I’m reading The Great Believers, by Rebecca Makkai. It is stirring up quite a few memories from my time as a medical student. It was 1994 when I met my first patients dying of the AIDS virus. I was a third year medical student – unworldly, eager, hopeful. This was also the year AIDS became the leading cause of death for all Americans aged 25 to 44. AIDS had been killing people for more than a decade. Fear of AIDS blanketed everything, but I had not yet met the disease in person. I met it a number of times in 1994 and the impression sits with me now. I’ve paused my reading several times as I remember a patient, an experience or a conversation. There were the scared, emaciated men on IVs in hospital beds, the anxious friends and lovers lurking in the halls waiting for family to leave so they could sneak a quick visit, and the devastated parents who were often more willing to accept the fact their child was dying than that their child was gay.
I learned how to diagnose Pneumocystis Carinii pneumonia (PCP) on a chest x-ray, bilateral interstitial pattern with a ground-glass appearance. I knew how to spot Kaposi’s Sarcoma, purplish-brown patches or nodules on the skin. And, I soon learned to be suspicious if someone came in with any unusual fungal infection, shingles, weight loss or chronic diarrhea. I practiced the art of talking to people who are dying. Not elderly people at the end of their lives, but the young, at the beginning. Their future lost. In 1994, AZT was still the primary drug. There were significant side effects and drug resistance, plus treatment was often started after an AIDS diagnosis and not necessarily following an HIV diagnosis. We had not yet turned HIV into a chronic disease. This book is set in the ’80s. At least we had hope in the ’90s, which was not present in the ’80s.
It is hard to explain the excitement medical students feel when there is a devastating diagnosis. It is an excitement for what you are getting to learn mixed with a great sadness for what you are witnessing. I was excited. I learned, I bore witness, I held hands, I listened to stories, I hoped, and I watched some leave and others die. I was devastated. Combination therapy would soon be available and that, with earlier treatment, would change the game. There are now over 1 million people living in the US with HIV / AIDS and it is not a death sentence, but for those that have gone before – we sit with only memories. And, now, we also have The Great Believers. Even though I haven’t finished you yet, I’ve already fallen in love. Thank you Rebecca Makkai.