave. I am never sick, thank goodness, and I try and plan my annual leave so I can be here at critical times.
I do love to travel and, usually, when I am off, it is for a week or more at a time. I was very proud of myself last week. I had had it (we are kind of in a down mode now, we have some new staff and new management,) I took two mental health days off, I had never done that before. I enjoyed the time off with my husband and grandbaby. I had an entirely different view on things when I returned.
Generally, by Thursday afternoons, my compassion level starts to fall ... and by Friday afternoon, I am ready to start the weekend. By Monday morning, I am ready to get back and start again. I tell my patients if they want me at my best, see me at the first of the week!
I feel my Christian faith has certainly helped me deal with the pain and suffering and the whole snowball effect that goes with this disease. I believe God has given me the strength to deal with this disease and the personality and stamina to deal with it as well. I am a people person anyway, a good listener and, with experience, hopefully, have helped many people. My rewards come from the thank yous I receive -- the hugs, cards and sometimes gifts. These are things I will treasure forever.
HIV has been my niche. I really love what I do and get great satisfaction from my job.
What is the biggest problem people with HIV face?
The biggest problem people with HIV face is the stigma associated with their illness. I have patients who don't want their family to know about their HIV. Depression also oftentimes presents itself along with HIV. Some patients become very low and they feel they can't get or hold on to a job or a partner. I treated a woman who went to get a job at a health insurance company; when they wanted to do an HIV test on her, she said she wasn't interested.
What do you think is the biggest risk factor for HIV?
I think the biggest risk factor for HIV is drug use and the promiscuous sex that goes along with drug use. There are innocent people who become infected by a partner who went out of their marriage or relationship to have sex with a stranger.
How do you feel about proactive patients?
I am very big on harm reduction. If a patient drinks 24 beers a day, and then changes behavior to only drink 12 a day, he will be better off. I don't think you can change the way people think. They have to desire to change. You can only suggest.
Does your method of promoting harm reduction work well?
We have had some success. For instance, there was a man who came in yesterday, and he has been off methamphetamine for a year. He's doing really well now; he has safe sex with his partner. Some people relapse -- and this particular patient is definitely having a hard time, but he's making an effort for his own good. He understands that it is something he has to do every day.
If you were infected with HIV, when would you start treatment?
When my T cells reached 350 and my viral load was 50,000. My clinic is on state guidelines, so we don't start any of our patients before then. They don't all want to start medications based on the state guidelines; some people want to do it with herbs or wait a while.
What do you think makes a great healthcare provider/patient relationship?
I think the key to a good provider/patient relationship is compassion and truthfulness. I listen to them and try to be helpful. I don't feel sorry for my patients, but I sympathize. I let them know that I care, that it isn't just a job to me. I call them by name and remember something about them for their next visit.
Does your straight-from-the-hip style ever rub your patients the wrong way?
Most of my patients have known me for a long time and appreciate my straightforwardness. I guess if they do not care for my "style" they stay away from me and see someone else. I do truly hope I have not hurt anyone's feelings -- usually after one gets to know me, they know I mean no harm, I am genuinely interested in them and their well being.
Is there anyone you would like to dedicate this award to?
I would like to dedicate it to my grandson, Jack Gannon.
Where do you live?
I live in Stone Mountain, I can see the mountain from my front yard.
Is there somewhere you would rather live?
I fantasize about moving somewhere exotic like Alaska or Wyoming. I'll probably go back to Commerce, Georgia, when I retire, back to my roots. I will want to get out of the city. The traffic is horrible and there isn't a public transportation system to speak of. It does have a good arts and entertainment section.
Can you tell me a little about your family?
My daughters are very close to me. My oldest daughter is a nurse who has a son named Jack. I have pictures on my desk. That's always a way to get on my good side -- talk about my grandson. My other daughter is a massage therapist. I got married for the second time, I found my husband on classmates.com. I hadn't seen him for 35 years, and now we've been married for three years. We didn't really date back in high school, because there was a bit of an age difference at that time. I tell him when I'm not at home he can be the boss.
What do you do in your spare time?
I am an active member of the First United Methodist Church in Atlanta and serve as the secretary of the Board Of Trustees. Plus I really value spending time with my family.
What kind of books do you like to read?
I like non-fiction, all kind of history books. I'm waiting for them to write a biography on the new serial killer BTK from Kansas. I like how a biography gets into people's minds. I like to know what they're thinking, to see what made them act crazy.
Where do you like to go on vacation?
I love to travel! I have been to Europe, the Middle East and all around the United States. My favorite place was Italy. I loved Pompeii, Florence, the statue of David and the Leaning Tower of Pisa. I go to Vegas, but I'm not really a gambler. I just like it because it's gaudy and glittery. Las Vegas is different, there isn't anything like it anywhere else. I have also been to Jordan, because my friend's brother was getting married. It was an amazing experience, I was the first foreigner to stay at her family's home, and we also were able to visit Jerusalem.
What kind of music do you listen to?
I love Elvis -- I like his songs and he's handsome. In 1973, my mother and I saw Elvis live at the Hilton in Vegas, and it was a highlight of my life. I've liked him since I was a little girl. My patients bring me Elvis stuff that I put up on the wall in my office. I think I've got too much stuff.
Do you have a favorite patient?
I have many patients who are special. There is an Ethiopian man I treat who calls me Mom. When he first came in, his platelet count was five. I immediately sent him to the hospital. I stay on him about taking his medicines. I go the extra step to care for him -- when he was injured at work and needed worker's comp, I called for him.