Episode 3: Caring for the first HIV patients

Comrade Uncle AJ Layon tells us what it was like to be one of the first doctors caring for HIV patients, back when we didn't know what it was... And how that relates to the present COVID pandemic.

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Jesus[Music][Music][Music] Oh you mean we left off last time we I think my return from uh from Nicaragua this is the middle not the middle the early part of the year 1981. so I had spent six months working with the sun in eastern Revolution again at the time um I had been it was to be really in 1981 it was the beginning of the time that Reagan attempted to destroy that Revolution um but came back initially was uh I was still a resident in Internal Medicine in Chicago but I flew back to the Bay Area uh and uh visited with my sister and your mom and and and dad my sister and brother-in-law for a couple of days just started to get reacclimatized I remember the the most impressive thing initially was how how oddly after only six months out of place I felt uh Reagan had been elected he had taken over um was you know a year into his tenure I think and it just felt uh felt different but after sort of reacclimatizing and I went back to flew back actually to Chicago and picked up where I left off um and this turned out to be one of the several more difficult periods in my um life um challenging challenging um Susanna my wife in comrade uh stayed in Nicaragua she was working for the ministry of social welfare uh our daughter Maria was who was I don't know she was still a neutero probably four months in utero um was there as well of course um and the plan have it was always to to go back and simply stay in Nicaragua and work there in some fashion or to as I mentioned previously worked as a medical worker with a gorillas in Guatemala um but it was a challenging it was a challenging time because things were a bit up in the air and what year would this event this was 1981 March April 1981 right so so went back and and uh just started picking up the pieces again of being a resident and um I will never forget a couple of things that that happened uh one was um at the end of every on-call period so we would have a a day when we'd go into the hospital at daytime start at 7am be on call all night long so until 7 A.M the next morning and then at about 8 00 a.m We would do Morning Report where we would talk about the admissions of the previous 24 hours uh and uh in front of the chair of the department and then roughly if I remember correctly roughly about two or three in the afternoon four in the afternoon after having been on call now this is now for 24 36 hours roughly we we go home sleep the rest of the day and then come back the next day uh to uh be uh to just do a rough a standard 12 hour shift seven to seven record and we were on call every fourth night so I was coming walking to the Chairman's office one morning after being on call and I stopped by the uh I stopped by the um dorm rooms where we where we slept if we were able to go to sleep we had mailboxes and I went to my mailbox and I got the latest number of the New England Journal of Medicine just to come out this is 1981 this is again I don't quite remember March April something like that maybe I don't remember you I don't remember but but it was relatively really not to anyone and as I'm walking I'm looking at it and I see the two lead articles are about this unusual uh series of cancers slash infections in gay men on the West and East coasts New York and San Francisco and I remember looking at this relatively small series was you know brand new and I remember looking at it you know there's more many times I've been many many times have been wrong of course and I looked and I said oh this is this is gonna this is gonna not be anything right uh and so when went to the Morning Report talked about our cases and and you know sort of went on about my business and and it was clear relatively rapidly within weeks as I remember I I mean the time is kind of compressed now I can't I don't quite have it how long it was but it was clear that there was a major major problem and and we had no clue what was going on uh a number of my co-residents and some of the attendings Were Gay and they were absolutely petrified they knew that there was something going on so the spread was pretty pretty wide at that point uh it had it was beyond the initial phase where it was just in a sort of isolated community and then now it was starting to really well it was yeah why it was picked up why it was initially picked up just there probably because of the larger gay communities more organized gay communities uh I'm not exactly sure but I suspect it's got something to do with that but it very rapidly it was no longer just there right it was in Miami it was in L.A it was in the middle of the country it was everywhere it was everywhere and you you have to I mean The Listener has to remember it was really a different time I mean when our kids my daughter who I just mentioned was like five months away from being born or something by the time we're talking about when she was born and in high school where my boys were born in high school they'd come home and say oh yeah um my friend I don't know Billy Bob I don't ask me I don't know if the name was but my friend just came out as gay today oh and and they go what do you mean and no issue and they say why would there be an issue now this is us in Gainesville Florida game in Gainesville is that it is the South Gainesville is a university town but but in my era when I mean to come out as a as a you know as a Young Man uh as a as a as a physician my colleagues who were gay I mean it was hugely problematic and to come out as a high school student where I grew up in the Imperial Valley I think I've mentioned a little bit about that place I mean you would have been killed I mean you'd have been killed I mean misogynist racist homophobic you name it I mean that place the Imperial Valley of California at that time was it was it was a problematic way so so this so this is clearly becomes more of a problem and and it was seeing the disease which was initially called grid gay related immune deficiency because no one had a clue what it was about was initially seen in gays in IB drug users and then oddly enough shortly thereafter in Haitians and and people were trying to sort out what the what I say people we were trying to start out and I was not a researcher at the time uh uh although but the medical community and the research medical research Community were trying to sort of time like what is this what causes it and what do we do about it I mean it was really challenging nobody had seen this before you guys thought it did you guys think it was a virus or was it like just so there were there were a number of there were a number of things that started coming out initially from primarily from the CDC um again my timeline is off a little bit so I may be mixing a couple of things up but but very rapidly because there was a series there was a host of symptoms people would present with fevers chills weight loss very bizarre infections and when I say bizarre I mean infections that you don't normally see in an immune competent host you just don't see them or with unusual cancersarcoma lymphomas odd things and the CDC rapidly figured out that back in 1970 I can't quite remember when but in the early 70s there was a report of exactly such a case that was in the morbidity mortality weekly review mmwr which is CDC puts out really yes it was so there there was one or two cases that we're seeing but nothing came of it no one knew what it was why did this person die we don't know but look at these unusual infections how could this