From: Billi Goldberg <bigoldberg@igc.apc.org>
Subject: As Real As It Gets:Review
Note: Copyright 1992, Dan R. Greening. Non-commercial reproduction allowed.
Archive-Number: 6701
Organization: unspecified
Date: Fri, 1 Jan 93 00:06:06 PST

The following article was printed in the San Francisco Sentinel on 
Thursday, December 31, 1992. It is being posted with the permission of 
the author, Charles R. Caulfield.
************************************************************************
Book Review: "As Real As It Gets"
Carol Pogash. Birch Lane Press. 1992
249 pages.  $18.95

Reviewed by Charles R. Caulfield

    If the ravages of the AIDS epidemic could be viewed as concentric 
circles, "As Real As It Gets" would be like looking at the epicenter with 
a magnifying glass. The book, which is subtitled, The Life of a Hospital 
at the Center of the AIDS Epidemic, is a penetrating look into the 
effects of the epidemic on the operations of San Francisco General 
Hospital. 

    With its foreword written by Randy Shilts, the author of "And The 
Band Played On," the book takes a much more humanistic and perhaps less 
histrionic view of the effects of this disease on the lives of those 
infected by it and otherwise affected by it than did the historic work 
of her mentor.

    The book, which reads like a thriller, would make great copy even if 
the story were a work of fiction. Unfortunately, it is not.  It is an 
inside view of the institutional turbulence generated by the onset of 
this new disease on the hospital, showing the bureaucratic struggles 
inevitable in coping with such a challenging course of events. But it 
also highlighted the courage, the innovation and the humanness of the 
health care professionals who devoted themselves to caring for those 
afflicted with the strange new disease.

    So many years after the beginning of the epidemic, it seems easy to 
forget that there was a time where health care professionals had no way 
of knowing if they were at risk of infection by simply breathing the 
same air as patients with AIDS. She documents the dedication of the 
professional caregivers who put themselves at potential risk, setting 
aside their fears in order to tend to their charges. 

    Central to the story is the controversy surrounding Dr. Lorraine 
Day, an orthopedic surgeon who advocated the right of physicians to know 
the HIV status of prospective surgical patients, and to retain the 
option of refusal of care. Day made the talk show circuit fanning flames 
of fear as to the transmissibility of the AIDS virus.

    Another central theme is that of Jane Doe, a staff nurse who, while 
infected by a needle stick with infected blood, fought with the 
assistance of her peers to retain her anonymity while receiving the 
disability benefits she was entitled to.

    Pogash deftly explores the quandary of physician researchers, who 
having in hand potentially promising therapies, must move through the 
sluggish channels of bureaucratic red tape, while watching potential 
beneficiaries of their research die agonizing deaths. This was 
epitomized by the dilemma of Dr. Mike McGrath with Compound Q.

    While the book explores the development of what was to become the 
model of clinical care for AIDS patients, the most compelling facet of 
this work is its frank look at the humanity involved in an intractably 
bad situation, and how the human spirit in many unacknowledged ways rose 
to surmount it. Few, if any other works have captured a slice of the 
AIDS epidemic as this work has.  
Newsgroups: sci.med.aids