Dr. Hacib Aoun remembers the moment at Johns Hopkins Hospital in February 1983 when he believes he became infected with the AIDS virus.
The Venezuela-born physician, then a 27-year-old resident at Hopkins, was taking care of a teen-age boy with leukemia who had undergone a bone marrow transplant and received multiple transfusions. Suddenly the boy began vomiting blood.
Aoun grabbed a thin glass tube and collected a small sample to get a quick measure of the patient's blood count. He ran to the laboratory and jabbed one end of the tube into a putty-coated card designed to plug the end so it could be spun in a centrifuge -- a simple action he had performed many times.
This time, the blood-filled tube shattered and Aoun inadvertently drove its jagged end deep into his finger.
Aoun became ill about three weeks later with fevers, a skin rash, exhaustion, muscle aches and enormously swollen glands. Blood tests and biopsies of his lymph nodes and bone marrow revealed nothing. After a few weeks he recovered.
At the time, the virus that causes acquired immune deficiency syndrome had not yet been discovered and no blood test for it existed. But when Aoun developed fatigue and weight loss last November, he and his doctor recalled the 1983 accident and decided to test him for infection with the AIDS virus even though he had no other risk factors.
The test was positive, indicating AIDS infection. A stored blood sample from Aoun's young patient, who had died of complications a few weeks after the 1983 incident, also was positive on two separate tests for infection with the virus, according to a report from the Maryland state laboratory.
Today both Aoun's health and his prospects have been shattered. He has AIDS-related complex (ARC), a disorder that is milder than AIDS but usually progresses to the full-blown disease. A former chief resident at Hopkins with a promising career in cardiology, he cannot find a job. On good days, he feels well. On bad ones, he feels warm and tired and his muscles ache.
Aoun's case illustrates the dilemma the AIDS epidemic poses for health-care workers and hospitals. For workers, there is increasing fear of accidentally becoming infected, with tragic personal and professional consequences. For institutions, there is concern over how to protect employes without denying care to people with AIDS. And when a worker is infected on the job, it raises thorny questions about confidentiality and institutional responsibility.
Aoun, by all accounts a brilliant and dedicated young doctor, said that one of his superiors, when told of his infection, responded, "You know, medicine these days has some risks because of this disease."
Aoun said that as a doctor, he accepts that risk. "If you're in the room and your patient starts to throw up blood, you're not going to say, 'I'm going out to put on my gloves and my gown,' " he said. "The risk is there. Fine."
But he added, his eyes filling with tears, "These institutions have a responsibility for the young people that work there on the front lines. They should provide them with life insurance and accident insurance, just like a NASA astronaut or a commercial pilot. Because if something happens to them, as in this case, it's very easy for the institution to get off."
In June, Aoun filed a $35 million suit against Johns Hopkins Hospital and two former superiors -- not over the accident but over the way he was treated once the cause of his illness became known. He claims hospital officials broke an agreement to keep his infection confidential, spread rumors that he had contracted the virus sexually, failed to provide promised compensation and manipulated blood samples to try to discredit his claim that he had been infected by a patient.
Attorneys for the hospital and Johns Hopkins University deny the allegations. They claim that the hospital had no legal obligation to keep Aoun's infection confidential and that he was offered a much more generous compensation package than required under state workers' compensation laws.
Dr. Patricia Charache, director of the hospital's microbiology laboratory, denied that the hospital had manipulated blood samples. She said three laboratories ran additional tests on the same sample that the state laboratory reported as positive and that the results were negative. However, she said the leukemia patient could have been infected with the AIDS virus without having a positive blood test.
Aoun became a resident at Johns Hopkins in June 1982. His accident happened eight months later. He said the patient had received "at least 50" units of blood, so he was worried about contracting hepatitis or other blood-borne infections. When he got sick after the accident, he went to see Dr. James Wade, his chief resident. A battery of tests came back negative.
Aoun said his symptoms disappeared after 15 days, except for the swollen glands, which did not shrink to normal size for months. He finished his residency in June 1984 and began a Hopkins training program in cardiology.
By last November, Aoun had begun losing weight, and at Thanksgiving he felt too tired to enjoy visiting with relatives. So he went to see Wade, now a cancer specialist at the University of Maryland. (Wade declined to be interviewed.)
Once again, Aoun said, tests for a variety of illnesses came back negative. "Jim asked me, 'Are you worried about the needle stick?' " he recalled. "I said, 'Yes.' " He said Wade then suggested that they test for infection with the AIDS virus.
Aoun and his wife, Patricia, learned that he was infected with the virus last Christmas Eve. "We had a miserable Christmas," he said. "Patricia would not stop crying. There was nothing I could do to comfort her . . . . There was uncertainty about everything, every aspect of our lives."
His wife and their 16 month-old daughter have tested negative for the virus.
Last January, according to Aoun, Wade obtained two blood samples from the leukemia patient that had been saved by cancer specialists at Hopkins. The first, taken before the bone marrow transplant, tested negative. The second was taken on March 21, 1983, after the patient had received multiple transfusions. It tested positive on two different tests, the ELISA and the Western blot, according to a report sent to Wade by the Maryland state lab.
Aoun said he then went to two superiors, Dr. John Stobo, chief of internal medicine at the hospital, and Dr. Kenneth L. Baughman, assistant dean of postdoctoral programs at the university. After each agreed to keep the information confidential, he told them of his illness and asked for financial help.
Aoun said Baughman promised him a job in the cardiology department. He said that a few days later, Baughman told him he had discussed the situation with several people, adding, "I had to give them your name."
Aoun said that after weeks passed with no news about the job, he consulted a lawyer. He said that in March, Stobo offered him a job in one of the hospital's clinics, which he accepted. Several days later, he received a letter saying that the job was part of a package that included workers' compensation once he became disabled and the chance to purchase life insurance from the university up to three times the amount of his salary.
Aoun decided the life insurance was inadequate and refused the package. He said the hospital then withdrew the job offer, instead offering a lump payment and suggesting that he declare himself disabled and apply for workers' compensation. He said he refused because he wanted to keep working.
"I have the talent. I have the energy. I dreamt all my life of being a doctor," he said. "I want a job and insurance for my family."
Meanwhile, Aoun said, lawyers for the hospital and university implied in letters to his lawyer that he had contracted the disease sexually, and rumors about his illness spread throughout the Hopkins medical community. Colleagues elsewhere told him they had heard the rumors.
In June, he said, his lawyer received a letter from university lawyers requesting a list of his past sexual partners. "I've never been in any risk group. I've never been homosexual or bisexual. I've never been promiscuous," he said. "I was the kind of person that professors at the hospital wanted to match with their daughters . . . . "
Dr. Jeffrey Brinker, a former colleague in the cardiology department, said he was convinced that Aoun's accident had caused his infection and that he knew of no conspiracy by hospital officials to suggest otherwise. "One of the problems you see when dealing with a disease like this is that . . . it is almost human nature to say, 'I wonder how he or she really did get it,' " he said.
The bitter legal battle, he said, has obscured the human tragedy of Aoun's case.
"The issue is: He is sick and deserves some reaction from us," he said. "I'd like to think physicians in universities like this could take care of their own. That's the biggest disappointment in all this."