be we don't know and it remained an enigma um and then beginning in 81 88 late 80 81 we start seeing you start seeing or at least these people reported clearly they had been happening before that unusual infections weight loss fevers chills malignancies and and we knew roughly who the populations were Cook County Hospital as I mentioned in previous uh previously was a safe Hospital in Chicago in Chicago a people's hospital we called it but it was a safety net Hospital folks who didn't have any money could come there and we could we just take care of them and and there was as a result of a fair number of folks who use drugs in one form or another who would come um and um quite rapidly there was a series of discussions all of it at least initially you know completely respectful and honorable I mean respectable pretty much because you know could this be an infectious agent could this be related to some lifestyle phenomena of gays like like the utilization of a drug called poppers um I believe oh my God I can't remember what that I believe it's nitrous oxide I believe or nitric oxide Nitric ammo ammo uh nitrate I'm sorry you're right anal nitrate forgive me could it be related to that what could it be could have been related overload because of uh anal sex with with a high levels of somebody else's semen and on and on and on trying to figure out why would your immune system fall apart was it drugs was it immune overload was it a virus it was unclear uh and then once you explain that well then then how do you explain why we're also seeing it in Ivory drug users share needles and share syringes and so forth you know there's no poppers there's no animal mites right there I mean is it immune overload or a virus and then and then it became it was seen in a Haitian population and that um I think that there were cultural issues that made it unclear why why it was seen in them what they gave were they drug users was a combination probably but it was not because they were black and Haitian it was you know it was it was other things that was going on that allowed that they encouraged the growth of the virus the receipt of the virus and then it's growing but rapidly people got scared and um one of the things that became clearer and clearer to me were a series of reports um about surgeons refusing to operate on patients who were IV drug users or were gay or who looked gay or who were Asian because they were afraid if I cut my finger with a scalpine believe me this is not some theoretical this stuff happens all the time if I stick myself with a needle while I'm switching am I going to get this and die I didn't sign up for this is what there was no no retrovirals no no uh no course there was an action there was nothing at this point there was nothing Hazard of thymine AZT came a bit later which is was essentially useless but but it was what we had initially um so people became really afraid and and not all not all searches of course not all anesthesiologists of course not all internets not you know but but numbers of people refused to care for AIDS patients and it was it was it was guys sometimes look man I'm just afraid but more often than not because you know people didn't want to admit Their Fear they would say well I don't believe in their lifestyle and I'm not going to put myself at this because of their lifestyle or or you know in Philip or this goes against my religious beliefs right this is one of the first times I'd ever heard such nonsense this goes against my religious beliefs so I'm not going to take care of them now I will remind our listeners that six months or something previously while I was still in Nicola well I was working for the Ministry of Health of the episode one night after a day in the hospital in a clinic while we were having some rum and beer and doing all the things we do this that young Nicaraguan physician I got a little tipsy drunk and you know pointed his index femur finger at me as if he was going to shoot me you know and said it's your fault it's your fault and you remember the the the response of my colleague in the comrade and dear friend who's now unfortunately dead Ricardo Morales who was the chief of critical care at uh University Hospital in Santiago[Music] remember he said first of all Joseph wasn't a physician in 1973 when Samosa had his heart attack this kid was saying if he'd let Samosa die no this would have happened we wouldn't have had to have a revolution people wouldn't have died and so forth he went Joseph wasn't a physician and furthermore we take care of everybody we are Physicians that did not go away when I left that country when I left Nicaragua that interaction is etched it is burned into my memory it's come up over and over and over again in the decades since and so seeing what was going on at the county where we had surgeons who didn't want to touch people who looked gay didn't want to touch IB drug users you know and then they didn't want to deal with Haitians I mean it became a seriously challenging and I had my own faculty not all of them some of them who would say you take care of this I'm not going to touch it they left it to us care for these guys and you know there was at the time no viral assay because we didn't know what the virus was right you you you were suspicious that this might be a problem that there might be a problem based on the symptoms or signs but also based on are you a drug user are you gay and people you know they just they learned rapidly in our patients they were going to say and then we learned rather rapidly that that of course it was heterosexually transmitted as well it was a virus and then you could be asymptomatic for a very long time before you while you were still infectious and so all bets were off right he doesn't look gay so I'll take care of him but he does look gay so I won't take care of him you know the whole thing was absurd it made no sense at all right because you couldn't tell first of all whose game is not second of all even if they were gay if they looked healthy they could still be infected you couldn't tell right right so relatively rapidly then thereafter we have people who are refusing to care for patients who might be uh infected I mean now we know one second who might have this disorder grid HIV AIDS and we and it did seem based upon them epidemiology the public health you know Public Health guys looked at this um that there had to be some transmissible something there just had to be so we learned rapidly okay so you wear gloves you wear a mask I suppose then you wear a gown you be careful you don't stick yourself and probably you're okay probably so that's what we did for the most part for the most part um it's harder than it seems if you've got the Gown up and mask and glove before you go and see every patient write universal precautions um um it slows rounds down people stop doing it because it just gets in the way of doing your work so you put yourself at risk again if you were supposed to We were supposed to we're still supposed to wear gloves every time we start an IV or something like that right it's a it's a it's a you know a peripheral IV is a supposed to be a pretty it's a clean procedure I don't think you'd call it a sterile procedure but it's a clean procedure but sometimes you can't feel the veins with the glove on your finger so you have to take that glove off and you feel the you know it there's a million shortcuts we do we take nurses doctors all of us because otherwise you can't get through the day so people were still at risk and and furthermore there wasn't you know we hadn't outsourced our entire economy to the Chinese and Vietnamese at that point but but there wasn't enough personal protective equipment and some of the personal protective