Art

THE LANCET

DISSECTING ROOM Living and dying on an AIDS ward ly conveys the sense of privilege at being allowed into patients’ lives at times of mortal crisis. He bears witness to his Daniel J Baxter. New York: Harmony Books. 1997. Pp 257. $24. patients’ lives and their suffering, showISBN 0-517-70699-7. ing his appreciation and respect for their stories. n 1989, my first year as an AIDS of Mr J. When she first appears on the Baxter is weakest when discussing his ward, suffering from pneumocystis doctor, I met Kevin J, a 21-year-old own feelings working with the mortally carinii, she is filthy and profane and vigboy. He had been raised in abusive ill. He often takes refuge in distancing orously refuses all medical intervention. foster homes and then spent his teenage intellectualisation: “I look at Hector Baxter describes his surprise and joy as, years tricking for food and shelter and and know that I must not allow myself after weeks in the hospital, Ms M blosto feel either sadness or indifference. closing his eyes to his failing health. The soms physically and emotionally. HowGiven the sheer magnitude of death and Kaposi’s sarcoma which had started on ever, he recognises that it is not his suffering on 3A every day, either emohis gums had grown to distend his lips tion every time a patient like Hector R medical treatment that has encouraged into a canine muzzle. An odour of rot dies would destroy me”. hovered on his breath and In other passages he relies in the air around him, and Nick Andrew on cliché: “Indeed, if doche rarely looked up or tors were to personalise spoke. Every day I forced too strongly their myself to walk into his patients’ sufferings, they hospital room and make would either become happy talk about his gods or go insane in the progress. Facing him, I felt face of the pain and death the inadequacy of what my they face every day”. medical skill could offer, Straightforward descripand the hubris of thinking tions of his feelings would that I could ease this kind have been more useful of pain or even understand and interesting; what are its depth. When he died a we to feel, when a patient few months into his 22nd is dying, if sadness and year, I could not suppress indifference are off limits? my relief. Despite occasional Most physicians share a clunky lines (“. . . as simprofound unease when ple reflection tells us, we faced with suffering for are all ultimately HIVwhich we have no medical positive in this cumbersalve. Like other human some experience called beings, we try not to think life”), and more than a about the inevitability of few notes of annoying our deaths; treating dying self-centeredness (he patients forces us uncominvariably refers to 3A as fortably close to that “my AIDS ward”), the This painting (acrylic on paper, 1995; 73⫻72 cm) is on loan thought. Ordering another book provokes valuable to the Springfield Annexe Nursing Unit, London and is one test or treating a minor self-examination. We all of many works of art owned by the charity Paintings in symptom distracts us from deal with the struggle to Hospitals. our own helplessness; the reconcile our humanity work gives us an excuse and our profession. In not to talk with our patients about the this year of protease inhibitors, we see this transformation, but rather the work fears that often are their most pressing an example in the behaviour of AIDS of the hospital’s pastoral care staff. problems. We prefer rearranging deck clinicians, who have become drunk with Their gentle acceptance provides Ms M chairs on the Titanic to sitting with our the excitement of finally being able to with a chance to express her best self, patients while the ship goes down. do something. Baxter’s book reminds healing a part of her life, even as she is Daniel Baxter explores these issues, us all of the importance for our patients dying. Sister Pascal, the pastoral-care and also the unexpected joy and richthat we risk feeling something as well. director, sums up the book’s theme: ness of working with the dying, in this “Sometimes our greatest gift to people memoir of his work with patients at the Spellman Center, a large inpatient HIV like . . . Rosa is just being there, just Kathleen Clanon unit in Manhattan. Baxter’s story of going in each day to say hello, saying a Division of HIV Services, Alameda County Rosa M, a 31-year-old woman with a few kind words”. Medical Center, 1411 East 31st Street, crack addiction, starts off like the story Oakland, CA 94602, USA In stories like these, Baxter powerfulThe Least of These My Brethren A doctor’s story of hope and miracles on an inner-city AIDS ward

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Paintings in Hospitals, c/o Samaritan Hospital, London, UK

Crespe

Vol 349 • March 15, 1997

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