LEAST OF THESE MY BRETHREN (Life on an AIDS ward)($13)

HB: 0-15-600588-3

Subtitled: A Doctor's Story of Hope and Miracles on an Inner-City AIDS Ward.

"Compassionate," "heroic," "inspirational," are the words people use to describe Dr. Daniel Baxter. Strangely enough, those are also the words that emerge when Dr. Baxter describes the residents of the Spellman Center at New York's St. Clare's Hospital, where the poorest, most neglected AIDS patients live out the last of their often miserable lives and where Dr. Baxter spent three-and-a-half years caring for them. It's in these darkest circumstances--in Spellman's chaotic, decrepit, death-choked hallways--where redemption happens, where life is, finally, reborn.

Baxter does not spare the gritty details of Spellman, but more profoundly affecting are his descriptions of the hope that rises from AIDS's ashes--the loving gesture where there was only hate, the lucidity where there was only confusion, the emotional connection where there was only alienation. Spellman becomes, in his telling, a crucible of despair and hope. At the very least, what Daniel Baxter gives us here is essential insight into the world of AIDS and inner-city medicine, but its heart-breaking stories and sharply observed details transform this book into a radically inspirational experience.

"'How can you stand to work with so much death around you all the time?' The pleasant young woman's query was voiced sympathetically---even admiringly--and without recoiling disgust or disbelief. My questioner was a recently hired secretary in the Spellman Clinic, who had been randomly seated next to me at the Helen Hayes Dinner Dance, the annual black-tie gala thrown by St. Clare's Hospital that is a major fund-raiser for the financially strapped hospital. After the initial, introductory pleasantries, our conversation that evening--as often happens in such situations---quickly devolved into talk about our work at St. Clare's, especially the inpatient AIDS ward on which I was an attending physician.

Indeed, the topic raised by my dinner companion--AIDS deaths, primarily of impoverished inner-city patients --seemed starkly incongruous with our august surroundings: a glittering ballroom with innumerable balloons and glimmering tinsel hanging from the crystal chandeliers in midtown-Manhattan's Marriott Marquis Hotel, where hundreds of elegantly attired and coiffed patrons and staff of St. Clare's Hospital were seated at festively decorated tables for eight and entertained by a live band. The elaborate six-course meal and fancy place settings almost made the $350-per-person cost seem reasonable. Fortunately, my secretary friend, like most other nonphysician staff, was there on a discounted $50 ticket. Nonetheless, the New York glitz was light-years away from my dingy, desolate AIDS ward.

"'I think what you do is wonderful,' my new admirer continued, again without affectation, 'but I just don't think I could handle it. How do you do it day after day?' Her question was difficult to answer succinctly without sounding like a Hallmark card, or dial-a-prayer sentiment. Her kind compliment about my 'wonderful'" work embarrassed me. I wanted to reply that I have always viewed my AIDS-ward work as a privilege, a job that always gave me more than I would ever be able to return--but in the past such protestations have sometimes sounded like false modesty. Being a doctor on an inner-city AIDS ward is a somewhat rarefied occupation, and I am often inclined to dismiss such flattery and inquiries with polite generalities, telling myself that people cannot really understand, unless they are right there with me, on my ward.

"Yet, as on similar occasions, I wanted to answer my dinner acquaintance truthfully, and I felt frustrated at my inability to do so. I wished I could share with her the incredible insights and important lessons I experienced every day in my AIDS work--to give full dimension to my oft-repeated assertion that my job at the Spellman Center, St. Clare's AIDS service, was 'the best job I've ever had' in my nearly twenty years of being a doctor. Moreover, on that gala evening, I wanted to reassure this young, attractive woman that death was not the fearsome enemy she seemed to imagine--that, if she harkened to the lessons of my AIDS patients, she could certainly 'handle' the many AIDS deaths on a Spellman ward not only with equanimity but also, perhaps paradoxically, with joy, a transcendent grace. But the loud band and the surrounding table conversation that evening did not permit such an impassioned reply to her well-intentioned and profound question.

"This book is intended, in part, to answer my dinner partner of that Helen Hayes benefit several years ago--to help her understand the extraordinary experiences I have had on my AIDS ward, in an attempt to illustrate the reassuring and life-affirming lessons that have so impressed me over my years there. Although enclosed herein are many patient stories of love, hope, and courage - stories that often transpire under the most desperate circumstances--this book is more than a collection of individual narratives. These patient stories--many of which are graphic and, at least on the surface, undeniably sad--serve a larger purpose of helping readers examine their own concerns about living and dying, since, as simple reflection tells us, we are all ultimately HIV-positive in this cumbersome experience called life.

"The idea for this book blossomed gradually. Initially, I had planned to write ouly an article about an extraordinarily 'impossible' patient I had cared for on my AIDS ward--the patient 'Stephen Y.' Stepben's case had so profoundly impressed-and emotionally exhausted---me that I felt compelled to share his extraordinary ordeal with others. Then, on a wintery Sunday afternoon, while listening to a sacred-music concert in a Midtown church--I was thinking about how I should approach the Stephen Y. story - the idea of writing a book about my AIDS ward flooded over me. Despite subsequent self-doubts, I have always persevered in my belief that this book's central message of hope must be told, both as tribute to my many memorable patients and as a cautionary message to others, such as my inquiring dinner companion at the Helen Hayes gala.

"This book is based on my three and one-half years as a physician at St. Clare's Spellman Center for HIV Related Diseases, New York's largest Designated AIDS Center. The patients' names and circmmtances have been changed, and to preserve confidentiality further, various details have sometimes been altered. Nonetheless, the pages that follow faithfully capture the essential nature of my experiences on my AIDS ward, that 'crucible of despair and hope.'" - from the Preface by the author.

"Extraordinary... You wish [Baxter] were every doctor, and that everyone you love could be in his gentle, supremely human care." - Chicago Tribune

"Extraordinary...He gives us an illuminating, selflessly affirmative answer to the eternal question and its mate: whether God is really with us, and for how long." - Newsday.

"Compassionate ... a tribute to the many patients, living and dead, for whom Dr. Baxter has cared. It is also his gift: to those of us who do not bear witness to the horrible scenes played out every day behind the doors of an inner-city AIDS ward; he gives us a chance to gain a little humility from listening to our dying brethren." - New York Times Book Review

"The stories ... possess a Tolstoyan power.... Clearly a man of immense sympathy and spiritual strength, Baxter here writes not only about the dying but also about the various ways that people confi:ont death .... This book makes for powerful reading." --Washington Post Book World

"This book does for the medical view of AIDS what Patti Monette's Last Watch of the Night did for the personal aspect." - Publishers Weekly (starred review)

"Although Dr. Baxter's well-told stories concern AIDS patients dying in the dreariest of physical settings.., they also show, with incredibly moving and honest compassion, a way to discover the human heart, basic values, and individual character. This book.., inspires us to wake up and care for our suffering brothers and sisters." - Thomas Moore, author of Care of the Soul and the Reenchantment of Everyday Life

"A powerful, challenging and highly spiritual book." - Catholic Register

DANIEl J. BAXTER, M.D., is director of adult medicine at the Ryan Community Health Center in New York City. He is also a member of the board of Body Positive and of the AIDS Divisional Committee of the Jewish Board of Family and Children's Services.

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