equipment we take for granted now hadn't even been so so okay so IV drug users and gays can be infected probably something transmissible so we probably want to be careful about blood and body fluids and that includes sputum and saliva and urine and stool and okay it gets harder and harder to be able to deal with patients but okay we can probably do that mostly are a number of my faculty simply refuse to see patients that could be gay or could be I think we didn't have us as I mentioned we didn't have a virus so we didn't have a study a test for it what we did know when we did know is that the ratio of helper to suppressor lymphocytes T cells a subgroup of lymphocytes inverted and T helper cells the numbers plummeted antigen presenting cells needed to fight off certain kinds of infection make antibodies apply the same kinds of infections they plummeted so but you couldn't get the I mean those those that study was done by hand at the time you had to get blood get lymphocytes use uh antibody to determine what was a helper cell and a suppressor cell and you'd come you know and use like immune fluorescence and count them under microscope they just couldn't do this on everybody but we did do a couple of we did a couple of studies when I was involved in one of them where we looked at IB drug use and looked IV drug users and looked for inversion of their T helper to T suppressor ratios and sure enough we found that there were now we didn't do a I wasn't smart enough I guess but you know we should have followed these guys longitudinally to see when they got sick if they got sick and wasn't really age but we didn't have the ability to do smarts probably had the ability to do the SMART student at least I did um but but that would have given us even more information but the point is the only point is is that we couldn't there wasn't that much to follow so there we were and I will never forget um I will just never forget being on call one night and I was always thinking about this you know am I going to get infected with this is something going to happen um and um I was on call one night and um I got called about three or four in the morning to come from my call room to the admitting Ward there's a new patient so I go up there walk in get that everything's on paper so I get the paper and look at it and it says jaundice febrile and I look over at the guy and he's a looks like some late 20s early 30s or old black guy and lying in the garden it does have kind of a yellowish tinge to him so they are so I start walking toward him maybe he's I don't know 25 yards away I don't know I'm about halfway there and all of a sudden he sits bolt upright vomits collapses and I keep walking toward him I'm looking around there's nobody there just[ __ ] nobody just me and I walked toward him check for a Carotid pulse there is none he's not breathing there's no pulse using cardiac arrest what am I going to do well I turn him on his side I clear the vomit out of his mouth I give him mouth to mouth I do CPR as I remember he died but I do remember thinking there was no masks to use there was no bag valve mask that we had in the medical admitting Ward and I remember thinking this is uh this could be the day that I died and and that I mean that was the that's the clearest memory I have of that I mean there were other days when other things happened that I was more vague but that again is just etched it's burned into my memory that day and I have no idea what he had all I know is that these days postmortem couldn't get I mean the rate of we should be getting postmortem exams on anybody who dies unexpectedly but the rate of postmortem exams is like two three percent of all deaths it's it's that's a different story that's a long story it's a complex it's primarily a financial and cultural story but but we we should but we don't and we didn't so I have no idea all I know is I didn't get sick but I remember being petrified for days weeks on it am I gonna is this gonna be me at my end it's just how I'm gonna meet my end um and and you know I sort of oddly enough is this how I'm gonna meet my end I'm walking out of the emergency department one night one day um I I don't know how much again the timeline is is all confused now but but in this General time period I'm walking out of the emergency department one day it's afternoon I'm I'm off I'm gonna go home and I'm walking there's like an Alleyway that the ambulances would drive up to get to the emergency department and the old Cook County Hospital and I'm walking down that alleyway and there's a sidewalk on the opposite side and there's two young women walking toward it and I just sort of glance over at them and they're obviously chatting and I look away or look down or something I don't quite know what I did and I looked back up at them and all of a sudden they're like falling all over each other they're not not literally falling but like grabbing one another like something's wrong you know what the f did I look straight ahead and literally I mean three feet four feet in front of me is this crumpled body this guy I walked up to him it was a guy man his head was split open his wrists his hands were disarticulated from his wrist this guy had been in the sixth floor psych unit had jumped through the window and landed in front of me and had I been walking just a tiny bit more briskly he would have landed on top of me and I would not be here talking to you today it was breathtaking and of course puts the lie to all these silly action movies where people jump out of a tall building and they're kind of a little bit of blood but he was his skull was wide open his hands were disarticulated from his wrist it was the most horrible thing I've ever seen I mean I've seen a lot of horrible stuff but this was really really important I mean I checked for a pulse there was no pulse I thought do I do see PR do it no there's nothing to be done here but but it was it was that was the that was the third time I think close to but I thought I had lost my life the first was that failed Ambush the second was the this event with this guy who died I had to give him up the mouth on them third was this uh it was just it was just amazing right because you guys still had no idea no real idea of what exactly was was trans but just that it was something to do with uh you know blood or something yes yes it was other than that there was it was just no idea had something with body fluids and and then the later it got the more it seemed likely it was a virus and then like the the major Labs at the National Cancer Institute Robert Gallo here in the United States and a guy named uh I think was burchard in France uh published I believe this is about 82 I think it's about 82 they found what they thought were viral particles in the lymph nodes of patients who had had HIV AIDS or Aids uh it was and that and Gallow thought it was a virus that he had initially discovered and person thought it was funny and it turns out that I don't know what it turned out that there was a battle over who was going to get naming rights and and claiming rights to having discovered it but the longest part of it is is it was found it was just it was termed uh human immunodeficiency virus developed we developed assays we could figure out who had it and and then we sort of moved on from there uh there was still no antiviral therapy and for the longest time um for the longest time uh Physicians nurses did not want to take care of these guys I mean I I wasn't I mean I was a I was an internal medicine guy I wasn't an infectious disease guy or anything but but for a while at Cook County and then when I came to University of Florida I was one of the few people who would care for HIV patients this when when when we