San Francisco General Hospital: treating AIDS on Ward 5B

Jared T. Griffin
Pennsauken, New Jersey, United States (Winter 2016)

San Francisco General Hospital on Flickr

Walking down Potrero Hill’s 23rd Street past the San Francisco General Hospital today, one would never suspect the history that lies beyond its brick walls. Today, AIDS has faded to the background of the national discourse, even in San Francisco, the one American city perhaps most famous for its history as an early haven for gays in the 1960s and 1970s and then as one of the first and most deeply stricken by AIDS when it appeared in the early 1980s. Many who lived during the time have all but forgotten the horror—and tragedy—of the virus that wiped out scores of innocent men without warning or hope and sent a whole nation into panic. Others, however, remember quite clearly, though perhaps they wish they didn’t. Recently Dr. Paul Volberding, MD, famed director of the AIDS Research Institute and director of research for Global Health Sciences at the University of San Francisco, produced a documentary “Life Before the Lifeboat” to commemorate the story of how the hospital rose to the challenge by managing patients with true humanity in the early days of the epidemic.

As the 1970s came to a close, welcoming a new era, a new threat was lurking. After the end of Hippie Movement had given way to the Gay Revolution earlier in the decade, San Francisco had become a site of immigration for gays all over the nation, a home where they could finally feel accepted. As a result, a large and vibrant gay population had formed, identified by everything from the pro-gay legislature to the annual Gay Pride Parade and the bathhouse scene.

But all of a sudden, on the opposite coast of the nation, patients in New York were mysteriously getting sick and dying, accompanied by the same telltale symptoms. Apparently it was a new disease. It seemed to be striking only men who had sex with men. Both the cause and the means of infection remained unknown.

More and more patients were being infected around the nation, now in San Francisco as well. An epidemic was forming.

At the time Dr. Volberding served as a physician and researcher at San Francisco General Hospital. Dissatisfied with the continued situation regarding the disease, which was now known as AIDS, in 1983 he responded by founding the world’s first outpatient AIDS clinic at San Francisco General Hospital. An inpatient ward was also established. On July 25, 1983, the commemorative plaque inside the building reads:

Here on Ward 5B, a group of caregivers gathered to confront a new epidemic AIDS. They created a haven of acceptance and compassion at a time when others called for isolation and rejection. They saw fellow human beings where others saw only contagion and disease. With the volunteer participation of a generous, loving community, they developed an internationally-renowned center of excellence committed to quality of care for the living and the dying.

“Life Before the Lifeboat” interviews several doctors and nurses who served the historic unit during its early days. During this time, due to the general lack of knowledge about the HIV virus, patients diagnosed were essentially expected to die. As a result, the disease appeared to pose a dangerous threat to the very caregivers who sought to help. Chancellor Susan Desmond-Hellmann, MD, who served as an intern and resident at the hospital from 1982 to 1985, recounts her friendship with one AIDS patient, how she lamented having to enter into his room fully gowned and gloved for each visit. “And I do remember talking to Nick, and my other fellow interns, about that big challenge of connecting to patients and feeling like you weren’t afraid of the patient, and yet protecting yourself—and how it just never matched up well for any of us. It was hard.”1

Patients were expected to die, there was nothing they could do, but the ward still sought to treat them as human beings. The community took part, contributing to what became termed the “San Francisco Model.” As doctors and nurses would provide medical care to inpatients, volunteers from the community would arrive on weekends, serving food, entertaining and bringing gifts. Some groups would donate toiletries, slippers and bathrobes, so the patients wouldn’t have to feel so much like patients. All parties worked together to bring them comfort in a stressful time. This period also saw the birth of the “Coming Home” hospice nearby, which was also supported by the Most Holy the Redeemer Catholic Church around the corner. In a lighter moment, one doctor recalls the year 1986, when San Francisco General Hospital participated in the annual Gay Pride Parade, spreading awareness about AIDS.

Though there was plenty pride and camaraderie within the city limits, many patients faced bitter isolation from their families. Ambassador Eric Goosby, MD, who served as Associate Medical Director of the San Francisco General Hospital AIDS Clinic in the 1980s, recalls a typical instance in which he encountered a bisexual man who maintained a wife and children but kept his sexuality hidden from the rest of his family. He was in effect living a “dual life.” Goosby tried to show the man how his dual life was contributing to an internal dissonance that was dampening his immune function even further. The excess stress was killing him, Goosby explains, but ward policy was to withhold judgment. He accepted that deep family tensions were an inevitable added pressure on patients. Families would visit the hospital from all over, struck with the shocking news that their son had AIDS, was gay, and was not expected to survive. Midcentury taboo and stigma had forced many into silence, and often the family would not acknowledge the patient’s partner.

Recognizing patients’ unique needs, the hospital committed the ward to what was called “patient-centered care.” While typical hospital rules restricted visiting hours to certain times, and to only immediate family, they recognized patients suffering from AIDS were dying, so they suspended many rules specially for them. Diane Jones, RN for Ward 5B/5A in the 1980s, describes the policy as thus: “You get to say who comes in your room, and who gets to be with you at the moment that you’re dying, and who is it that you’re going go home to, and who do we teach how to help take care of you when you go home.”2 As caregivers, she says, their job was to take care of physical pain, but also to “speak to the psychical pain, the emotional, spiritual issues that were going on for them, and I think that was a lot of what we did, was to try to create this environment.”3  Lisa C. Capaldini, MD, MPH, who served as an intern and resident at the hospital from 1983 to 1986, reflects warmly on the experience: “I think that was one of the great things about that ward was it was run by nurses.”4

Now that in the years since we’ve learned to control the HIV virus to a large extent here in America, we may feel a certain detachment from this chillingly recent period in time. But as the film comes to a close, Dr. Volberding hopes their work will not go in vain: “To me maybe the most important thing is that we need to remember.”

Notes

1. “Life Before the Lifeboat”
2. Ibid
3. Ibid
4. Ibid

References

“Life Before the Lifeboat: San Francisco’s Courageous Response to the AIDS Outbreak”. University of California San Francisco. pub. 28 April, 2014.
Ruiz, Sergio. “San Francisco General Hospital Expansion”. Wikipedia. <http://en.wikipedia.org/wiki/San_Francisco_General_Hospital#mediaviewer/File:San_Francisco_%20General_Hospital_Expansion_(9037575223).jpg>

 


JARED T. GRIFFIN is an English teacher who lives in Pennsauken, New Jersey.

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