PIONEERING S.F. AIDS WARD CELEBRATES ITS FIRST 20 YEARS

It's Become An International Model For Compassionate Care

When San Francisco General Hospital opened the world's first AIDS ward on
its fifth floor exactly two decades ago, a lot of people thought it was a
bad idea.

Dr. Mervyn Silverman opposed it. As director of the San Francisco
Department of Public Health at the time, he feared that patients sent there
would be shunned, and others would live in dread that they were destined
for a lonely place of no return.

"Fortunately, I was proven completely wrong," said Silverman, who will join
with other veterans of the early years of the AIDS epidemic tonight to
celebrate the 20th anniversary of the opening of Ward 5B.

From almost the moment it opened to widespread publicity, the AIDS ward
became both a national symbol of the disease's terrible toll on San
Francisco and an international model of compassionate care. Politicians and
celebrities made courtesy calls. Physicians who worked there became
celebrities themselves.

And a cadre of nurses -- most of them from the gay community they served --
developed an esprit de corps usually reserved for veterans of military combat.

Since 1981, a total of 19,393 San Franciscans have died of AIDS. Estimates
are that a quarter to one-third of those who died were hospitalized at some
point during their illness in Ward 5B or the larger Ward 5A, where the unit
moved in 1986 and has been ever since.

"From the day it opened, it took on a life of its own. We knew we were onto
something," said Cliff Morrison, a nurse who designed the AIDS unit,
recruited its nursing staff and ran it as clinical coordinator until 1986.

Dealing with an unprecedented disease presented Morrison with an
unprecedented opportunity to do things differently. At the core of Ward
5A/B was the notion that the patients, not just doctors and nurses, have a
role in planning their care.

ADVANCES IN GAY RIGHTS Ward 5B also broke new ground in gay rights. Until
then, Morrison explained,

it was common practice for hospitals to exclude all but spouses and
next-of-kin from visiting critically ill patients. "Gay partners were not
recognized as such," he recalled. "We changed that. We redefined what a
'family' was."

Dr. Paul Volberding, who directed AIDS patient care at the hospital until
2001, said the unit was created at a particularly frightening time in the
epidemic, when no one was sure what the disease was or where it was headed.
It was difficult to find nurses and hospital orderlies willing to treat
AIDS patients, even at San Francisco General. "All of the nurses who worked
in 5B did so quite willingly. It was a calling," he said.

It was the life in the AIDS ward, rather than the ever-present specter of
sickness and death, that brought about its legendary status. Amid the grief
and gloom, characters like Rita Rockett -- a San Francisco dancer and
single mother -- brought food, music and tapdancing entertainment every
other Sunday to patients and staff. So loved was Rockett that the sunny
parlor at the west end of Ward 5A was named the Rita Rockett Lounge.

"I came from a large family," said Rockett, who moved to Ohio three years
ago to take care of her father and sister, who were ill. "Whenever there is
something wrong, you take food."

She held birthday parties, pajama parties and hosted Christmas dinners.
Rockett reckons she knew three-quarters of the patients who were staying
there on any given day. "For all the friends I've lost, I've also gained,"
she said. "I've got a book full of mothers I've met. We stay connected. I'm
so sorry they've lost their sons. There are such beautiful women I've come
to know."

COMMUNITY CONSORTIUM Dr. Donald Abrams, who began his career as an AIDS
clinician at San Francisco General just a few weeks before 5B opened, said
that "as a gay man, I wasn't sure I liked the concept" of an AIDS ward. But
he, too, was quickly won over. As the ward became the focus of the epidemic
in the gay community, ideas sprouted, such as the "community consortium"
that pooled public and private clinics to test new drugs.

Abrams' own scientific studies of medical marijuana were inspired by Mary
Jane Rathburn, better known as "Brownie Mary," who supplied patients at the
hospital and in the daytime clinic with pot-laced sweets.

