When Christine Grady started work as a clinical nurse specialist at the National Institutes of Health two years ago, the AIDS virus was still a mystery and the disease itself was just being recognized as a major public health foe.
Today, researchers have identified HTLV-3 as the AIDS villain. But such advances come too late for most of the AIDS patients Grady has nursed. All but one or two of the 20 patients she met when she arrived have died -- a harsh reminder of the grim statistics of AIDS.
Many might find nursing AIDS patients too depressing. But for the 33-year-old Grady, the job was a natural progression in a varied career that has spanned 12 years.
During that time, she has ministered to patients with infectious diseases in Central and South America, treated cancer patients in Boston and worked in a hospice in northern California.
"So it's not a new phenomenon for me," she says, "to see people very sick and dying."
Yet this soft-spoken woman admits that experience can't always ease the pain of watching so many patients die.
"But on the other hand," Grady says, "I think that some of the most important things I've learned about life have been from people who are close to death. I continue to feel that way with these AIDS patients."
Grady's work puts her at potential risk for the disease, although to date there are no known cases of health care personnel contracting AIDS from on-the-job exposure.
But Grady does believe that "proper precautions" must be taken when treating AIDS patients. "Whenever I teach nurses, I try to emphasize how important that is. I can tell you that the AIDS patients are the first ones to remind you about precautions . They are as freaked out by someone who does something without gloves as they are by someone who puts on armor. They are very careful about protecting others around them."
Every six months, Grady is one of 400 health care personnel at NIH who are tested for antibodies to the AIDS virus. No one who wasn't already in a risk group for AIDS has turned out to be positive for the antibody, a fact she thinks should ease the fears of many people in the general population.
"Here are 400 people who have direct contact and many of whom have been stuck by needles and things like that from AIDS patients , and nobody is antibody positive," Grady says. Grady works at the NIH clinic where many AIDS patients come for confirmation of their diagnosis and -- if they meet the right criteria -- for admission to an experimental treatment program.
She is responsible for easing their way into the NIH system.
"With the AIDS patients, especially on the first visit, I try to spend time with them mainly to calm them down," she says. "I try to tell them that they'll meet a lot of people who will ask them a lot of questions. That they'll get blood drawn and they'll be poked. And I try to tell them to ask as many questions as they can think of. And finally, I tell them not to worry, that there are people who will help them through the process."
About 300 AIDS patients have been treated so far at NIH, and Grady -- who holds a nursing degree from Georgetown University and a master's in nursing from Boston College -- has treated about half of them.
Her work continues on the hospital ward where AIDS patients are treated. Since strong bonds develop over the course of this illness, Grady also is likely to be at their bedside during the final moments of their lives.
Meeting patients early in their treatment gives health care personnel like Grady the opportunity to know them while they're still fairly healthy and functioning normally. Caring for people who are "very, very sick and dying" is much easier, she says, "when you know them and have an appreciation for who they are."
Being close to patients also means sharing their triumphs. She cites one AIDS patient who was diagnosed with the disease two years ago -- on his birthday -- and is beating the odds by continuing to feel well. "He still has Kaposi's lesions one of the opportunistic diseases that often kill AIDS patients , but there aren't any new lesions, and he hasn't been infected with another organism," Grady says. "He's doing very well. He still works full-time and he plays softball.
"This is a very gratifying case."
Then there are the personal tragedies AIDS patients often face in addition to their disease, such as being abandoned by friends and relatives. "It's terrible to have a terrible disease, but what's worse is having your friends and your family turn away from you."
Some AIDS patients are so afraid of the reaction they may get if they divulge their illness that they hide it from family and friends, Grady says. "That's total devastation, because you go through something that's difficult to go through totally alone."
hen the emotional pulls of her work become too strong, Grady says she remembers the words of a dying woman she treated in a hospice. The woman told her that the change that comes over many people in their final days of life is like the brillant transformation that occurs during autumn.
"The leaves are their most beautiful just before they drop from the trees," Grady explains. "In some ways, that's what happens to a lot of people. They become unbelieveably strong and beautiful."