|Office of NIH History|
|Previous Page | Next Page (2 of 5)||Transcripts|
Harden: It probably helped, too, that doctors and nurses were not getting AIDS. It became obvious that people would not get infected just by walking into a patient's room.
Baird: It was a case of “I will watch you and if you are all right, then I will do what you are doing. It must be okay.” But the fear was overwhelming. I would sometimes get a call from the X-ray department if I sent a patient down there. The people there would say that I needed to tell them about these patients because they were ten times worse than a patient with chicken pox. I would reply that this was not so. Chicken pox is transmitted by droplets. This disease is not transmitted that way. This was after we knew it [AIDS] was caused by a virus.
The fear was a big problem and it probably still is in some rural sections of the country. Staff education and development have improved the situation [in hospitals]. People now use appropriate protection and do not take unnecessary risks. When people do not wear gloves and take appropriate precautions, it becomes a safety issue. In contrast, too many inappropriate precautions have the effect of making the patient feel unclean, isolated, and rejected. You have to strike a balance between protecting yourself and not having the patient feel like a leper.
Harden: Were you in a management position at this point in relation to the other nurses? Were you trying to educate them, or were you more or less taking the lead on your own initiative?
Baird: It was more or less the latter. My children were grown, and I was not anticipating getting pregnant. Caring for patients with viral diseases is always a problem for a nurse who is in the stage of her life when she can get pregnant, because of the effect that some viruses have on a fetus.
To be on the cutting edge of characterizing a new disease was fascinating. About a year later I went to see Dr. Henry Masur regarding a position he had for an AIDS nurse. I said to him, “I have read everything written on AIDS.” Of course, that only lasted one year. I was very interested in knowing what the latest developments were and I would volunteer to take care of every AIDS patient who came on the floor. The other nurses were very happy to allow me to take care of these patients. There were two or three patients, and I would always take them as my assignment. These patients needed a lot of nursing care, because of dementia, incontinence, and the many medications they were taking. It was very good experience, interesting and depressing at the same time. Dr. [Clifford] Lane was a good teacher. He would always explain his plan of care to me and the related pathophysiology. It was a very good learning experience at the time I was a staff nurse.
Harden: How many AIDS patients were there in the Clinical Center before you began working with Dr. Masur in October 1983?
Baird: There were probably three or four AIDS patients between 1981 and 1983. There was one patient whom I cared for, actually, for a whole year. I was his primary nurse. He was an in-patient for a whole year. In fact, the Philadelphia Inquirer writer Donald Drake came down and did a feature article on him. He was one of a pair of identical twins. He was the very first twin with whom Dr. Lane did research. We did not know that the patient had HIV at the time, but Dr. Lane knew that the man was an identical twin, and that his immune function was depressed. He knew the man had an identical twin brother who was not gay and who had intact immune function. His goal was to reconstitute the immune system of the sick twin, without knowing about the virus that was there.
For a whole year the patient received interleukin-2, but it did not do anything for him. I think he also got gamma interferon. He was a very good patient because he was intelligent, articulate, and compliant. He was very good for the purpose of conducting research. Toward the latter part of that year, Dr. Lane decided to do a bone marrow transplant [between the twins]. Up until this time, nothing was working. When he did the bone marrow transfer, the patient had a little reaction, he got a rash, which was considered a “graft-versus-host” reaction.
In the subsequent follow-up laboratory work, Dr. Lane showed me how the patient's immune function had improved temporarily, but after a period of months, it dropped back down again. Dr. Lane said that there was something in this man's bloodstream that was causing his immune function to go down. Until we found out what that infectious agent was, we really needed to approach the problem from two perspectives. He said that an anti-viral agent was needed, which later turned out to be AZT [3'-azido-2',3'-dideoxythymidine], and he said that we needed something to boost the immune system. Conceptually, Drs. Lane and Fauci were the leaders in the field.
In August 1983 the twin died. During that year Dr. Masur had come to the NIH from New York. He had been one of the first physicians in New York to identify the syndrome in women. Dr. Lane and Dr. Masur began to collaborate. Dr. Masur was with Critical Care Medicine. Dr. Lane was with NIAID. Dr. Masur was also board certified in infectious diseases, therefore his interest in AIDS. Many of these patients who had pulmonary problems would be sent to Dr. Masur's Critical Care Medicine Unit to get a bronchoscopy. It was a natural collaboration for the two men as both had the same interests and, of course, they both were interested in what was happening in these patients and why immune dysfunctions were occurring.