when High activity antiretroviral therapy was developed it was then it was then no longer such a horrible issue because you could then live with a disease almost like a chronic disease like hypertension diabetes or something and it can't um but at the beginning at the beginning it was really scary and it was a death sentence and it was a deficit I mean we did all the stuff we did I mean right we did our political work we had fun we whipped out but always sort of hovering over us was this angel of death and we never knew when it was gonna when it was gonna come for us you know is it going to be when I try and put the IV in this guy is it going to be when somebody bites me you know we thought that was a way it could be translated we didn't know at the time you know how am I am I am I going to die from this I mean a generation two generations before my generation of Physicians and nurses doctors and nurses died relatively regularly from what are now treatable infectious diseases streptococcal pneumonia pneumonia pneumonia pneumonia uh things like that I mean we die we die um in the piano taking care of sick people and it was just like it you know it's not like okay it's all good but it's like it's just the risk um and in the generation before me that had pretty much gone away and when this thing came up again and it came up with HIV AIDS it came up with ebola it's come up with covid-19 it'll come up you know with SARS cov2 which causes covid-19 pneumonia um again some of our colleagues just they don't want to be a part of this they this is not what they signed up for and and you know I mean while I understand well I do understand it is what you sign up for when you do this it's like it's like what you sign up for when when I signed up to go to Nicaragua I knew it was a zone of conflict when I took care of the HIV AIDS patients I knew there was risk I mean it didn't mean I was not scared I was scared but I did what needed to be done despite being scared when I signed up with msf medicine went to Nigeria again zone of conflict not a war zone but Boko Haram was around the corner but the point is the only point is is that is that there is a certain set of skills if you're a nurse or a physician that you have and my set of skills relates to Intensive Care Medicine Critical Care Burns trauma as well as sort of general or anesthesia and general anesthesia so so there's the kind of stuff that you see in zones of conflict or War zones is the kind of stuff that I've spent the whole life taking care of training programs so it makes no sense to me to not utilize those skills in service of our brothers and sisters and you can say well but wait a minute why don't why didn't you go to South Sudan or why don't you you know I mean it's all true there's way more places to go than than it's possible to go but to have the skills I think until you no longer have the mental or physical capacity you have to use them in service to our people and as I've said I'm sure I've said it to you in the past you know who are our people well you know I was born in the U.S so clearly the people in the United States are my people but you know I have family in Lebanon so those are my people people of Palestine are my people the people of Israel are my people right our people I mean I am an internationalist yes there are governments I had to test there are politicians I detest but institutions systems institutions right there are behaviors I detest but our people are the people and they exist in turkey and Greece and Israel and Palestine right in China and Japan in everywhere I mean and and and what I've tried to do in the time I've been allotted on this Earth is to utilize those skills Best of You and to some extent I think I've been successful the last handful of years have been more challenging than previously and that's a that's a topic for another story for another time start another time do you uh see did you see I guess you know with the the covid uh epidemic did you see any um like relations between uh the HIV crisis or the you know HIV epidemic or pandemic I guess yeah but they're both pandemics um uh do you see any like um yeah you mentioned the the not having enough PPE um I know that that was the thing during the beginning of covet is there anything else is there any like you know um you know correlations or or just uh similarities that you've seen contrasts there there were some there were there were some uh they may they may be looser than I but sure but broadly speaking early in that aids crisis people at Anthony fauci Who was the I believe at the time he was that just appointed head of the National Institutes of allergy infectious disease I think he may have he may not have been the head right then but shortly after there after he became the head of them but you know Anthony fauci you know a colleague a guy who I think is just an incredible researcher in a position Sid to the gay community who came to him we need some kind of treatment we need something and he said well we have to do uh you know initial investigation it doesn't work and the test tube then does it work in animals then does it work in small groups is it safe is it effective and then we'll do randomized control studies and then we'll have it and they said we'll be dead will be dead and act up in other groups right um uh said we can't wait and to his credit fauci who you know he's a he's a died in the world scientist I mean you use the scientific method you can't just do stuff I mean you can't but and he did but it was really hard he did AZT very rapidly but look at my working in vitro and you know intestines let's try it and it was try it didn't work very well made you sick as a dog but you know he rapidly changed course and was responsive and became clear Ally to the to the age to the gay community just folks who had a clear balance so what's interesting is there are people not all Maga types some anti-vaxx types some just don't understand them who are now criticizing pouching for the use of AZT which really didn't work very well when in fact it was in an attempt to do something with a little bit of evidence that existed to make it work that same sense the sense of fear on the one hand do something on the other hand we saw with we saw with Ebola but it was it was a little more isolated and we certainly saw with SARS Kobe 2. the same fear the same I don't want to deal with this the same and now and now and now we had Hospital corporations that were utilizing just-in-time delivery of supplies of equipment that were not all but some for profit and you know and they did not have enough people enough nurses enough stocks enough and slurring people when I say honestly I don't mean like secondary I mean you know everybody else that makes the place work because without people to clean the rooms and make the food place doesn't work there weren't enough there weren't enough supplies and and and it was absolutely frightening I I mean there were people especially I think nurses in big cities in New York was probably the worst who went to work and they didn't know if they were going to come home I mean I went to work in August I think it was August of 20. is it 2020 or 2021 it's all kind of confusing I think it was 2021 and basically left in September I mean I literally wasn't there 24 7 but but as I was there between 14 and 16 hours a day would drive home go to sleep get up and come back and there were two of us there were two of us in this this was a hundred and five bed hospital small place I had initially been asked to help set up an ICU before covet and we were we were seeing there were 150 160 patients in that hospital it didn't have room for that many patients but they were there every day and the list we had of covid