The New York Times, 24 August 2004
Many young doctors dream of having an article published in The New England Journal of Medicine. Hacib Aoun achieved this, but not in the manner he expected.
Dr. Aoun’s piece, ”When a House Officer Gets AIDS,” appeared in the Sept. 7, 1989, edition of the journal. It told the story of how, in 1983, as a 27-year-old medical resident, he contracted the disease from a workplace accident. Dr. Aoun’s candor, and the journal’s willingness to publish his first-person account of his illness, helped capture the terror, and the arbitrariness, of the early years of the AIDS epidemic.
Fifteen years later, in an era of triple-drug therapy for H.I.V. infection, Dr. Aoun’s piece reads like ancient history, but it also remains surprisingly relevant.
I vividly recall seeing the article for the first time. I had just completed medical school and residency in New York. Like other doctors in training then, I had been caught unaware by the gravity of AIDS. And I had had my share of possible exposures to H.I.V., the virus that causes it.
Dr. Aoun, a Venezuelan training in the United States, had been cut by a broken glass tube containing blood. His patient was a very sick boy with leukemia, who had received dozens of transfusions of blood products. Three weeks later, Dr. Aoun became severely ill, with a fever and a rash. No diagnosis could be found and he recovered.
In 1983, the medical profession and the country were abuzz with discussions of AIDS, a puzzling and severe new illness that mostly affected gay men and injection drug users. But in Dr. Aoun’s case, AIDS ”was not even a consideration,” he recalled in his article. ”The virus had not yet been discovered, there were no tests for AIDS, and the illness had been reported in only two cities.”
There were no known cases in which health workers had become infected through blood.
Looking back, neither I nor my colleagues were especially afraid of contracting AIDS. We were daunted by its ability to devastate the bodies of previously healthy people, and some surgeons were reluctant to operate on AIDS patients. But we went about our business without much anxiety.
In retrospect, we were incredibly naïve. I often ask medical students to read Dr. Aoun’s piece, and then tell them how we used to draw blood from AIDS patients without gloves and omit protective masks and goggles when we were too busy.
The students, most of whom were younger than 10 in the 1980’s, are amazed at how terrifying AIDS was but also at our seemingly cavalier response to it.
To our credit, we wanted to give good care to these patients. There was a macho element, too. As Dr. Janet Mitchell of New York’s Harlem Hospital confessed in ”AIDS Doctors,” a collection of oral histories, ”You weren’t a real obstetrician unless you had blood all over you.”
But as young doctors, we also had never experienced a mysterious epidemic. It seemed more natural to try to defeat this disease than to worry about our own danger.
The senior doctors, who should have known better, were fascinated by the opportunistic infections that ravaged AIDS patients’ bodies. I recall one attending physician who brought our team into the room of a patient with lung tuberculosis brought on by his immune-compromised state, and then had him cough while we listened to his chest.
When Hacib Aoun became sick again in 1986, this time with weight loss and fatigue, a test existed to identify H.I.V. His blood tested positive as did blood saved from the leukemia patient, who had died. ”The mystery was solved,” Dr. Aoun wrote, ”and the nightmare began.”
He then wrote about the deterioration of his health, his inability to find work, the lack of adequate disability insurance from his employer.
It often takes a tragedy to wake us from our complacency. Because of AIDS, hospitals now take infection control much more seriously. But as the recent global outbreak of SARS demonstrated, health professionals are still vulnerable to new infections. And while most possible blood exposures cause no problem, it is estimated that over 500,000 still occur annually. One student told me that Dr. Aoun’s article made her openly confront risk and sacrifice, even though these are uncomfortable issues.
To his credit, Dr. Aoun never cursed his fate, at least in public. Despite having a terminal illness, he traveled to medical schools and conferences, urging more careful attention to the issue of occupational injury.
As his own condition worsened, he used his case to shift the focus back on the patient, especially if that person was dying. He publicly thanked his doctor, who had accompanied him to medical procedures and had been available on weekends. And he criticized doctors whose own discomfort with death led them to avoid dying patients and to make ”unwise or inappropriate remarks, especially those that hurt your hope.”
Dr. Aoun wrote these words in an article in another prestigious medical journal, The Annals of Internal Medicine, in its Feb. 15, 1992, issue. He died from AIDS the day after it was published.