Dr. Lane told me that Dr. Masur was looking for someone to replace a fellow who had been doing some research for him. He said that Dr. Masur thought that a nurse would be a perfect person for the job because the job required someone who could identify clinical problems, such as when a patient called and said that he had a fever or some other symptoms. In addition, a nurse could also evaluate laboratory work, and a nurse was very detail oriented. Dr. Lane also said that Dr. Masur was married to a nurse, and that his understanding of a nurse's strong points, the strengths that a nurse has, was very good. Actually Dr. Lane was also married to a nurse, so both of them knew about the knowledge and skills of a nurse. Dr. Fauci also married a nurse. Dr. Masur interviewed me and asked if I would be interested in the job. Basically, the job included a wide range of tasks: seeing the patients in the clinic; giving the medications; gathering the data; and doing laboratory work. I was to draw all the bloods, take them down to the laboratory, centrifuge them, and pipette them off into small tubes for frozen storage. Nurses are not trained for laboratory work, but Dr. Masur said that he would teach me. Dr. Masur also said that he wanted me to learn how to use a computer program so that I could keep the data for this project.
I subsequently took the job and about a week into it, I thought, “What have I gotten myself into? Computer work, laboratory work, is this really what I want?” But it was fascinating, and Dr. Masur was a good teacher. He made available to me all of the resources that I needed to learn. I went over to the computer building. I was tutored over there, and I would study the books at night. Then I went down to the laboratory, and the people there showed me how to pipette the blood off. Looking back, I realize that I was not in the appropriate environment as it is now done in the laboratories. I was just wearing a gown, a mask, and gloves to pipette the blood off. Now, all this is done in an P4 [facility]. There was not even any hood because there was so much we did not know, and we thought that it must be safe. Fortunately, I only did this for two to three years. Because the program expanded, laboratory persons were hired for the blood work and they did the work under hoods.
Harden: Would you explain a little more about what the purpose of gathering this information was? What were you looking for in that blood? What data were you getting from that blood?
Baird: Dr. Masur had two interests: first, he wanted to characterize this disease; and second, he wanted to store the patients' sera so that at some point when we did develop a test, we could do the test on the frozen sera. This is, in fact, what did happen. In 1984 we tested the frozen sera with the HIV (HTLV III) test. Dr. Masur wanted to characterize the symptoms of HIV disease and he wanted to characterize the opportunistic infections. He was interested in identifying the pulmonary processes, because many of these men were showing up at the emergency room with Pneumocystis pneumonia unable to breathe. Dr. Masur wanted to know if we could intervene earlier. He wanted to identify some of the earlier signs and symptoms, and he considered whether we should be suggesting some prophylaxis. He had many questions. He was a visionary; he wanted to collect the information. He may not have known what the information meant or how to apply it at the time, but he felt certain the information would come together to indicate something meaningful.
Harden: In your computer program, you would plug in that today you saw a patient with Pneumocystis pneumonia and X, Y, and Z symptoms, and then you would draw blood from the patient and centrifuge it. What else did you do?
Baird: At that time, also, in my computer program I had the names of all the HIV patients, their NIH numbers, and their diagnosis. For instance, if the patients had Pneumocystis pneumonia they would be in one group, if they had Kaposi's sarcoma they would be in another. If they had started any drugs or any studies, that date was listed; if they had been on any other medications, that was listed; and also their status. At the same time that I was generating this program and these data, the NCI [National Cancer Institute] and NIAID were collaborating. A group met every Wednesday. The group included [Dr.] Ed [Edward] Gelman, [Dr.] Dan [Daniel] Longo, Joan Jacob, and several other investigators from the NCI, [Dr. Abraham] Abe Macher from Pathology, Clifford Lane, and several others from NIAID, and Henry Masur and myself from CCMD. The investigators from NCI thought that they should give the patients with Kaposi's sarcoma, which is a neoplasm, chemotherapy, but they were not certain what the chemotherapy would do to the immune system. So the Cancer Institute was naturally approaching the problem from the direction of oncology, while Dr. Lane, who was looking at therapy with gamma interferon and IL-2 [interleukin-2], was approaching the problem from another direction. Dr. Masur was focusing on the pulmonary problems and diagnosis of Pneumocystis pneumonia, and on prophylaxis. The group problem solving was very stimulating intellectually as well as developing new approaches to the problems.
My job was to gather information on everything that the members of the group were doing and get it organized. There was one other nurse, Joan Jacob, who worked as a study nurse with the Cancer Institute at the time. We were the only two nurses, everyone else was a doctor. Joan was keeping track of the NCI patients, but she did not know how to use the computer. She would give me the names and information, and each week I would generate a table for each study. One study was a six-drug chemotherapy for Kaposi's sarcoma. I would create a list of who was on that study, when they started, when they stopped, and their response to the therapy. Fortunately, there were not that many studies and not that many patients, perhaps about fifty. I worked a lot of overtime trying to manage all the data, but it was manageable then compared to the large volume of data now. The program is probably 30 times larger now than it was at that time.
|Previous Page | Next Page (2 of 5)||Office of NIH History | NIH| DHHS|