By Robert Kroll
Long after the advent of palliatives for AIDS and anti-retroviral drugs, University of Maryland virologist and HIV/AIDS specialist Dr. Carla Alexander was having Thanksgiving Day dinner at a colleague’s house in San Francisco. At the dinner table, the host told Dr. Alexander, “You are sitting next to a woman who lived through the AIDS epidemic as a nurse at SF General.”
“We turned, looked at each other, locked eyes, and burst into tears,” said the clinical physician specializing in palliative care of AIDS patients and, now, of patients with Covid-19.
“We had been at war and nobody knew it was going on,” said Dr. Alexander about the AIDS pandemic. She has been one of the generals in that war, with the resume of an eminent physician, academic, and scientist at the top of her profession. Currently, she is an assistant professor of medicine at the University of Maryland, Baltimore, and also a physician serving predominantly African American youth.
Dr. Alexander and many of the thousands of physicians and nurses whose careers intersected with the AIDS epidemic, and who have continued to practice into the Covid era, suffered along with their patients—experiencing crushing feelings of loss, stress, depression, and trauma from the daily combat with a relentless enemy they couldn’t see as it killed and killed.
By the 1990s, when methods of treating and managing HIV/AIDS were discovered and their use became widespread, the damage to clinicians had already been done. Comparable to the Vietnam War having caused veterans to suffer flashbacks and triggering incidents for the remainder of their lives, the Covid-19 pandemic crisis has created a similarly untreated cohort of physicians and nurses—frontline workers who also suffer, mostly in silence.
Dr. Alexander’s problem now spans two pandemics. She feels many of the same tugs on the heart and mind that she experienced when working with AIDS patients before their care was manageable. She noted that doctors assigned to other cases in the same hospital had often been unaware of the catastrophe in the AIDS wards because, for those doctors, medical life was going on as usual.
Regarding Covid physicians, Dr. Alexander said, “Many of the younger doctors were in the same state of high anxiety that we were in 40 years ago. They got too close to people (their dying patients). The HIV experience gave me a better sense of what was going to happen. I understand viruses.”
Dr. Alexander said that in the early weeks and months of the current pandemic, she worked on a project for hospital workers on how to cope with the number of people dying…and what support to give the front-line workers. She suggested the use of community volunteers, and that was implemented.
Worldwide, although there is still a stigma surrounding HIV/AIDS, there is the possibility of camaraderie, Dr. Alexander said. That is not the case for Covid-19 sufferers, however, because the highly contagious aspect of the disease requires its sufferers to quarantine.
While this writer was researching PTSD-like symptoms among HIV and Covid-19 caregivers, he came across another physician, a man now working for the U.S Food and Drug Administration and involved with HIV/AIDS policy. The physician, who introduced this writer to Dr. Alexander, was in complete agreement on the substance of what she has said about stress and trauma symptoms.
Asked if she had any particular stories that conveyed the significance of the impact of HIV/AIDS or Covid-19 on her colleagues, Dr. Alexander chuckled sardonically and said, “My best friend, a physician, killed himself (during the current pandemic).” She couldn’t say more about that, but offered to try to think of an upbeat story that would explain the need for physicians to heal themselves.
As our interview ended, she was asked to email such an uplifting narrative; but as of this writing, nothing upbeat from the good doctor has come to this writer’s attention.