Despite the camaraderie, the common bond was tragedy. "We really lived
through a very heavy time. It was almost like a war, losing so many young,
otherwise healthy men," he recalled.

AIDS took a terrible toll on the nursing staff itself. Many of those who
cared for AIDS ward patients were gay men who were infected with HIV
themselves, and as the virus slowly eroded their immune systems, they came
down with the same horrific opportunistic infections they were treating.

Nurse George Jalbert was the first to die. His fellow nurses signed up for
shifts at a hospice until he succumbed in 1987.

Jalbert's name is inscribed on a brass-and-walnut plaque on the wall of 5A
today. Below the plaque are three more, bearing a total of 42 more names.
Most are the names of male nurses who died of AIDS.

One of them, 33-year-old Robert Andrian, worked on 5A until a month before
he died in August 1989. He, like Jalbert, was one of the original dozen
nurses who opened the AIDS ward 20 years ago.

NURSES A CONSTANT IN WARD Nurses were the heart and soul of Ward 5A. The
average length of stay for a patient was about 10 days. UCSF
doctors-in-training would come in for a month rotation. "We were the
constants," said 51-year-old Steve Keith, one of the original staffers, who
retired in October and serves as unofficial historian of the unit.

A gay man who worked at the hospital as a psychiatric nurse, he volunteered
for the ward in 1983 knowing very little about AIDS. He'd seen pictures of
the purple Kaposi's sarcoma lesions on a poster at a Castro district
pharmacy. The work looked interesting. He stayed nearly 20 years.

"It's like an old boyfriend," he said of the place. "You never stop loving
that person. They are always part of your life." Keith has put together an
exhibit of AIDS ward memorabilia and maintains his own memories of
extraordinary people in an extraordinary time. "It really could have been
just as easily any one of us, in those beds," he said. "Later, a lot of us
did get sick."

Six times during his nursing stint in the AIDS ward, Keith accidentally
stuck himself with a needle. Eight years ago, he learned that he was HIV
positive. He does not know if a needle was the cause or not.

"Jane Doe" had been a nurse for three years when she accidentally jabbed
herself with a needle, while connecting tubes in an intravenous line.
Twenty-five years old at the time, she wasn't worried, because the chances
of contracting the AIDS virus from a needle stick are low. But after she
eventually tested positive, she said she drew strength from the patients
around her.

"I was just at the beginning of this, and they were at the end. Just
watching the courage of my patients was so helpful," said Doe, in a recent
interview.

Although an HIV infection seemed a virtual death sentence when her needle
stick happened in July 1987, Doe remained healthy long enough for the
development of AIDS drug combinations in 1996 that dramatically improved
the health of patients. "I'm healthy enough to be an ornery old nurse," she
said. Although she keeps her identity private, she continues to work as a
nurse at the hospital and campaigned actively for the passage of state and
federal legislation mandating the use of safer, retractable needles.

21,500 ADMISSIONS

Since the first patient was admitted, the hospital has recorded 21,500
stays in 5A and 5B. Many of those were patients treated on repeat visits,
having cheated death in a previous AIDS crisis. The epidemic peaked in
1994, and the hospital began to add cancer patients, who had medical issues
similar to those of immunity-compromised AIDS patients, to the mix. Today,
only 1 in 3 being treated in 5A is suffering from AIDS.

Nurse Diane Jones, one of the original Ward 5B recruits, said that working
there was a continuous lesson about human dignity. She remembers in
particular a gay man who had one of the most severe cases of Kaposi's
sarcoma the medical staff had ever seen. He had been a handsome man, a
professional model. His features were so distorted by the purple lesions
that he resembled the "Elephant Man."

There had been a long death vigil for this patient, so long that his family
had come and gone. As she gave his swollen skin a sponge bath one evening,
the patient explained to her why he couldn't simply give up and die. The
man told her, "I have a commitment to life. I cannot turn off the life force."

"Life doesn't usually teach those lessons in your 20s and 30s," Jones said.