By David Wohl, MD
There are specialists and then there are the super-specialists. The ‘super’ here should be taken less as a superlative and more as a suggestion of beady-eyed focus and a lack of breadth. Instead of knowing a lot about something special, super-specialists know a lot about a part of that special something. Picture the entomologist whose career has been dedicated to the gut of one particular species of ant, or the historian fascinated by the life of one U.S. vice president. What do you see? Probably someone who is not all that fun to have at a dinner party.
I am a super-specialist. It’s okay, I own it. In fact, I have been proud of it (and I am pretty good at dinner parties). Microbiology and infectious diseases may have been my favorites in medical school, but it was HIV that pulled be over the buggy side. Sure, I dutifully completed an infectious diseases fellowship and every decade I sit for that discipline’s certification board examination. But the truth is I am really an HIV-ologist in infectious disease specialist’s clothing. All but a handful of my patients are HIV infected. The journal articles I actually do read are almost always HIV-related. I attend only conferences dedicated to HIV/AIDS. Don’t get me wrong, hanging around an ID division, I do pick up some factual knowledge of lesser pathogens such influenza, cholera, and Malassezia furfur. But, what I know of these and other non-HIV germs is not half of what I know about HIV. HIV is what I do.
Well, now it is not the only thing I do. A few months ago, something new started to pull me from the HIV doc ranks. Ebola.
HIV doctor takes on Ebola: it is a story we have heard before and it should not be a surprise. Much has been written about the parallels between HIV and Ebola: uncontrolled spread, fear, stigma, risk. The current massive and unprecedented outbreak has claimed over 8,000 people this year, many of them young. As in the early days of the HIV epidemic panic has replaced reason, lack of coordination has delayed response and all the while people die. It is déjà vu all over again and last August, when the director of Doctors Without Borders called for clinicians to step up to combat a burgeoning Ebola outbreak in West Africa, I applied. All infectious diseases and HIV providers, I felt, needed to at least ask themselves if they could and should respond to the outbreak of Ebola.
Without level 4 pathogen or outbreak response experience, I was not what Doctors Without Borders wanted. But, it turns out this was for the best, as I realized that a better way to tackle Ebola was to apply my clinical research skills – experience honed by my focus on HIV.
Tales of what I have been doing and have seen in West Africa can be saved for another time. As I type while flying back from Sierra Leone, I am wondering how it was that I became so dedicated for so long to one pathogen, albeit the cause of a pandemic that has killed millions and has significantly altered many aspects of modern medicine. Moreover, I reflect on how it came to be that I was pulled from this comfortable orbit by this even more sinister infection. Perhaps it is the particular monstrosity of Ebola that created my urge to respond – just as the swiftly spreading and devastating AIDS crisis of the 1980’s attracted me so strongly then.
Nagging at me, though, is an inkling that there is more to my motivation to respond than the overlap between HIV and Ebola. Can it be that now that HIV medicine has become largely a routine of well visits among people living with undetectable levels of the virus in their blood, when we track LDL cholesterol more closely than CD4 cell counts, that I and other HIV providers are seeking the excitement and novelty we once had? Are we increasingly becoming susceptible to the lure of the next big thing, be that HCV or, for some of us, Ebola? Our victory against HIV has been accompanied by the loss of intensity that drove many of us to the fight against AIDS. And, so, no wonder that our gaze falls elsewhere.
I have to believe that I am driven toward Ebola by more than some sort of professional mid-life crisis; that my deciding to be involved reflects a commitment to help make things better for those infected and affected by this horror. Yet, I am also aware that why we do what we do is complicated.
I am not giving up my day job and will continue to be an HIV doctor until there is no HIV. Yet, I have to break the news to HIV that I have started seeing another virus. It is scary and wild and thrilling and it is also something I feel I have to do– just like back then, when young men started getting sick and I, along with many others, felt we had to come calling.