patients was something on the order of 40 to 50 patients every single day one doctor cannot care for that kind of persons I mean I did that stuff and Nicaragua right remember I think I mentioned we would see patients in the hospital and then a group of us we would make five or six would see 150 200 outpatients right in a clinic in one Clinic it was I mean people would line up and we'd do the best we could but but this was utterly impossible I mean I've written a little bit about this but but it's it was there we the whole I see was full of ventilating mechanically ventilated patients the floors were full of patients who needed to be in the IC but there were noisu bills there was nowhere to transfer patients to because everybody else was full as well and so what my I had a a partner it was a he is still a wonderful guy he is training his anesthesiology but he's he had done enough ICU and he said I'll help and he and I would divide the patient list every day and we would just do the best we could in the ICU and then do the best we could with patients on the floor and and there were deaths every single day over and over it was worse for our nurses it was worse they you know I mean but it was every day the youngest patient I had the youngest kid I had to die was a 19 year old in my arms with his mom watching right trying to save him and I said my mommy I was holding him I mean we were trying to save him and you know and the oldest was six to seven yeah who knows I don't even remember but young people 39 year old I'll never forget came in he was in his hunting pause right sort of camouflage that and I remember I asked him I said it looks like you've got covet test I think was back and it was a positive and I explained what was probably going to happen and I said you know have you been vaccinated said no I didn't believe it when we talked and he said I said he said please just get me through this I promise I'll go do it and he called his wife and told his wife to go get vaccinated but they didn't believe it this is this isn't a part of North Central Florida that's that is bought Hook Line and Sinker the nonsense that come out of that came out of the mega slash Trump slash Fox slash interviews breaks off a handful of crazed doctors and nurses mouths doesn't exist it's just the flu it's not important he died that man died you know another guy another guy I'll never forget you know older guy he was on the floor right he was sick enough to be in the United States we didn't have a bed and he turned up on my list one day and I went to see him and he basically waved me off and told me to leave him alone I don't really have AIDS he said I don't really believe in it and I don't want anything just leave me alone and then about a week later there is a rapid response which is when there's a medical emergency they call the nursing leads from the ICU and the ER to help the California patient and then they'll call me if they need it and so they called me it was the same guy and he was breathing 50 times a minute couldn't get off it was oxygenation level was horribly low he was in respiratory failure I mean he was so I I you know same guy and I said look we're going to have to put a breathing tube in you try and get to the ICU and so and he said and he said he looked at me he said enough you know I don't want to be intubated between breaths he said just please stay with me and until that moment everything was sort of normal medical stuff I had I don't know 20 or 25 patients to go see and take care understand just stay with me so I stayed with him and we talked I mean as much as he you know between breaths when we use non-invasive ventilation all this stuff to try and make things better but but he told me you know he had been a Submariner in the Navy um we talked about the Navy we talked about my son who had been in the Marines talked about my dad was on the USS York town now we sort of bonded right and I was with him and just before he died he died with me I did not leave him until he was dead and just before he died he said to me I need you to do something for me so tell me I'll do it so I want you to tell my wife who had been called but she hadn't gotten there tell my wife that she's the most beautiful woman I've ever seen that I love her and to get vaccinated because these guys hadn't believed in vaccination either and and he died and I I you know one of the tasks of the physician is to declare the time of death I declared his time of death and then his wife showed up I was back in the ice unit and so I went to see her and I told her what had happened and I said but there's three things he asked me to tell you I said he said that you're the most beautiful woman he's ever seen and she's smart and he said that he loves you very much and she beamed and he said please get vaccinated and she said he said what That's How Strong the anti-vaxx anti-science I I don't even know what else to call it ignorance that we dealt with and to some extent still deal with was in that moment it was it was real real horrible and we were short of everything we were sort of everything personal protective equipment masks clothes our the leadership in this little hospital I'm at the small hospital is a great little place this woman who had become a CEO was literally I think there's a couple of weeks into that spot and this hit and she performed like a Workhorse I mean she I I couldn't believe it I mean not I had no reason to not think she would but it was breathtaking how good she was it was just amazing uh this is on a small Hospital in Northern Florida an HCA Hospital clinic in Lake City the woman's name is Jill HCA Hospital Corporation America is a private Court profit Jill Adams is her name she's the CEO of still and I am prouder of her something I agree with her on everything of course not but that's not the point I'm prouder of her because I could be a anybody for the way she worked the way as a team the team she put around her the way we worked was breathtaking breathtaking and and so there was good as it was you know bad but there was good as well and and again every day I'd go to work and I would say is today the day I'm gonna get sick because you know I mean I'm healthy we don't have any chronic time Dynamic chronic illnesses um nothing and I but am I going to get sick you know I'm already how old was I uh you know I was I don't know 70 now so I was you know it was 68 69 something uh you know am I going to get infected and and die I I don't know I mean I was careful we were always careful but you know even as careful as you are I mean there's more than one time when somebody who didn't have covid by the test turns out on second test to have had covet and there we were without masks so that was when I said you know what the heck with all this on second on second uh on second um what do you call it uh PCR test no it was the rapid I'm sure it took too long this would be a patient who came through the Ed if you have a a negative rapid antigen test and then followed a few hours later by or the next day by another second or you know hours later by a second negative is probably negative but but the sensitivity which is uh true positive divided by true positive plus false negative tests it is a little lower than the 60s percent rate so on more than one occasion that happened so I just hit the heck with it I'm wearing a mask all the time every time and that's what I did and do to this day I just in the hospital I wear a mask all the time except when I'm alone my little in the office writing that's it and uh you know it's it's not horrible person but it's nothing um but but it was it was challenging and there are plenty of nurses now who have just been docs who are just simply you know is the word