San Francisco Chronicle - Monday November 13, 1989
Jerry Carroll, Chronicle Staff Writer

This is the medium in which orthopedic surgeons often function. Their craft only begins to express itself in the scalpel's silent slice. After that, they hew hard bone, sawing and drilling with power tools whose whirring torque throws up this miasma of blood. To them this is no big deal.

But imagine wondering whether sometimes there might be something lethal in that blood rising like fog from the patient, a contagion that worms its way into human cells, yours, and waits, sometimes for years, to attack and then maybe to kill.

One more thing. Imagine you have a husband you love and two beautiful children. Everything to live for, as they say.

Having accomplished this, you are now in the mind of Dr. Lorraine Day, chief of orthopedic surgery, on Oct. 2, 1987, at a meeting with the other chiefs of service at San Francisco General Hospital.

Bad news, the doctors are told.

A nurse at the hospital who accidentally stuck herself with a needle filled with blood taken from an AIDS patient has been infected with the virus. Before this, the experts had said needle-sticks were nothing to worry about.

"I first went to the infectious disease people in 1984 and said we get stuck a lot and did they think this was a problem," Day recalls. They shook their heads and patted her on the back comfortingly.

"Even in 1986 I would say to them, 'This seems dangerous to me.' " She remembers their looking her square in the eye and saying, "No, no, no. You need more blood than that."

But she told herself these were the same people who insisted with equal authority that you couldn't get AIDS from a blood transfusion, only to eat their words later. The same people who also said only 10 percent of those people who were HIV-positive would come down with AIDS and who now wonder whether it might not range up to 100 percent.

Day sat in her chair at the meeting absolutely stunned, as she says, at the news of the nurse with AIDS from a needle-stick. "My whole life passed before me."

She knew how common it was for orthopedic surgeons like her to nick themselves with a bone splinter or a tool during an operation. "I thought, 'How am I going to escape getting this disease?' "

That meeting marked the beginning of Day's emergence from the obscurity of a physician and medical professor respected in her field, but not much known beyond, and her entry into the vortex of bitter controversy and dispute.

Day, now 52, came to be considered by many as a closet homophobe who lent a spurious medical authority to the pronouncements of knuckle-dragging conservatives hoping to herd gays with AIDS into internment camps with towers and razor wire.

"I think she is politically a right-wing fanatic, and that this in part is responsible for her attitude toward the groups that have the infection -- gay and bisexual men and IV users," says Dr. Laurens White, immediate past president of the California Medical Association. "I think she regards them as the scum of the earth."

Others pity her ignorance.

"Sweet Lorraine," sighs Dr. Mervyn Silverman, president of the American Foundation for AIDS Research. "I think she is truly frightened and unfortunately is letting that fear get into the way of a rational approach."

Hearing her critics, you expect to find a virago with stringy hair and burning eyes. Instead -- and in a way this made her provocations worse -- Day is a cool blonde with the classy looks and presence of an anchorwoman in a major market. That, as much as the maverick nature of her views on AIDS, catapulted her into national fame.

And now, as Day told "60 Minutes" in September, she wants to withdraw from the AIDS front lines. Like a pilot who has flown too many missions over enemy territory, she thinks she has used up her luck.

"You don't keep people on the front lines under the threat of death indefinitely," Day said.

Stepping Down

She is stepping down as chief of orthopedic surgery February 1 to concentrate on her duties as an associate professor of surgery at the University of California at San Francisco. Day will still operate on patients, but only a fraction of the number that come before her at San Francisco General, one of the foremost trauma hospitals in the world. For Day that will mean less time in the red mist.

"I do as many operations in one year as the average orthopedic surgeon will do in 10."

In an interview, she spoke in detail for the first time about her rocket ride to high profile and the corresponding hostility of the academic bureaucracy and the potent AIDS research establishment.

Day, who was a model in her undergraduate days, still looks as if she could make a living in that line of work if she had to. Her serious manner is lightened by frequent smiles. Every inch of surface in her office is filled with stacks of medical files, and a three-foot-high backlog of unanswered correspondence sits on the floor.

The day after that bad-news meeting, she and the resident doctors she taught asked for blood tests to determine whether any of them were HIV positive.

"When AIDS first came along, I didn't have much association with the problem. But over time, HIV-positive patients started coming into the emergency room because they got hurt or injured just like everyone else. They've been shot or stabbed or they've fallen out of windows.

"When you have a broken bone, it sometimes has sharp splinters like wood. They go right through your glove. You might have a broken-skin puncture four times a month."

The request for blood tests was stonewalled for two weeks. Imagine her state of mind, says Day.

"I was very nervous. I'd had enormous exposure. It's a nightmare when you go through it the first time."

Finally blood was drawn, and seven weeks later the results came back showing none was HIV positive. Why the delay? Day says she never found out but believes the university was afraid of offending the gay community.

A Sense of Betrayal

The more Day thought about it, the more she thought she had been betrayed by the experts on epidemiology. She began boning up on AIDS research herself. "I found all sorts of things we weren't told."

She soon was in hot water for asking that patients for elective surgery voluntarily be tested for AIDS. This, she said, was so she and the others in the operating room could take extra measures to protect themselves, techniques Day went on to pioneer.

The hospital's position was "I didn't need to know, that all I had to use were the universal precautions, gowns and gloves, which we've been using since the discovery of bacteria. That just showed their blatant ignorance about what goes on in orthopedic surgery."

Most had no problem with the blood test, Day remembers, "until I came to a young man who was obviously a high-risk gay male. He looked at me and set his jaw and said, 'You have to take care of me and you're not testing me for nothing.' "

He told the newspapers Day was demanding blood tests, a big point with gays who feared those found positive would be stigmatized. Day's request became distorted in the telling so it sounded as if she refused to do surgery unless a patient first had a blood test.

