But when it comes to HIV, Dr. Russell often sings the blues -- when he has the time. As medical director for Coastal Family Health Service in Biloxi, Mississippi, Dr. Russell oversees the treatment of 1,000 patients at 17 clinics for people who are largely uninsured and poor. He also operates two clinics dedicated to the treatment of 350 HIV patients spread across the Mississippi gulf coast.
"The scary part is that 1,000 more have tested positive for HIV but aren't seeking treatment," says Dr. Russell. Many, he explains, are afraid to come forward because the region is "notoriously brutal to anyone different."
Gays are ostracized, abused and called "Evil Ones." People with HIV are often similarly treated because the disease is commonly viewed as gay related. Even non-gay people with HIV, though called "Innocents," are stigmatized and looked at with suspicion. Those factors along with a growing cultural phenomenon called the "down low" have combined to ignite a veritable explosion of HIV across the South. The "down low" refers to heterosexual men who engage in sex with other men, but don't identify themselves as gay or bisexual.
And people with HIV are "getting younger and younger," into their early teens, which really shakes Dr. Russell, who defies the conventions of his community. He not only lives with his partner, a retired coal miner, he's adopted two sons and he treats the very people others scorn -- with an open heart and open ears.
"The art of medicine comes in when you are actually able to listen to what the patient wants to tell you but isn't saying; that is when you get to what is truly troubling the patient and treat the patient as the whole patient," says Dr. Russell. "Nowhere in your approach should the route of infection or the lifestyle of the person be an issue. It is a virus and it doesn't care who it infects."
When he was growing up in Mississippi, Dr. Russell told his father that if he had to work anyway, then he wanted "a job that really made a difference." And today, he has that opportunity in his home state. "While I can't fix everything, I can actually make a difference in a person's life," he says. That's a tune anyone can dance to.
How long have you been practicing?
Nine years in September.
Can you describe how your work has changed since you first started?
Lots more choices in HIV treatment, but same old problems of adherence.
What's the best thing about your job?
Besides the free hospital food? When I was very young, I told my dad that if I had to work anyway, then I wanted a job that really made a difference. While I can't fix everything, I can actually make a difference in a person's life.
What's the worst thing about your job?
Besides the free hospital food? I have small children, so the hours bother me. However, the true worst thing would be a toss up between two situations:
What have been your greatest successes in your work? Greatest failures?
Greatest success: Snatching a person back from impending doom. I live and work in a region of the country that is notoriously brutal to anyone different. If you are gay, the local community attempts (and often succeeds) in shaming you into low self-esteem. The same attitude is true for those suffering HIV/AIDS regardless of how transmission occurred. In our area, people with HIV are divided into the "evil ones" and "the innocents." (Though minimal tolerance is available for "the innocents" who are infected, they are stigmatized because they have disease). Although to answer the question, I very often have people come in recently diagnosed because of PCP [pneumocystis carinii pneumonia] and these people are very near death with an attitude of blaming themselves for their current situation. I'm often able to turn it around to show them that not only are they fixable, but they deserve to be fixable as well.
Greatest failures: When either patients don't take the medicine correctly or they continue to do the self-destructive behaviors associated with low self-esteem (drug use, risky sexual behavior) and I can't save them. I feel like the community of condemnation won.
What is the biggest challenge you face as a clinician? Would other clinicians give a similar answer?
The biggest challenge I face comes from the environment where I work. Since finishing residency, I have been working in a community health center which is designed to treat people with no insurance. My daily struggle is trying to get a person a needed test, medicine or referral when they have no funds and no insurance. So, I doubt that physicians in private practice would have the same complaint.
What do you think is the biggest problem people with HIV face today?
Remembering that they are sick. When they forget that because they are suddenly looking and feeling better, they are at greater risk of missing doses and screwing up the very thing that made them well. They are also at greater risk of having unprotected sex and sharing the problem.
For the most part, what do you think is the biggest risk factor for HIV?
The general perception that the very effective medicines are a cure instead of a treatment. The irony is that the virus was first prevalent in the gay community, which was perhaps the reason it got so much attention. When you attack a group of highly intelligent, very organized people with nothing to lose, they are going to make a lot of noise and that is exactly what called attention and funding (and eventually treatment) to the crisis.
Now in that same group there is an attitude that risky behavior is okay because there is a cure. Add to this the emergence of highly aggressive, highly medicine-resistant strains of HIV and we are in the position of repeating the devastation of the 1980s and early 1990s.
Do you think that the prevention efforts are sufficient?
NO! Prevention based on abstinence is flawed because we've already seen that even if sex is not talked about, it is going to occur. Prevention should focus more on how to protect yourself. In this area, you can only talk about abstinence, and we know that doesn't work. It's taboo to talk about safe sex. And when people do get infected, there's a lot of denial.
What do you provide in terms of education or counsel for a patient who is just diagnosed?
I spend a lot of time counseling newly diagnosed patients for two reasons:
But, besides meeting with me, those patients are perhaps better served by the other counselors we have them see. They go further in-depth into the areas of mental health, social services available and substance abuse (a big problem that can interfere with compliance).
What do you provide in terms of education or counsel for a patient who is about to begin treatment?
Besides what is mentioned above (all very important components in compliance), I also let them know the consequences of poor adherence, that these wonderful new meds can't save you if you get resistant.
If you were infected with HIV today, at what T-cell count would you begin treatment?
Depends on viral load. Certainly at 350, but I would need to see how aggressive the virus is going to be.