burned out or is there a word that they've been injured morally moral injured probably a little of both and and you know and when you still have people who who actively deny that there's such a thing as covet and who actively are aggressively you know opposed that vaccination and and you know I mean nobody nobody threw a punch it but I have never been screened at and cursed at as much as as I was then and you know and there was a there was one young guy some I don't know mid-30s young hulking muscular guy and his dad was dying he was convinced it was our fault uh it's dying of Covenant and you know you can tell by Body Language and somebody's on the edge of I mean on the edge of violence and and he was and you know it's like that that is it is all jobs are all work is work all jobs were difficult in their own way this is hard in lots of different ways and it was it was made harder it was made much more difficult by the science denying right-wing anti-vaxx um fellow citizens who to this day have have not have not stopped doing what they do no not at all did you see any of that in uh with HIV um the same sort of science denialism this sort of you know this reaction no the thing we saw I saw with HIV wasn't that um it was it was you look gay stay away from me you look gay don't come into my restaurant you look gay I don't want to be you know it was that kind of stuff it was different the same energy I guess you could say but but different the same genotype a different phenotype how about that for Infusion scientific language right that's pretty good it was it was it was just a different way of expressing the same the same kind of intolerance uh and you know and and people were killed people were beaten people were killed because other people were afraid that they might get AIDS from this guy who kind of looked gay maybe he was maybe wasn't who knows there was that kind of stuff that happened it was it was you know it was in our United States it happened but it wasn't just in the US to happen in scary times you need people who can keep their heads about them the kind of guide lead guide is through um it's hard enough to do no matter what it's even harder when all around you people are screaming and uh threatening violence it just didn't seem it wasn't quite like that with HIV but it sure was with covid I mean it sure was HIV was a social medical problem medical slash social problem there were social implications like they're out with most disease right but but covet it was because of the science denying that actually let me step back on that one it's not just science no it was that it was that fact denying Republican party really which has become a a and I don't use this word you know Evolution a fascist organization that really has become a fascist organization over many years it's not Trump trump to my mind is just an Exemplar of what they become but this starts years ago it is it's a progression of it's I mean you know this is the natural um this is a natural uh uh I wouldn't say conclusion but evolution of of that whole thing this sort of you know big big business marriage of big business interests with uh you know crazy conservatives right with conservatism with a political organ with a political with uh with the government I mean the party of Lincoln right always a party of capital but the party of Lincoln becomes what Mussolini called Mussolini described fascism as a union of government and big business absolutely and that's what we've got and you know and there was it may not have seen it from those years I mean we are not Mussolini we are not Muslims Italy you know all that I mean of course you can say all that but but when you see what's become of this organization and what they do so it's not just the fact that there was Trump and Trump was science denominator it was he was an Exemplar of what that organization had become and there was many many more people the guy who's in this the governor of this state is a vaccine denier is a mask denier I mean he's an incredibly dangerous to my mind say his name the centers vote against uh you vote against DeSantis yeah I I mean it's it's it is truly breathtaking and uh and you know what's to be done I mean what have you done is is I mean we just keep plugging along talking to our fellow citizens many of whom don't agree but as Michael Moore says you know you don't or you don't organize by walking up and saying oh you say let's talk about politics you organize by saying hey man I see your car's broken down how can I help you fix it right yeah that's how the left organized in the past 20s and 30s 30s and 40s that's how we should be organizing too and and you know I still as old as I am in as many hits as many blows as I've taken I've taken some blows man I I continue to believe that most people want to try and do the right thing in our at heart decent and if we give them the opportunity to behave that way they will um yeah absolutely even when they disagree with us in the beginning even when they disagree so it all it all matters but anyway that was that's what it was like in that era that's for sure wow it's not completely gone either sure certainly isn't yeah wow uh that is intense so you know um if there's any lessons that you think we could have learned as um you know one that leaps to mind is probably universal healthcare um of course uh uh that we could have learned from the HIV uh pandemic ongoing HIV pandemic that would have applied to covid as well um yeah you know what do you think the number there's a number I mean first of all the public health Public Health infrastructure in this country has been absolutely devastated over the last I don't know 40 50 years just devastated underfunded under staff old equipment old Supply you name it so we should have figured out that we needed a robust Public Health uh component to our inadequate Health System that's number one number two it is true that um and it becomes more so with HIV but but equally true with coded and the next disease it'll come along too I don't know what it's going to be but but even without pandemics that the lack of a national health system in the United States publicly funded tax fund but don't say I don't I won't use the word free because that's that's bogus there's no such thing as free it's tax funded we pay for it and that that's as it should be right it's our system that's what the Brits are saying now about the National Health System it's our system that you conservatives are trying to give away to the uh private center in our country our taxes should pay for a nationally funded health system that everybody has access to and had we had that we would have probably in fact we would surely have not had the hospital bed shortage that we had and have the Pediatric bed shortage that we had and have um you know that the neoliberals starting with certainly with Reagan but progressing through uh through uh Clinton Bush uh Obama and um okay the former guy I mean they decimated decimated isn't even the proper term they destroyed our industrial capacity Outsourcing everything so that the rich could get richer destroying union jobs um the fact that we don't have the ability to make our own personal protective equipment is completely bogus I mean Trump and frankly now Biden picking fights with the Chinese who make a huge swath of our PPE like how stupid is that and and and and unless somebody think that I'm just making this up I've got photos on my phone of the uh Supply when you open a whole packet of gowns or masks come with a with a description of what they are and where they're from and it's China it's people's Republican China That's where they've come from I mean we don't make this stuff it was outsourced it wasn't outsourced in us in