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Interview with Barbara Baird
This is an oral history interview with Barbara Baird on 17 March 1993 at the NIH Clinical Center, Bethesda, Maryland. The interviewers are Dr. Victoria A. Harden, Director, NIH Historical Office, and Mr. Dennis Rodrigues, Program Analyst, NIH Historical Office.
Rodrigues: Would you begin by telling us about your background and training and what led you into a career in nursing?
Baird: As a young adult, I was originally trained in pharmacy. I had gone to George Washington Pharmacy School in Washington, D.C. This was before it was closed down. Before graduating, I got married and moved to California with my Naval officer husband. I was a homemaker and had three sons. About 15 years later, we moved back to the Washington area. By that time the pharmacy school had been closed, so I could not continue my pharmacy degree. I had always been interested in the health sciences, and George Mason University was opening a new nursing school. Many of my credits could be transferred and I was accepted as a member of the second or third class of nursing students.
Harden: Had you grown up in the Washington area?
Baird: I actually grew up in the Pittsburgh area. My young adult life was in the Washington, D.C., area going to school. I lived about eight years in California and then we returned to this area. I decided to go back to nursing school as my children were already in school, and I was getting a divorce. I graduated at George Mason in 1979. After receiving my degree, I worked for a couple of years in Northern Virginia, which is where my home was at the time. I met a person who had been a patient at the National Institutes of Health [NIH]. He told me how great the NIH was and how impressed he was with the care and the research there. I began to look for a position in the Nursing Department at NIH. I found a position as a staff nurse on Eleven East in the NIH Clinical Center.
Harden: What year was that?
Baird: It was 1981. The eleventh floor of the Clinical Center was where patients with immune disorders and some with infectious diseases were housed. These were all National Institute of Allergy and Infectious Diseases [NIAID] patients. I actually worked for the Nursing Department, which was under the Clinical Center.
Harden: What month did you come?
Baird: March 1981.
Harden: That was definitely before the first publication about what came to be called AIDS.
Baird: Absolutely. We had some patients who had genetic immune disorders, some had infectious diseases, others had acquired immune disorders from other causes. We did not have any cases that resembled HIV infection until about December of 1981. Dr. [Anthony S.] Fauci would conduct rounds. That was when his office was still over here in Building 10. I was attending rounds one morning, and we had a patient on the floor who had an unexplained immune dysfunction. During rounds, outside this patient's room, Dr. Fauci expressed concern and was wondering if this patient's case was similar to some he had read about in the MMWR (Morbidity and Mortality Weekly Reports), which is the Center for Disease Control's [CDC's] publication. The article was about a number of gay men who were showing up with a type of immune disorder. Dr. Fauci said that he did not know if this man had the same disorder. There was also some speculation in the group of physicians and nurses as to the man's sexual preference, because at that time we did not query patients about lifestyles. That would have been considered irrelevant information. That was the first time, I think, that anybody had any awareness that something new was going on.
Harden: That was December of 1981?
Baird: Yes, about November, December 1981, or January 1982. We continued to watch that patient. We also did not know that there was an infectious agent causing the disorder. At the time, there were three major speculations about the cause. I remember attending one of Dr. Fauci's lectures in which he discussed how researchers could not determine the cause of this immune dysfunction. At the time they only saw the disease in gay men. They thought that maybe the body was having an immune reaction against the sperm, so that when another male was exposed to sperm, his body would develop an immune response. They did not know whether it was that, or perhaps a response to nitrite usage, because many gays would use “poppers,” which contained nitrites, and we knew that certain chemical exposures could cause immune disorders. An additional speculation was that it was caused by some infectious agent that we did not know anything about and had never seen.
Harden: Were you personally attending this first NIAID AIDS patient? How many nurses probably would have been involved in his care?
Baird: Probably about six, because we had three shifts. The patient had a primary nurse, but during the other shifts, other nurses attended him. We covered Eleven East and West. Sometimes the nurses would cross over and double cover each side. The patient probably had about five or six different nurses. I did not attend him very closely. He was one of the first patients, and I only knew him in a peripheral way.
Harden: Was the nursing staff given any kind of guidelines at the outset in terms of special safety precautions to take?