What treatment regimen would you choose if you had to begin treatment today?
Given that I completely screw up my once-daily blood pressure medicine, let's hope I never contract HIV. But, should that occur in the future, I'd certainly mess up anything that wasn't once daily ... and I wouldn't hold out much hope on that even. Please don't tell my patients I said that.
What's the key to a great healthcare provider/patient relationship?
Take the time to talk to them. If you don't have a sense of who they are and what their motivators are, you can never adequately treat them. And, if you don't take the time to answer their questions, they don't know why you want them to do certain things.
How do you feel about patients who take a proactive role in their own treatment? Do you have many patients who are proactive?
Again, dealing with very intelligent, highly motivated young people. They are constantly on the Internet and talking to each other. Then they come in and ask extremely pointed, well-informed questions. I think it is great. They are taking an interest in their treatment and keeping me on my toes. They're not the group to deal with if you haven't done your homework.
Who was your all-time favorite patient and why?
I can't pick just one. I have had many great patients. One of my favorites came to me with a viral load in the 400,000 to 500,000 range, CD4 cells in the 30s and declining health over the prior few months. I kept assuring him that he was fixable ... he kept taking medicines. He did well, as we got his viral load suppressed and his CD4 count went to 300s.
I didn't realize how sick he really was until about four months after treatment he came in and said. "I hope I have been appropriate at my visits." I asked why and he said that over the past few weeks, he felt like he had been coming out of a fog. He later said, "I don't really remember anything before last Wednesday." He is now doing very well, working full time and he is a member of our board of directors.
What is the most important or memorable thing you have learned from your patients?
The most important thing I have learned from my patients is to treat people like people regardless of income level or education. The smartest people I have ever met have been uneducated. The most giving people I have ever met have been really poor.
How do you maintain a positive outlook and avoid burning out?
I have two great kids. Ian, now eight, I adopted when he was six days old and Grant, now four "almost five", who I got when he was 20 days.
I do medicine to support my music habit. I have the most advanced recording studio between New Orleans and Pensacola. I use music writing and recording of music to get rid of lots of stress.
If you weren't a clinician, what would you be? Why?
Musician or researcher (I really love science) or a computer geek. I have the most complete recording studio from Pascagoula to New Orleans. I write and record, mostly techno music.
Who would you dedicate this award to if you could?
My parents. I had a great childhood and only benefited from that. My dad died this past November and it has been really difficult. I know that I am who I am because of the two of them.
Where did you grow up?
What did you want to be when you were a kid?
Still haven't really figured that out.
What kind of work did your parents do?
My dad was a ship designer and my mom worked as a secretary at an elementary school while we were in school. She would only work when she didn't have a child at home. I have two older brothers and a sister born when I was 18.
When did you decide on medical school? What was your major in college?
I was on the decade plan for my first degree. I majored in everything from piano to horse production (breeding) to chemistry. Then I got into computers. A teacher taught me how to take any problem apart and figure it out. Suddenly everything clicked. It suddenly occurred to me to go to medical school one day and I focused on a biology degree, did well and went to medical school.
What made you decide to go into HIV care?
It was more or less through default. When I moved back to this area after medical school, the only doctors in the area who were treating HIV were the oncologists. The community health center where I work was awarded a Ryan White Title 3 grant and as medical director (and also because I wanted to), part of my schedule was set aside specifically for HIV. Now almost all of the area physicians refer to me.
Who were the most influential people in your life, both professionally and personally? Why?
My parents and Dr. Blais, my residency director. He was tough, smart, held us to very high standards and while he was the first to brutally attack when we didn't do something right, he was also the loudest and strongest support when we residents were unfairly blamed. He also truly believed in me.
What do you do in your spare time?
Besides taking the kids to dance or gymnastics or birthday parties or the studio, I try to travel with the kids as much as possible. I want them to see as much of the world as they can. This year we are taking a cruise to Mexico, a trip to New York City to see The Lion King and Disney for a few days.
Do you have a partner? (What is your partner's job?) Kids? Pets?
Partner: Scott Hartzel, retired coal mine worker ... Is that cool or what?
Son: Ian Blake Russell
Son: Grant Alan Russell
Horses: Jazzy and Blackie
Where do you live? What kind of community is it?
We live in what used to be a small area on the Mississippi Gulf Coast, but in the last 15 years it has grown into a fairly active casino resort area.
If you had anyplace to live besides where you live now, where would it be?
My dream life would be a series of places to live. I would spend a couple of months in New York City, then tropical coast, then a mountainous area and hopefully one of those places would be very secluded.
What's the best vacation you ever had?
A trip to Disney with Scott and the kids. Just to watch their eyes light up when they see Mickey is worth everything
What's the biggest adventure you ever had?
Being on tour with a drum and bugle corps for a couple of summers. Practice all day, buses and gym floors all night and competitions a few times a week. Had a great group of friends and couldn't have had a better time. Good thing it happened when I was younger, I could never sleep on a gym floor now.
Currently, the great adventure I have is playing with the Mississippi Gulf Coast Symphony Orchestra. I'm a percussionist and lovin' it. Also, I play the xylophone, piano and keyboard.
What's currently on your bedside table for reading?
Currently, I'm reading The New England Journal of Medicine and another Dan Brown book.
What kind of music do you like to listen to? What album do you listen to the most?
I like dance -- techno music, but also love classical music. The most influential album is Upstairs at Eric's by Yaz. Though Billboard compared my first album to Joy Division ... I like them as well. This is really showing my age.