a in any rational National International way that you know to so that people who there's a term in economics and I'm blocking on it was only outsourced so that the wealthy corporatists would get what could become wealthy it's all it is and to destroy American union job that's all that's all it is that's all it destroy the power of Labor yes it's come back to bite us and you know it's there's there is I would say weekly that maybe on daily there are lists of medicines fluids supplies that we can no longer get we no longer have access to because something has happened to the one Factory where it's made in Puerto Rico or somewhere else right or in India we get it from India and now the FDA says look there's something wrong with wrong with you gone the whole thing I mean we are we are on knife's edge and they will come up you know if this isn't fixed and there's no sign and it's going to be fixed we are nice as the next pandemic if it sweeps through the country more rapidly we'll just destroy everything we were on the cusp of being overwhelmed with Kobe I mean it is unsustainable to do what we did to do what our nurses did it's unsustainable and the result of that unsustainability is that today you see nurses and docs who have simply had it and they're just leaving they're just leaving um not like they're rich and they can just like go and live the life of leisure but they just can't do it anymore and and the next pandemic if we're not prepared in a better way and we can be prepared I mean it it you know I mean again part of what what drives me to distraction which frustrates me beyond belief is that there are really good smart people in our country who knows and and they're all they're not all of the left believe me but they know that in health care it's our patients our people who come first full stop there was a guy this is a guy who recruited me when I went to the Northeast guy who I knew but not really well but I liked it smart good had come from the University of Wisconsin and I mean today I would follow him I incredible way more conservative than I am but at this health system that we were at that had always had a very very very robust possible Right there was a slight downturn and as a result the CEO at the time this is about two thousand thirteen maybe the CEO at the time stopped hiring nurses because there was a known number of nurses that left every year and we would just replace he slowed that process down so we didn't really replace them and we didn't replace environmental service workers either so this guy who had recruited me and I and a few others went to the CEO's office and we said why why policy nurses why don't we cut salaries starting with you CEO making a couple of million dollars a year down to Joe's level right beneath my level nobody would be touched but it would be you know maybe 25 for the CEO 10 for me all the people at my level at our levels right all the big administrator type and at the time I was and then we'll get the money back I mean it's okay we're not going to starve but that way we can keep the place going right the guy who led that charge was a guy way more conservative than me he calls himself he calls himself a libertarian but he knew what matters and What mattered was the ability to take care of our patients the people in that case and that's central Pennsylvania but seeing authors on the offices so you're a bunch of comments ago it never happened and as a result and as a result iterations like right there's not it's not a directly linearism but as a result of that kind of behavior we couldn't take adequate care of patients people got sick people got sicker and eventually they were and they were again related to this kind of lack of focus on on appropriate patient care and prevention and so forth children in the in the Pediatric Hospital alone direct linear relationship not perfectly correct but it's all related right because quality is never one single thing it's a handful and and what drives me crazy is that there we could do so much better I mean our life expectancy in the United States over the last couple of years has decreased has decreased we are we have fallen off the curve we have fallen off the curve the same way that the former Soviet Union fell off the curve the longevity curve when their country collapsed in the USSR collapse we have fallen off the curb and we spend more money than anybody else and we have worse outcomes and people are dying more it's not just covet but it's covet it's not just opiates but it's opiates it's not just women who die in the peripartum period but it's them too it's racism it's class it's all the above we have refused to deal with it and the consequence is we are I mean I've said this several times not now but I say it often we are a failed country a failing country I the the historical example isn't the USSR to me the historical example is the Ottoman Empire which as it began to collapse on itself did nothing but fun it's massive military nothing but that and it was hollowed out inside she's like I mean it's not an exact example but it's just it's just an example so there's many things we could do differently that might from HIV to cover that might have made things better and there are many things we could be doing now that I'm afraid we're not doing and I don't know what the next pandemic will be I don't know what it's going to be it'll be something and it will hurt us are we prepared we are not prepared we are not prepared not being worse than a worse position now than we were before uh in some ways at least we've lost nurses and doctors right yeah yeah I mean you can say all you want people somebody can say all they want well I did my research I can figure this out you know and it's like dude like I have as much respect for sort of folk wisdom as a next guy I mean I worked in Greece I worked in Turkey I mean I've been there United but come on if you get really sick and needed ventilator you're not going to be able to do this by figuring it out and I've had people tell I've had I don't know well say to me just because you've got a couple of pieces of paper doesn't mean that you know more than me I've done my research you know your research is done while you're sitting on the toilet I mean you know I'm a postgraduate year 42 in medicine it's been 42 years actually what am I I started medical school in 1975 so you can do the math I graduated in 79. so as a postgraduate year basically 43 this year and and had four more years to that for medical I mean it takes a long time to figure out how to do this stuff sure and and sometimes I mean I mean my point isn't to be you know a a an elitist no an elitist I don't mean like that but I mean but there there is knowledge that you need to do stuff that's complex it's not folk knowledge we did that during Jackson's tenure in that what it was 1820s but fine but medicine science engineering it wasn't just saying that so yeah and you know I think I think it Bears saying that that uh you know it also shouldn't be their responsibility you know it every single you know if we treated the sewer system for example yeah like the way that we have treated uh Health decisions with covid uh our sewer systems would not further be [ __ ] in the streets uh you know and there was once upon a time we did treat the sewer system uh like like we treat covet this huge this privatized you know oh you know everybody's just gonna every municipality is gonna make their own decisions uh you know whatever uh and and it was terrible and it didn't work and socialists uh in Milwaukee uh created the first public service system and and it it worked better and it's spread across the country and in a similar way if we expect every single uh person to be become a health