Fresh from nursing school in the early 1980s, Eugenie Marek didn’t know her first job as a registered nurse would find her in the middle of San Francisco’s burgeoning AIDS epidemic. But it was soon clear, she recalls of her early days at Mt. Zion Hospital, that “there was something going on.”
“There were rumors, and then strange cases began showing up in hospitals”—such as cases of Kaposi’s sarcoma, which disfigured otherwise healthy young men. “It came to be called ‘the gay disease,’ briefly, because it seemed to be affecting only gay men,” she remembers. “That was about as deep an understanding as we had in those days.”
As the new disease devastated the city’s gay neighborhood, Eugenie took care of her patients—and worried for her friends. “I’ve lived in San Francisco since 1976,” she says. “Here, it was very easy to have gay friends in my life. So I knew people, and I had friends who were worried for themselves.”
“Then the newspaper started profiling the disease, with a lot of unanswered questions,” she adds. “The progression was: You got HIV, you advanced to AIDS, and you died. It was extremely frightening, and at that point we really didn’t know what might be an infectious factor other than blood and sexual contact.” As a nurse, Eugenie approached the fear and uncertainty with common sense, and never questioned her vocation: “It was my job to be a nurse.”
Although standard practice today, wearing gloves during medical procedures was not always common among health care workers before the HIV/AIDS epidemic. Something good to come out of the fear and uncertainty of the time, Eugenie says, was the adoption of now-standard “universal precautions” like wearing gloves with all patients to avoid exposure to potential pathogens in body fluids. With these new precautions, “you assumed there was always a chance of some infection risk with any patient, regardless of their diagnosis or medical history, so you always protected yourself,” Eugenie explains. At the time, adopting these precautions not only protected care providers but was also destigmatizing: Health care workers donned gloves before contact with any patient’s body fluids, rather than gloving up only with their AIDS patients.
Eugenie’s experience as a nurse was put to use outside the hospital, as well, as friends became ill and needed information and help. “I tried my best to do what I could for them as their disease progressed, but there was not that much I could do early on, before antiretroviral drugs were available. Mostly, it was trying to give them a hand, spending time with them, being a friend,” she remembers.
“I lost several very dear friends,” she says. “It was heartbreaking.”
Eugenie vividly recalls the difference combination antiretroviral therapy made in the mid-1990s: “People were surviving. First of all, Kaposi’s sarcoma became much less prevalent, and the disfigurement decreased. AIDS became manageable for many people.”
“In fact,” she continues, “I remember a dentist telling me that for several years, he did not urge his HIV-positive patients to undergo potentially painful, costly procedures when their life expectancy was so unsure. But after the medications came out, he changed his mind and started telling all his patients they must get their dental work done.”
Something else that changed was the way medical care was provided. Stronger hospice programs were created to provide end-of-life care for young people, not just the elderly, Eugenie notes, and protocols were developed to allow ill people to have intravenous infusions in their own homes instead of at hospitals or clinics.
And perhaps most noteworthy, the patient-provider relationship was forever changed, as individuals educated themselves and advocated for their own health and medical care. Eugenie remembers how Mt. Zion’s Dr. Marge Poscher—a colleague of Dr. Marcus Conant, who co-founded San Francisco AIDS Foundation in 1982—modeled an open doctor-patient relationship by including her HIV patients in planning and decisions around their medical treatment, which was decidedly not the pre-AIDS standard approach. “There was no guarantee of recovery, even with the new medications, so Dr. Posher gave them information and choices about their care,” Eugenie says.
After all she has seen in three decades of nursing, what does Eugenie think today when she hears phrases like “ending AIDS” and “AIDS-free generation”? “It’s quite amazing that we may be close to the end,” she says. “At the time, it was so frightening and seemed so overwhelming, and people were trying to rush any development forward. I didn’t know if we would find something that would turn it around.”
Today Eugenie is a case manager at Stanford Hospital, less than 40 miles from the hospital where she first faced down HIV and AIDS. As she reflects on her nursing career and looks ahead to her 70th birthday next month, what does she say has been most rewarding about her work as a nurse?
“I still get pleasure from going into a room to meet a patient and family members, and talking to them about their options for care. I enjoy that connection,” Eugenie says. “Everyone is so different; you can’t assume you know what people might want, or how they are accepting medical care, or what fears they might have. I like to think that I listen to people.”
Have you seen how dedicated nurses like Eugenie make life better for the people in their care? Leave them some words of thanks in the comments below!
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