"I never said that."

"Frontline" sent a crew to San Francisco General six weeks later to interview members of the medical staff, none of whom agreed with Day. The administration emphasized its displeasure by not allowing the TV crew to talk to her on the premises.

"We had to go outside. I'm the only one talking on the program whose hair is blowing in the wind."

Abandoned

Day says she asked herself: "Whatever happened to academic freedom and freedom of speech?"

A university lawyer called Day while she was in the middle of an operation. As someone held the telephone to her ear, he said that if she were sued for malpractice the university would not defend her.

"How would that make you feel?" she asks. "Nobody even bothered to talk to me to find out if what they were saying was false. They abandoned me and left me there to twist in the wind."

Day says she heard threats she would be removed as chief if she didn't shut up. "For a long time things were tight here, and I was considered a pariah."

Yet Day was deluged with speaking invitations from surgical associations throughout the country. "There's nothing in the Hippocratic Oath that says I have to sacrifice my life for the patient," she reminded doctors.

Day began dressing for surgery like someone entering a space shuttle.

"A year and a half ago, I started wearing a plastic face shield. When I started, I was ridiculed. Now they are mandatory for every nurse. Then I began wearing a space suit a year ago, and other surgeons said, 'Where are you going? Mars?' " Then they began borrowing it.

Little-Known Research

Her close search of the literature turned up bits and pieces of research that were known to the narrow circles of AIDS researchers but that she thought didn't get enough attention from health care workers.

Day began publicizing them herself. Among them:

-- HIV infection in homosexual men at high risk may occur at least 35 months before antibodies can be detected, according to the June 1 New England Journal of Medicine.

-- Contrary to belief, the AIDS virus is not fragile. A 70 percent alcohol solution failed to kill the virus on a surface within 20 minutes, according to a report given at the Montreal AIDS Conference in June.

-- Tests of surgical gloves don't detect holes smaller than 10 microns in diameter, which would allow AIDS and other viruses to come into contact with the skin, according to the Surgical Practice News of August 1988.

-- The AIDS virus may actually be able to enter the body through skin contact, according to The Lancet of Nov. 7, 1987.

"They like to make me out as some kind of a wild woman," Day says, "but I have documentation for everything I say."

Aerosol Vapor Danger

An article last year in the Journal of American Medicine led her to question whether the face mask alone was protection enough. The article about the use of a laser on venereal warts warned that the intact virus was found in the aerosol vapor created by the surgical procedure and was small enough to pass through a surgeon's mask.

When Day wondered why this wouldn't also be true of the kind of surgery she did, her enemies whispered that Day believed you could get AIDS just from breathing the air. "I never said that," she says with cold anger. It is a phrase that recurs in her conversation.

Day began to wear an industrial respirator along with all of the rest of her protective gear, which in some operations came to include double shoe covers, knee-high boots, reinforced disposable gowns, additional sleeve covers, face shield, double or triple latex gloves. Then the space suit.

"I can't say that the AIDS virus is not transmitted by an aerosol," says Dr. White. "It's tough to prove a negative. But I don't know of any evidence that it is, and she doesn't. But she's scaring the socks off people."

There would be a lot more physicians with AIDS if it could be transmitted as easily as Day fears, he said. "It's amazing how hard it is to transmit the disease by accident."

Fanning Hysteria

Her boss at San Francisco General, Dr. Merle Sande, chief of staff, said Day "has fanned the hysterical parts of our personalities and has been destructive in that respect, but I respect her right to her views."

Silverman said if the disease could be spread through intact skin it would be far more prevalent. "Isn't it interesting that she is standing somewhat alone. One would think that if she were somewhat in the mainstream, there'd be support for her from some medical organization."

Day would not have stirred the bitterness she did had she not also attacked what she saw as politically powerful gay pressure groups trying to protect a wanton lifestyle, even if it meant putting others at risk.

As examples, she cites the long political hesitation over whether to close the gay bath houses, one of the great engines of the AIDS infection, and the way public health officials turn a blind eye to the quiet revival of sex clubs.

"When you have hundreds of sexual partners a year, that's not a lifestyle, that's a dangerous behavior."

She was active in the Proposition 102 campaign last year, defeated 2-to-1, which would have required doctors to report everyone infected with AIDS and to allow employers and insurance companies to test for the disease.

"The person who has the fatal disease has all the rights and the public has no right to remain uninfected," she says. "All the legislation that has been passed has been to control the behavior of people who don't have the disease, such as laws against discrimination in jobs and housing. And I think those are good things. But no legislation has been passed to control the behavior of people who have the disease and can give it to others. It amounts to government endorsement of the most self-indulgent and self-centered lifestyle."

Day says she has no political or religious affiliations, nor is she homophobic, as her critics say. "I have nothing against gay people. I'd like to see them stay alive." She sees special hospitals being built in the future to treat AIDS patients as the epidemic grows.

"Oh, now she wants quarantine," she says with sarcasm, anticipating her critics. "They'll get far better care there."

Nurses will have to get hazard pay, she says, and doctors will be drafted military style for duty in them, being rotated out after a time in much the same way Day is pulling herself off the front lines.

At UCSF, Day says, she will be dealing with far fewer AIDS patients, meaning lower risk to herself. But that could change.

"If the risk gets too high over there, I'll have to consider getting out of surgery altogether."

Always watch for outdated information. This article first appeared in 1989. This material is designed to support, not replace, the relationship that exists between you and your doctor.

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