expert you know what what are they going to do they're going to do their research and if there's a lot of people putting out misinformation what's that research going to lead them to even if there isn't you know like I mean how to build a sewer system I don't know make a gas but like it's not my responsibility that is the government's response to to prove and our Collective responsibility through you know because of the government is us right I mean it isn't it's supposed to be it's supposed to be right yeah right you know and and I think even more specifically to be specific about it the it is class struggle it is capitalism capitalism creates this sort of system the system is is not necessarily it's a failure for us it's succeeding at what it is though it is capitalism is to maximize profit right and you know in order to maximize profit you need people to be fooled into thinking they should go back to work that covet isn't real that uh that you know gay people are to blame for HIV or whatever you know any any or racism another way to divide uh divide us um and and that's I mean you know and it's and meanwhile we get Hoodwinked even on things that are common sense uh there is 60 between 60 and 70 of of people in the US um agree that there should be Medicare for all at a minimum and what do we have nothing right even when the Democrats had a super majority we still had nothing uh uh so it's not you know it's not isolated to one party however of course you know I mean there's exceptions amongst the Democrats there's no exceptions amongst the Republicans um so you know I just wanted to make it you know abundantly clear that this is capitalism if we want to do better we need to shift away from capitalism we need to shift towards collectivism and like you said an internationalism because these diseases don't emerge from nowhere and we can't treat just like we can't treat covid like it's confined to a state uh one state you know Florida can oh Florida can be terrible and and you know uh Georgia can be better like no right no right right no no we're all connected and the world is like that too these diseases don't just I mean you know some diseases may arise in the U.S uh others might be the Congo others might be whatever England uh but if we treat Health if we treat disease if we treat uh you know truly International concerns for all of humanity like they're confined you know like it's not our problem the bull is not our problem you know uh HIV is not a problem uh you know whether it's confined to a class A Country an ethnicity uh you know uh gender or sexual orientation or whatever and we're all connected you know you know we all know I think you're yeah I think you're right and I think the the most frightening possibility is is that with climate the climate emergency yeah there'll be more and more and more uh I know um emerging diseases infectious diseases that we don't have a handle on we can't do that I mean in the United States we can't do that with a health system we've got but we can't do that in isolation in any event I mean the the the the the the biggest crime the biggest crime it's been perpetrated by our ruling class slash leaders it's not that they ignored kovid or even that Reagan didn't get didn't care about HIV I mean those are all those are crimes but the biggest crime is it is the climate emergency deniers and it to date I mean it is true that Biden did get some stuff passed that's the biggest so far and and it's good don't misunderstand me but it's not enough and it's not enough that we do it here it's got to be done everywhere everywhere it's not it's not enough that we just you know we ship our you know our trash somewhere else or or you know we uh we send our carbon emissions to a different country like yeah no it's just got to be done on a worldwide level and rich countries have to pay for poorer countries who have not we don't know the resources to do Windmill and tide and solar and so forth right it has to be done we have to pay for it the Chinese have to pay for it the Brits the French the Germans all of us we have to do that to each according to visibility from sorry from each according to his ability to each according to his need that old Mantra of Marx matters you know and it and I don't mean it in some hokey way I mean there are governments that don't have the resources for whatever reason yes maybe because they've got their own levels of corruption but for whatever reason it might be because of us it may be because of us so we have probably it's in our interest to help because the the end of our the world as we know it the world actually I shouldn't even say that because the world is not going to end what's going to happen is we will end the world will be just fine we will end and you know there's enough poetry and literature and art and children and joy that I've seen that I want to continue to see that I want to continue to exist that is worth it that we not cease to exist it just appears that our leaders don't quite see it that way because the result I mean this is not just a mistake this is not just oh God if you just give them another fact the outcome of a system is the outcome that the system was designed to produce and that's what we've got and that's why we need to alter this economic system I mean if you want to have sort of small level capitalism by all means I don't care I'll buy my tomatoes from you they don't have to be from you know but the big stuff and I I grant you that it's a it's a discussion I don't know where the line is drawn I don't you know but but in general the big stuff needs to be handled on a national level and in this case probably on an international level bigger stuff right because we've got to fix the climate emergency so that we can actually continue to exist so we can make these decisions right it won't matter if we want to have a national health system before if you know our countries have flooded and the other half is dry right anyway on fire uh yeah yeah yeah and you know I think that um I think it's worth saying a couple concrete steps um you know for example really small easy to do things uh when Biden was elected he talked about uh releasing the patents for so at least other countries could make uh could make vaccines you know based on our stuff these these vaccines by the way which were developed with public infrastructure public money with the collective human knowledge of humanity uh they didn't do that by themselves regardless of if they did even if they made it completely by themselves I don't care uh this is a global pandemic it is a global emergence it needs we need to not just vaccinate ourselves we don't need to do that we vaccinated everybody and right now the U.S has the only bivalent vaccine the best new vaccine we've kept for ourselves we we refuse to give the rest of the world that and that's not helping us I mean okay fine maybe we're the Cesspool of covid uh in the world we have some of the worst numbers in the world a very sane uh uh but uh uh but actually we have the worst um but uh you know there's little things even even not huge asks that we could do right this second you know that would make a huge difference uh um the outcome you get from a system is the outcome that it was designed to produce that's all I can think of that's there's there is not a fact or a moral example I don't think it's going to change these guys because the data are clear the data are as clear as they can be but right on right on comrade uncle okay so we'll do this next time again yeah that sounds great all right thanks next time it'll be sure next time we'll talk about uh yeah yeah absolutely I'll look forward to it okay man talk to you bye thank you[Music] thank you foreign[Music] foreign