I feel sorry for the aspiring young doctors who are assigned to me as residents and house staff; they have to put up with my nonsense and pretend to enjoy it. At the outset of our time together, I always say to them with mock gravity, “I will give you my three rules for survival as a physician, and a fourth rule for when you’re on service with me.
“Rule One: Treat every patient as if every one were a family member. Every one of them deserves the best you have to give.
“Rule Two: Be honest, especially with yourself. Don’t bullshit yourself or pretend you know something you don’t, because that’s when you’ll make a mistake and people will get hurt.
“Rule Three: Have fun. The practice of medicine should be a joy, and if you aren’t having fun, you’ve either picked the wrong specialty or you’re morbidly depressed.
“And the fourth rule, specifically for when you’re working on my service: No matter what, it’s all about me.”
After listening with extreme earnestness to my first three rules, the newbies hear Rule Four and crack up. They exhale and relax—and, sometimes, they get my point: that this life is never all about any one of us. It’s about teamwork toward a common goal.
It’s also true of this book.
After years of threatening to write a book, I never would have gotten off the dime to do it without the support of two people: my cousin and inspiration Mary Fisher, and my longtime adviser and friend, A. James Heynen.
Mary has shown me, through her example, that living courageously and with purpose, we can all make a difference and that everything is possible—including writing a book. Mary has been with me through the past twenty years of my professional journey, as a patient. She’s heard me marvel at the advances we have made on the science front; she’s listened when I despaired at barriers interfering with making the science come to life in practice.
Jim Heynen is my guardian angel. His “day job” is as an organizational consultant, but for me, he is my lead sounding board and “life coach.” I am very grateful to both of them for helping to convince me that a book in this area was needed, and for encouraging me to keep pushing until it was done.
Patty Edmonds has served as my lead editor for this project. While I have written many grants and manuscripts for publication in the scientific literature, I have never attempted the type of writing required for telling a story in a book. Patty led me gently into this new world and helped me find my voice. I am forever grateful to her for her patience, honesty, impeccable journalism, professionalism, and soul!
A huge shout-out goes collectively to my colleagues, my fellow providers and fellow investigators, locally, nationally, and around the world. As I have said to most of them while I was writing this book, “Any one of you could have written your story and it would be just as compelling.” Each one of us took care of too many patients to count who touched our lives, moved us to tears, and inspired us to do our best to bring HIV/AIDS under control. The work we did at the University of Alabama at Birmingham (UAB) was directly connected to clinics and labs around the world, each of us doing our part to contribute to solving the mystery of this horrific disease that rudely roared into our consciousness in the early 1980s. This is especially true regarding my colleagues at the 1917 Clinic, several of whom are profiled in this book. Jim Raper is a consummate leader who puts his soul into his work, as well as his heart. Malcolm Marler brought GRACE to the clinic, both literally and figuratively. And the many, many coworkers, physicians, nurse practitioners, nurses, social workers, pharmacists, receptionists, lab technicians, psychologists, counselors, clergy, and medical records and administrative staff, all of whose collective intellect, insights, wisdom, generosity, honesty, tireless effort, and heart—always heart—are constant inspirations. Especially while writing about these folks, I’ve seen again how their heart has eased the pain of the collective losses we all experienced over the years. Thank you.
At the risk of leaving out some key colleagues and collaborators, I am compelled to mention several collaborators and friends who enabled me to have success both as an investigator and as a provider. Paul Volberding and his San Francisco colleagues’ vision for a comprehensive HIV outpatient clinic that merged the best in science, clinical medicine, and heart into a single center set the stage for our clinic, and many, many others, to become complete medical “homes” for patients with HIV and their families. Paul’s vision has served me well over my entire career, and he has been a “consultant” to me on many topic areas, ranging from which professional opportunities to engage in to which shoes to buy while in Italy!
Paul could not have set up Ward 86 as completely as he did without the support of Merle Sande. I met Merle through Paul, and Merle took me on as one of his own. Even though I never worked at San Francisco General Hospital or UCSF, Merle always treated me as if I was one of his faculty members, creating many opportunities for me over the years. I am grateful to him.
