Los Angeles Times; Publication Date: Tuesday April 22, 1997 Page E-1 (Home Edition)
David L. Ulin

Although Baxter may be right, it's hard to spend much time in his presence without thinking he's being modest to a fault. For the last five years, he has cared for New York's indigent AIDS population, first at St. Clare's Hospital's Spellman Center for HIV Related Diseases, and since 1995 at Casa Promesa, a residential facility in the South Bronx. A thoughtful man with a well-groomed beard and thinning salt-and-pepper hair, he speaks with obvious concern about his patients--who have been largely overlooked not only by society, but within the AIDS community.

These include the homeless, drug addicts and HIV -infected convicts released by the correctional system and essentially left to die. Throughout the 1990s, such people have accounted for an increasing percentage of the AIDS population as the face of the disease has changed, affecting a greater proportion of minorities and drug users.

Yet for all that, Baxter asserts, "a lot of my patients have no advocacy whatsoever," especially when it comes to basic issues like access to the newest AIDS drugs. "I have seen many of my patients taking the cocktail of drugs, and they're doing very well," he explains. "But the type of people I take care of have big-time problems. It is a challenge trying to address not only AIDS, but the myriad psychosocial problems they have. I realized very quickly that although on the surface these patients appeared different from you and me, they had the same basic needs. Intellectually, we can all say, 'Yes, they do,' but experiencing it makes it real."

Baxter's own experience is at the heart of "The Least of These My Brethren: A Doctor's Story of Hope and Miracles on an Inner-City AIDS Ward," just published by Harmony, in which he recalls his years as an attending physician at St. Clare's AIDS Ward 3A. Hardly a memoir--it features virtually nothing about the author's personal life--it is instead a memory book for "people who by and large have been ignored, who are marginalized, who are not really thought of as being important."

Baxter begins and ends his account by describing memorial services the hospital holds every three months for patients who have died. Generally, they are sparsely attended; as he writes, "There are often more people at a Greenwich Village memorial service for one gay man than there are at St. Clare's 30 minutes of remembrance for the scores of its AIDS patients ." That's a vivid metaphor for the isolation of these individuals, and it is underscored by Baxter's decision to spend the bulk of his book writing about people he first introduces among the dead.

As a result, this is an AIDS book like no other, a report from the inner-city trenches of the disease. St. Clare's, in the Hell's Kitchen neighborhood, is overcrowded and dirty, with doctors and nurses stretched to the limits of their endurance. Patients often disregard treatment, going AWOL for sex or drugs. In one especially wrenching episode, a patient named Sarah overdoses on crack in a hospital linen closet, and CPR is initiated in the corridor, beneath holiday tinsel.

Sarah, however, will neither die nor be revived. Instead, she slips in and out of death, "like a wraith that refuses to disappear completely." Each time she's declared dead, someone detects a heartbeat, inspiring a new round of resuscitation. Finally, with a priest yelling, "Lord, make up your mind!" Sarah gives up the ghost. It's a difficult moment, heartbreaking and absurd, but Baxter describes it with an unemotional eye.

*

Given the intensity of even the most routine day in a place like Ward 3A, it's no surprise that a major issue is doctor burnout, more than threats like needle-stick infection, which, contrary to popular opinion, is exceedingly rare. "Tuberculosis is a big thing to be concerned about," Baxter says, "but a far greater danger is the damage that working in a setting like this can do to people's souls and psyches."

Paradoxically, though, his experiences have led to precisely the opposite reaction: a sense of privilege and commitment enhanced by what he faces on the job. Thus, while often angry at the difficulty of providing adequate treatment--"any doctor who's worked at Spellman or a similar institution can cite many instances where people did not get what we judged to be optimal medical care"--Baxter aspires to a more philosophical point of view.

"Because of my AIDS work," he says, "I realize that we all live in inconstant time. As glib as it may sound, we're all HIV -positive, which is one of the many lessons I learned from my patients. There's a sense of exhilaration I have leaving work, not an exhilaration of 'Oh my God, I'm glad I'm out of that place,' but a sense that life is very important, very valuable, and you never know when it's going to be your last day. A happy life is one that carries death on its shoulder as a friend."

