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Becoming a Physician—By Being a Patient (Part 2)

By Keith E. Loring, MD, MPH, FACEP

Note: Part two of the "Leaning to be a Physician: Experience Gained from being a Patient" article originally published in the June 2014 issue of San Francisco Medicine.

After all the build-up, I was completely unprepared for the emotions that came flooding in when I began taking meds. That's when my HIV infection finally became very real. And reality hit hard. I shed a lot of tears and relied heavily on the counselor I had found through the Episcopal Cathedral congregation in Baltimore. For a good ten days, it was all I could do to stay awake long enough to get through an eight-hour shift. Yet it was in those dark days of starting medication that my spiritual journey finally took off. Suddenly and unexpectedly, I woke up one morning feeling like a kid, fully energized. I was also filled with a profound awareness of just how much my body—and my spirit—had been hijacked by the virus. In that moment of awakening, it was clear to me that I had a great deal to be thankful for, not the least of which was quality of care I was receiving. 

Renewed energy also awakened my inquisitiveness about HIV in general, which in turn heightened my level of anxiety about every little itch and scratch. I began reading obsessively and started pestering Janet with every little worry. She cured my hypochondriasis in one fell swoop by asking me what I was reading. "Harrison's chapter on HIV.” “And who wrote it?” “Anthony Fauci.” "Do you know how many patients Anthony Fauci has seen in the last ten years?” “No.” “The answer is none! Keith, I need you to stop reading for now and let me be your doctor." It was a liberating moment, a release and a relief. I could place my energies elsewhere, trust in my physician, and move forward with my life.

With my fellowship year quickly coming to a close, my heart was set on returning to the Bay Area, which prompted one final referral from Joel: his former residency colleague, Lisa Capaldini, who became my physician here in San Francisco. And like every good doctor before her, she set some very clear expectations: “I have two rules: Number one: If you experience any symptom for more than three days, then I want you to call me. Number two: Every Christmas, you have to send me a card with a picture of your dog. If you don't have a dog, a cat will do." Like Janet before her, when it comes to managing my HIV, I defer to Lisa. And it is all working out just fine.

In that moment when I knew I was exposed to HIV, I knew exactly what I needed to do. My intuition was to go out and get some AZT and start taking it. In 1989, there was no data to back such a move; however, I just knew it would work. In retrospect, my intuition was spot on. But I didn't follow it. I was frozen by shame. I allowed myself to believe in a lesser me who was getting just what he deserved. When I finally was able to gather my courage and reach out for help—as a patient—I was met with nothing but courageous compassion. Was it because I was a physician? Did that make a difference? Perhaps. But looking back at those delicate, angst-filled moments two decades ago, I find it hard to believe how anyone I confided in could see much more than a frightened little boy in need of some direction and a lot of reassurance. Because my caregivers believed in me when I didn't, they showed me how to care for myself, and thereby others, in a very profound way. As a patient, I was taught ever so elegantly by Joel, John, Janet, and Lisa how to be a physician, how to listen with my ears and my heart as the best way to help patients muster the strength and courage they need to find healing in their lives. 

And now, two decades later, thanks to a lot of good fortune and a willingness to follow my intuition, I'm currently participating in a Phase I HIV immunotherapy protocol. Whether it is in the direction of a cure or not, I cannot begin to describe the amount of gratitude I feel to be in a position to participate.

Click here to read part 1 -- Becoming a Physician—By Being a Patient.

Keith Loring, MD, currently practices emergency medicine at the Davies Campus of California Pacific Medical Center. He graduated from the Stanford University/Kaiser Permanente Emergency Medicine Residency Program in 1994 and served as assistant chief of service in the Department of Emergency Medicine at Johns Hopkins Hospital from 1994 to 1995. He then joined the part-time clinical faculty in the Division of Emergency Services at San Francisco General Hospital (1995–2010) and established a full-time clinical practice at St. Mary’s Medical Center (1998–2012), where he served as medical director and chief from 2002 to 2006 and vice chief of staff from 2007 to 2010. 

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