Although similar in age to me, George Shaw and Beatrice Hahn are my primary mentors in all things related to basic science. My formative years in their lab had everything to do with my decision to become involved in AIDS medicine. They made it fun, exciting, and productive. Their collective intellect and intuition is as strong as any I’ve ever encountered in science, but their generosity is really what sets them apart. I cannot imagine more generous mentors, and I have tried to emulate them in my relationships with the investigators and house staff I mentor.
Donna Jacobsen and my fellow board members of the International Antiviral Society-USA have provided remarkable insight into the ways of the world, especially related to what true continuing medical education is and what it takes to do it right. I am grateful for their guidance as I navigated the turbulent waters generated at the interface of education and indoctrination. Thanks to them for the way forward.
The University of Alabama at Birmingham has been a magical place to work. There is a can-do, entrepreneurial spirit there that I have not seen at any other academic institution. As is evident throughout this book, I was afforded opportunities very early in my career that would not have happened elsewhere solely because UAB and its leaders focus on ideas, not on the age of the person who brings the idea forward. In particular, my distinguished mentors, Drs. Claude Bennett, Bill Dismukes, and Glenn Cobbs, are special beyond words. George Karam, a close friend and colleague, has likened mentorship to parenting: “You give unconditionally to those who you mentor with the hope your guidance will help your ‘offspring’ become all they can be, without any expectation of payment or recognition in return.” My mentors are the embodiment of this ideal and I am grateful for their vision, insight, and encouragement over the years. And I am grateful to the many visionary leaders and colleagues at UAB—Joe Volker, Tinsley Harrison, Dick Hill, Scotty McCallum, Jim Pitman, Bill Koopman, John Durant, John Kirklin, Ray Watts, Dick Marchase, and Rich Whitley—who created a nurturing environment in which I could thrive. I am privileged to have worked at UAB for over thirty years.
William Osler, the legendary physician who set the tone for modern American medicine, once said, “He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all.” I could not have gained the insights I have regarding the practice of medicine without the patients for whom I have been privileged to provide care, as well as their families. Over the years I strived to give my best effort, and in return they put their trust in me. I learned, and continue to learn, from every patient I see. And my obligation is to take this collective knowledge and use it for the benefit of the next patient I’ll see. My experience learning from and with so many patients in need is what motivated me to write this book. To all of them, my heartfelt gratitude.
To the activists, who spurred us all on to do better even when we thought we were doing our best, my thanks. Larry Kramer, Martin Delaney, Dawn Averitt-Bridge, and countless others are all heroes who saved the lives of millions around the world through their impatience grounded in grief. And a very special thanks to Tom Blount, a quiet warrior whose grace, intellect, generosity, and heart made so much happen for so many, including me.
Finally, to my family, whose love and support over the years has enabled me to do what I do every day. Some of their stories are highlighted in the book, others are not. My extended Weil family in Birmingham, especially my mother-in-law, Pat Weil, and my late father-in-law, Leonard, who supported Amy through all the days and nights I was consumed with my work. My mom, Elaine Koppel Saag, has provided steadfast support; I hope the pages within the book do justice to her hard work. Eddie Saag, my father, was and remains my rock, laying out the principles for leading a good and fun-loving life. My sisters, Terry and Barbara, along with their husbands, Gary and Greg, have always been there for me and sustained a “functional” family dynamic. Our oldest son, Andy, and his wife, Brittany, have brought joy to us every day. They have both been great editors for the book. Harry, our middle son, has played a key role as a sounding board for me while I formulated ideas for this book. His insights and groundedness are invaluable. Julie, our daughter and youngest, is pure joy. She lights up a room with her sunshine at all times.
And Amy, my wife of thirty-six years … there is a place in heaven for you, simply for being who you are.
My heartfelt thanks to everyone for putting up with my nonsense and quirks over the years, especially during the time I spent pulling this book together. Without that ongoing support, none of this would have happened.