This position is particularly interesting since Baxter regards himself as an atheist and claims to have no religious views. "As Christ says, 'The kingdom of God is within you,' and I happen to feel that we're the gods." It's an attitude contrasted by the religious artifacts in his apartment, as well as his habit of describing aspects of his life in spiritual, nearly biblical terms.

Of the decade he spent in private practice, for instance, first in Michigan City, Ind., and then in Clinton, Iowa, he says, "Basically, I was lost in the wilderness," referring to a lack of connection in his work. "There was no empathy, no examination of larger issues. I was very young and full of myself, and the relevancy of death and disease and suffering to me personally was something I never really considered. So in 1987, I decided to get out."

Although it may seem overstated, Baxter's passage from a traditional medical career can be read as a pilgrimage from detachment to engagement with the larger world. For his part, Baxter sees it as a more accidental process, noting that he took the job at St. Clare's both for its challenges and because he wanted to move to New York. By the same token, he says, the fact that he is gay played little part in his decision to immerse himself in AIDS work.

"Even if I weren't gay , I would still want to do the sort of work that I do. The vast majority of people I took care of at St. Clare's, and I'm taking care of now, are not gay ."

Nonetheless, it's not difficult to trace a progression from the values of service and humility Baxter learned as a child through his residency at Case Western Reserve University, where he was taught "my medical conscience." At St. Clare's, this mantle has been taken up by Sister Pascal Comforti, head of the pastoral care program, a woman Baxter calls "an extraordinary friend and mentor, and a living saint." Perhaps because of her influence, he says simply that "if Christ were alive today, he would be at St. Clare's, not at St. Patrick's."

Baxter's point is made explicit by a passage when he asserts that "the body of Christ has AIDS," a reference to his belief that "the HIV epidemic is the challenge of our time."

"You see," he continues, "AIDS is our chance, our opportunity, to care for other people. Of course, in the world today, it's not looked at like that, it's looked at as a plague, something unclean, something people would prefer to just go away.

"But I believe that human beings have an obligation to take care of each other, an obligation to care about both themselves and other people. We should take Christ's words, 'Inasmuch as ye have done it unto one of the least of these my brethren, ye have done it unto me.'

"It doesn't have to be religious; you can make it purely secular and humanistic by changing the words to: 'Inasmuch as you have done it unto one of the least of these my brethren, you have done it unto yourself.' But the point is that the human race has never suffered when people stop and take care of other people."

(BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Changing Face of AIDS in L.A.

New cases in Los Angeles County attributed to men having sex with men:

1988: 83%

1995: 75%

New cases in Los Angeles County attributed to intravenous drug use

1988: 5%

1995: 6%

New cases in Los Angeles County among African Americans

1986: 15%

1995: 21%

New cases in Los Angeles County among Latinos

1986: 16%

1995: 35%

New cases in Los Angeles County among whites

1986: 66%

1995: 42%

Source: Los Angeles County Health Department

BEGIN TEXT OF INFOBOX / INFOGRAPHIC)

Changing Face of AIDS in the U.S.

1985 1995

New cases in U.S. attributed to men having sex with men 60% 40%

New cases in U.S. attributed to intravenous drug use 17% 26%

New cases in U.S. among African Americans 25% 40%

New cases in U.S. among Latinos 15% 19%

New cases in U.S. among whites 60% 40%

Source: Centers for Disease Control and Prevention

PHOTO: "I believe that human beings have an obligation to take care of each other," says Dr. Daniel J. Baxter, whose new book describes his work among people with AIDS.; PHOTOGRAPHER: JOE TABACCA / For The Times; GRAPHIC-TABLE: Changing Face of AIDS in the U.S.; GRAPHIC-TABLE: Changing Face of AIDS in L.A.

970422
LT970406

Always watch for outdated information. This article first appeared in 1997. This material is designed to support, not replace, the relationship that exists between you and your doctor.

AEGiS presents published material, reprinted with permission and neither endorses nor opposes any material. All information contained on this website, including information relating to health conditions, products, and treatments, is for informational purposes only. It is often presented in summary or aggregate form. It is not meant to be a substitute for the advice provided by your own physician or other medical professionals. Always discuss treatment options with a doctor who specializes in treating HIV.

Copyright ©1980, 1997. AEGiS. All materials appearing on AEGiS are protected by copyright as a collective work or compilation under U.S. copyright and other laws and are the property of AEGiS, or the party credited as the provider of the content. .