Baird: No, not specifically. However, we all knew the standard infection control guidelines that were in place at the time and we implemented them when appropriate. The HIV guidelines began when I had my first primary patient. It was at that time that Dr. David Henderson, who is the Clinical Center's epidemiologist, came to me and said that he and other physicians thought that the male patient whom I was attending might have an infectious disease and that they needed to see how I was taking care of him so that they could develop some specific infectious disease guidelines. He asked me what kind of precautions I was instituting. I said that the patient had diarrhea, and I described how we dealt with that. We went through the list of the patient's symptoms, and I told Dr. Henderson what precautions I was taking. I did not wear a mask, but I wore a gown and I wore gloves.
Harden: I remember reading about Dr. Henderson's guidelines, and I would be very interested to know just how they were developed.
Baird: I did not realize the implications at the time nor did anyone else. I was just using standard precautions when Dr. Henderson asked me to tell him what specifically I was doing because he wanted to write guidelines for this particular situation. A couple of years later, I thought about the pretty remarkable things that had happened then, even though we did not know what was going on.
The particular patient that I was caring for was from New York, and he happened to have cryptococcal meningitis. I knew that the disease he had was possibly infectious and it was affecting his brain, causing him to have some odd behaviors. For example, he would walk out into the hall without his pajama bottoms. He also had difficulty with personal hygiene. He was also incontinent of stool, he could not always get to the bathroom in time. He would have diarrhea on the floor. He also had difficulty with coordination and would sometimes spill his urinal. With those kinds of risks, I wore gloves, a mask, a gown, and even sometimes shoe covers because, if I went in the bathroom, excretions might be on the floor. If I was going to do anything where I might aerosolize the urine, then I wore a mask so nothing splashed on my face. If I changed the bedding I would wear a gown. However, if I was just taking in his food tray, I did not wear any special covering. It was also important not to make the patient feel any more isolated or alienated than he did already. Handwashing was one of the most essential and critical elements of infection control.
All of the precautions I was using were adopted as the protocol for these patients with AIDS. I did not know that I was protecting myself against HIV because we did not know then that AIDS was caused by a virus. At that time some nurses were wearing gloves when they drew blood and some were not. I think I wore gloves most of the time, especially if I was going to have my hands in anything, because my hands were chapped and I knew I would be at risk of absorbing something. I probably wore gloves a lot.
Harden: Were gloves specified in those first guidelines?
Baird: Yes. I think gloves have been recommended from the beginning.
Harden: Was everybody good about abiding by these guidelines?
Baird: At first they were not because any kind of change is difficult to implement. It was usually forgetting rather than lack of desire to comply. Many times nurses would go into a patient's room, and simply forget to take the precautions and it seemed like too much trouble to go back out into the hall to get the gown, gloves, and so on. The importance of the precautions had not really been instilled in the nurses. As soon as staff education was in place, people started following the guidelines, but it was fascinating then to see how everybody went too far in the other direction. Everybody then dressed from head to toe, with shoe covers, mask, gown, gloves, and goggles just to go into the person's room. It was a response of fear among many of the personnel.
Harden: Did this response occur before HIV was identified as the cause of AIDS?
Baird: Yes. The housekeeping, nutrition, maintenance, and phlebotomy people were all fearful. Some of the nurses, some of the nursing assistants, and some of the clerks were also fearful. While it was difficult to get some nurses to wear the appropriate garb, other people wore too much, which was also inappropriate.
If I wanted to send a patient down to the Eye Clinic, for example–and this happened several times until we finally got it sorted out–the Eye Clinic would require that the patient wear a gown, a mask, and gloves. I told the Eye Clinic personnel that they were not at risk. The patient did not need to be walking in the hall with all this garb on, and if they wore gloves and washed their hands that would be adequate protection. The patient would only need a mask if he was coughing. They did not believe me, and this sort of reaction continued for a while.
If the cleaning people went into a patient's room, they went in gowned from top to bottom or they did not go in. A room would not be cleaned for a week or so before we realized what was going on. The nutrition people would leave the trays outside the patient's door, they would not take them into the room. After much staff education, after the virus was identified, after the CDC and others identified the appropriate precautions, and after many classes for nutrition staff and other personnel, people finally got it right.
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