Michael Saag - Positive: One Doctors Personal Encounters with Death, Life, and the US Healthcare System

The names and identifying characteristics of some of the persons referenced in this book, as well as identifying events and places, have been changed to protect the privacy of the individuals and their families. However, whenever possible, actual names and events were used when the person or a family member granted permission.

Published by Greenleaf Book Group Press
Austin, Texas
www.gbgpress.com

Copyright 2014 by Dr. Michael Saag

All rights reserved.

No part of this book may be reproduced, stored in a retrieval system, or transmitted by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the copyright holder.

For permission to reproduce copyrighted material, grateful acknowledgment is given to the following:
Mona Okada on behalf of Bruce Springsteen: From ONE STEP UP by Bruce Springsteen (ASCAP). Copyright 1987 by Bruce Springsteen. International copyright secured. All rights reserved
Rutsongs Music and Ocean Music Ltd.: ALL FOR ONE. Words and Music by Eric Idle and John DuPrez. Copyright 2004 by Eric Idle and John DuPrez.
Sony/ATV Music Publishing LLC, 8 Music Square West, Nashville, TN 37203.: From A DAY IN THE LIFE. Written by John Lennon and Paul McCartney. Copyright 1967 Sony/ATV Songs Publishing LLC. All rights reserved.

Distributed by Greenleaf Book Group LLC

For ordering information or special discounts for bulk purchases, please contact Greenleaf Book Group LLC at PO Box 91869, Austin, TX 78709, 512.891.6100.

Design and composition by Greenleaf Book Group LLC
Cover design by Greenleaf Book Group LLC
Cover images:
iStockphoto.com/enjoynz/ enjoy industries; iStockphoto.com/Hocus Focus Studio

Publishers Cataloging-In-Publication Data
Saag, Michael S.
Positive: one doctors personal encounters with death, life, and the US healthcare system/Michael Saag.1st ed.
p.; cm.
Issued also as an ebook.
ISBN: 978-1-62634-064-0
1. Saag, Michael S. 2. PhysiciansUnited StatesBiography. 3. Medical careUnited States. 4. AIDS (Disease)PatientsUnited States. I. Title.
R154.S22 A3 2014
610/.92 2013948287

Part of the Tree Neutral program, which offsets the number of trees consumed in the production and printing of this book by taking proactive steps, such as planting trees in direct proportion to the number of trees used: www.treeneutral.com

Printed in the United States of America on acid-free paper

13 14 15 16 17 18 10 9 8 7 6 5 4 3 2 1

First Edition

For those we might have saved yesterday, if only wed had more knowledge. And for those we could have saved today, if only wed had more courage.

I feel sorry for the aspiring young doctors who are assigned to me as residents and house staff; they have to put up with my nonsense and pretend to enjoy it. At the outset of our time together, I always say to them with mock gravity, I will give you my three rules for survival as a physician, and a fourth rule for when youre on service with me.

Rule One: Treat every patient as if every one were a family member. Every one of them deserves the best you have to give.

Rule Two: Be honest, especially with yourself. Dont bullshit yourself or pretend you know something you dont, because thats when youll make a mistake and people will get hurt.

Rule Three: Have fun. The practice of medicine should be a joy, and if you arent having fun, youve either picked the wrong specialty or youre morbidly depressed.

And the fourth rule, specifically for when youre working on my service: No matter what, its all about me.

After listening with extreme earnestness to my first three rules, the newbies hear Rule Four and crack up. They exhale and relaxand, sometimes, they get my point: that this life is never all about any one of us. Its about teamwork toward a common goal.

Its also true of this book.

After years of threatening to write a book, I never would have gotten off the dime to do it without the support of two people: my cousin and inspiration Mary Fisher, and my longtime adviser and friend, A. James Heynen.

Mary has shown me, through her example, that living courageously and with purpose, we can all make a difference and that everything is possibleincluding writing a book. Mary has been with me through the past twenty years of my professional journey, as a patient. Shes heard me marvel at the advances we have made on the science front; shes listened when I despaired at barriers interfering with making the science come to life in practice.

Jim Heynen is my guardian angel. His day job is as an organizational consultant, but for me, he is my lead sounding board and life coach. I am very grateful to both of them for helping to convince me that a book in this area was needed, and for encouraging me to keep pushing until it was done.

Patty Edmonds has served as my lead editor for this project. While I have written many grants and manuscripts for publication in the scientific literature, I have never attempted the type of writing required for telling a story in a book. Patty led me gently into this new world and helped me find my voice. I am forever grateful to her for her patience, honesty, impeccable journalism, professionalism, and soul!

A huge shout-out goes collectively to my colleagues, my fellow providers and fellow investigators, locally, nationally, and around the world. As I have said to most of them while I was writing this book, Any one of you could have written your story and it would be just as compelling. Each one of us took care of too many patients to count who touched our lives, moved us to tears, and inspired us to do our best to bring HIV/AIDS under control. The work we did at the University of Alabama at Birmingham (UAB) was directly connected to clinics and labs around the world, each of us doing our part to contribute to solving the mystery of this horrific disease that rudely roared into our consciousness in the early 1980s. This is especially true regarding my colleagues at the 1917 Clinic, several of whom are profiled in this book. Jim Raper is a consummate leader who puts his soul into his work, as well as his heart. Malcolm Marler brought GRACE to the clinic, both literally and figuratively. And the many, many coworkers, physicians, nurse practitioners, nurses, social workers, pharmacists, receptionists, lab technicians, psychologists, counselors, clergy, and medical records and administrative staff, all of whose collective intellect, insights, wisdom, generosity, honesty, tireless effort, and heartalways heartare constant inspirations. Especially while writing about these folks, Ive seen again how their heart has eased the pain of the collective losses we all experienced over the years. Thank you.

At the risk of leaving out some key colleagues and collaborators, I am compelled to mention several collaborators and friends who enabled me to have success both as an investigator and as a provider. Paul Volberding and his San Francisco colleagues vision for a comprehensive HIV outpatient clinic that merged the best in science, clinical medicine, and heart into a single center set the stage for our clinic, and many, many others, to become complete medical homes for patients with HIV and their families. Pauls vision has served me well over my entire career, and he has been a consultant to me on many topic areas, ranging from which professional opportunities to engage in to which shoes to buy while in Italy!