HIV/AIDS: a personal retrospective on a prototypical pandemic

The HIV/AIDS pandemic richly illustrates the historian Charles Rosenberg's construct of epidemics as four-act plays: progressive revelation, the management of randomness, the negotiation of a public response, and subsidence and retrospection. In developed countries, we are now in Act Four. Among the numerous areas of HIV/AIDS that invite reflection, I've focused on its implications for medicine as a profession as opposed to a job or trade. The availability of effective technology determines the relative importance of competence (doing the right thing well; basic professionalism) and "compassion" (service that clearly transcends self-interest; higher professionalism). Those of us who became "AIDS doctors" during the pandemic's early years were privileged to live through what amounted to a truncated history of medicine. It was quite a ride. But most of all, I remember patients, both individually and collectively, from those early years. My proudest achievement is that none of my private patients died in a hospital. My most-cherished memento is a paperback book bequeathed to me by the widow of "Jake"-the early AIDS victim who never told his wife how he got those scars on his forearms. She'd inscribed it: "Dear Dr. Bryan, Thank you for letting me die gracefully." She and many others gave me lessons in courage and in what it means to be a doctor.