European Stars And Stripes (Newspaper) - June 23, 1987, Darmstadt, Hesse                                Toy out health aids patients death in t what they fear it s the dying doctor talking with an aids patient at ooh water memorial hot Hal in Haw York. By Jan Gross new York times s their Days dwindle those Are things aids Pali Enla say they want most Cool sheets a hand to hold a Promise thai they will not have to Bear lob great a suffering and that they will not Havi 1o die alone. These s male wishes Are nol uncommon to those with terminal illnesses. Bui they Are becoming More Dill cull to fulfil As the aids epidemic grows steadily worse in new York City. Incised there is a serious shortage of establishments where patients with a disease thai has never been cured can die in dignity. Deals in t whal Hay Lear it s the dying said sister pair ice Murphy who fun a supportive care program or tha terminally ill at St. Vincent s Hospital. 11 and i Here has to be a Sale  nearly 200 people die of aids every month in maw York and thousands More Are dying. Yet fewer than 100 spaces exist in programs offering the combination of Succour and science needed to ease life s end when it cannot be prolonged. Local health planners agree that a Lack of hospices and other terminal care institutions is one of the most urgent problems of the aids epidemic. Long Lew care will be the most rail ficut Issue for us said Mel Rosen the head o the Sale aids Institute which coordinates new York s policy on the disease. It s an enormous task almost  at institutions designed to ease dying the focus is More on emotional support Ihan intensive medical cars. Acquired immune deficiency syndrome scorns to add its own dimension to the fearsome process. Many Al omens the relative newness of the disease the Lack of understanding of its origins. The Way it destroys the immune system and makes a victim vulnerable to All varieties of fall diseases from pneumonia to cancer the social stigma seem to Combine to produce heightened anxiety. F there is time at an aids hospice away irom the olten hectic Pace and nervous High tech drone of a Modem Hospital Lor a quiet Idle Chal Al a patient s bedside or time to discuss Powers of attorney wills and do not resuscitate orders or for dying men and women to describe their fear of Ever intensifying pain or their inclinations toward suicide. At St Vincent a sister Patrice is besieged by questions the same ones Lime and again. Whal will it be like to die her patients say. Will i a Brave enough most of them know at least one person who has already  she said and some know As Many As a dozen so they All have a picture in their mind. I Tell them we will stand on our Heads to make them As comfortable As humanly possible. That s a reassurance that must be Given Over and Over the concerns Are the same among aids patients at the hospice Al 8elh Abraham Hospital in the Bronx. They want to know whal the potentials Are said the director Lucille Brown. They want to know am i going to have pain and whal Are you going to do about it they Are afraid of being left alone and  she added you have to repeal Over and Over yes we Are going to be Here for you no you will not to loft atone yes if you ring the Bell we will come,1" sister Patrice looks Lor clues thai a patient is ready to open up tears perhaps or a flurry of casual questions As she is about to leave the room bul sometimes she Force the Issue because of the Specter of mental impairment which has become far More prevalent in the late stages of the disease Iown was first realized. We really have to be rigid Aboul getting them to think about these issues while they re still Well enough said Kathleen Perry the social worker for the St. Vince no s program. In the beginning we did t recognize the dementia for whal it was she added. We thought it was depression. And we often did l talk until it was too  it is this dementia that makes supervised care so important. As the aids virus attacks the brain patients become helpless groping for words forgetting what Day it is getting lost on the subway. Brown described the worst cases of neurological impairment As literally losing your mind an Inch at a  the one Consolation she said is that they do not despite their earlier fears die struggling but rather  doctors anxieties Over treating aids by Lawrence k. Altman new York times he aids epidemic is having a draining and emotional Impact on doctors forcing some hospitals to develop special programs to help physicians Cope. Young doctors in training who Treal Many aids patients Are suffering nightmares becoming preoccupied with the fear of gelling the fall disease imagining they have become Inlet led with the virus and reporting other forms of marked arvely. The overwhelming majority of doctors questioned in two studies said they believed their anxieties Aboul aids acquired immune deficiency syndrome did not adversely affect patient care. At the same time a fourth of 258 doctors surveyed in one of the studies said they believed it was not unethical to refuse to Caro Lor people infected with the aids virus this is a surprising and disturbing Challenge to the longstanding tradition that doctors will Render care to those in need and if necessary risk their lives to do so. That Credo has contributed in a major Way to the pre Sligo of the profession. The View that doctors May refuse care to patients appears to undermine tha tacit social contract that has Long Enisley Between physicians and their communities or. R. Nathan link who headed the team doing the new York study. Whether these views reflect trends thai will Compromise the level of medical care that will to available to aids a aliens remains  ads related emotional problems in health care workers Are especially serious because the epidemic is sure to gel worse before it gets better. Public health service officials have predicted thai by the end of 1991, aids will have struck 270,000 americans. So far 36,000 cases have been reported. The studies questioned doctors in training at hospitals in new York and san Francisco to assess distress irom treating patients Wilh aids. The hospitals were new York University Bellevue Hospital Montefiore Hospital and Albert Einstein medical so tool in new York and the University of California Al san Francisco. The results of the study were presented Al the third International conference on aids. Some participants in the conference r Aid Tho reluctance to treat aids patients expire red by the Young doctors reflected a failure by medical schools to Leach the traditions of the profession. The questionnaires did not ask the respondents to explain their anxieties. But the authors and those working Wilh aids patients have uttered Many explanations including these physicians Are frustrated by their inability to offer a cure for aids. Today s medical students Are accustomed to being Able to cure and treat effectively Many life threatening diseases that once killed patients of their older colleagues. Most doctors in training Are Young adults irom the same generation As Many aids patients. Identifying with Young aids victims the physicians find it difficult to confront their own mortality. There was one positive note about the doctors attitudes As expressed in the studies. The More experience the doctors had in caring for aids patients and the More medical training they have the More Satis cation they said they derived from their work. For centuries Many doctors have risked their lives caring Tor patients Wilh tuberculosis and other infectious diseases that could be spread through the air or through casual person to person Contact. And As Iho Young doctors in the two studies Viilu Strale Many doctors Are caring for aids patients today. Page 16 the stars and stripes tuesday june 23,19b7