Doctor Daniel Baxter on Giving Care to the Most Vulnerable AIDS Patients

Show: FRESH AIR
Date: JUNE 11, 1997
Time: 12:00
Tran: 061101np.217
Type: FEATURE
Head: Lawrence Walsh
Sect: News; Domestic and International
Time: 12:06

TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross.

For six years, Lawrence Walsh was responsible for investigating the Iran-Contra affair and for prosecuting the crimes committed by the people behind it. His final report was released in January of 1994.

Now in his early 80s, Walsh has written a memoir describing what happened behind the scenes of the investigation. He titled his memoir "Firewall" because he says Ronald Reagan was protected from disgrace and possible impeachment by the firewall his advisers erected around him.

The Iran-Contra affair dates back to the mid-'80s, when the Reagan Administration illegally funneled support to the Contras -- a paramilitary group fighting against the Sandinista revolution in Nicaragua.

The administration also violated its own policy of not negotiating with terrorists. It sold arms to Iran in exchange for the release of hostages. The profits from the arms sales were diverted to the Contras.

Walsh wasn't able to get many of the convictions he wanted. I asked him the result he most wishes he'd achieved.

LAWRENCE WALSH, FORMER INDEPENDENT COUNSEL IN THE IRAN-CONTRA INVESTIGATION, AUTHOR, "FIREWALL: THE IRAN-CONTRA CONSPIRACY AND COVER-UP":
Well, I guess the full disclosure of the truth would be highest, and that would mean proving the responsibility of the highest officers, who were responsible for the acts that were unlawful, and if, in certain cases, to have prosecuted them.

I guess if I were going to pick an example, Attorney General Meese, in my judgment, formulated the false position of the administration, denying certain arms sales through the Israelis, even though he knew the president had known about them and had authorized them, and even though all of the president's top foreign policy advisers knew that. They all sat silent while Meese told them the president didn't know, and if he did know, it could be unlawful.

Now, we didn't get this information. We didn't get Weinberger's notes, which carried this almost word for word; or Donald Regan's notes, which carried it word for word, until five years after the investigation started. And at that point, I didn't think we could effectively prosecute Meese.

GROSS: What are some of the things you believe, but you couldn't prove, about the people at the top -- former President Reagan, former President Bush?

WALSH: Well, my impression was that President Reagan knew the substance of what was going on. He might not have been told in detail, but he knew that the arms sales were funding the Contras, in my judgment.

And we were never able to prove that because Admiral Poindexter, who was the person who from whom we would have learned it, always said that he didn't have to tell that to the president because the president -- he knew the president would have approved it if he had told, and he wanted to preserve his deniability.

Yet when Poindexter went to trial, Poindexter's lawyer told the judge that the president knew everything that Poindexter had done. In reciting these things, it included the diversion of funds from the Iranian arms sales to the support of the Contras. So that is what my impression was and that's what the status of the proof was.

GROSS: What about George Bush? What do you believe that he knew, but that you couldn't prove?

WALSH: I think Bush knew quite a lot. He's always denied that he knew about the diversion of funds, and no one has ever testified that he did in fact know about it.

But he -- he had been a former director of the CIA, and he was privy to the -- all of the president's morning intelligence briefings when he was in town. And Poindexter said that as far as the arms sales were concerned -- the Iranian arms sales were concerned -- if Bush missed a meeting, he would personally go and brief Bush.

And in fact, when those sales were threatened with being broken off, he went to -- when he was in Israel, he received a briefing on the arms sales, and then came back and briefed the president and the sales were resumed. So he was not a stranger to the transaction.

GROSS: One of the things that seems to have made you angriest was former Secretary of Defense Caspar Weinberger lying about having notes. He took notes on the meetings. He told you he didn't. That seems to have gotten to you perhaps more than a lot of the other things that got to you.

WALSH: Well, just look at what happened. We started our investigation in the beginning of 1987. We got his notes in 1992 -- five years had been lost.

If we had his notes at the beginning, believe me, proof would have been marshaled very quickly, and the problem of one, the statute of limitations running -- or second, people's recollections fading over five years would have been eliminated.

And finally, I just think it's wrong for -- the Secretary of Defense was right in the center of this. The Hawk missiles that were shipped through Israel -- they had to come from him. He had to be the person who would replace the Hawks for the Israelis, so that the Israeli arsenal wasn't depleted.

So this wasn't something in which Weinberger was a bystander. He was the criticalest cabinet officer. And for him to lie to Congress about the substance of the facts and then to sit, as he did when they took his deposition, he sat looking at his great big desk, which was full of his note pads, and as he -- even while he was looking at it, he said he didn't keep notes; that he only kept a few, and that they had gone through the filing system of the department, whereas he was keeping his personal notes in his own office.

GROSS: You were also pretty angry at George Bush for pardoning Caspar Weinberger shortly before George Bush left office. It was Christmas Eve, was it?

WALSH: Christmas Eve.

GROSS: Yeah.

WALSH: That was perhaps the most disgraceful single act. That was worse in -- what President Reagan did, whether it was right or wrong, lawful or unlawful -- he really did think he was acting in the interests of the country. George Bush was acting in his own interest.

He was trying to cut off the Weinberger trial, because he knew the trial would expose publicly the participation, not only of Weinberger but of those with whom Weinberger was associated, including George Bush -- was at the meeting when the false position was laid out.

GROSS: Did you ever consider subpoenaing George Bush?

WALSH: Yes, I did. That was -- about the last thing. After Bush pardoned Weinberger, and he was still holding out his own notes. He'd given us some prior to the pardon -- only a few -- a week or two prior to the pardon.

And then we still had more to come, and he -- we had delayed his final interrogation until after the campaign was over because we did not really want to intrude in the campaign, although he always thought we deliberately did.

Then when we came to question him, he wanted to limit his questions to his notes, and not be questioned generally about his knowledge of Iran-Contra, and I thought that would be a charade and I wanted to subpoena him before the grand jury. At this point, my staff was almost -- was unanimously against me.

They felt that it would look like I was retaliating for the pardon, which of course I wasn't trying to do, really; and second, that we did not have a sufficient probability that a crime would be proven to draw the grand jury into it and start grand jury interrogations; and third, that the public would misunderstand our activity and have an exaggerated anticipation of what was going to come out, when the odds were that we would not indict Bush.

GROSS: Early on, one of the things that really worked against your investigation was the Congressional hearings into the Iran-Contra affair. And the biggest problem there, I think, was the granting of immunity to key figures like Oliver North and John Poindexter.

They got immunity so that they could speak and tell everything they knew, or hopefully tell everything they knew, without getting prosecuted themselves. The sacrifice was: OK, we won't be able to prosecute them, but at least the truth will emerge.

How did that work against your investigation?

WALSH: Well, it hurt very severely, and it caused the reversal of the convictions of North and Poindexter. The jury convicted both of felonies, and Poindexter was actually sentenced to prison.

But because of the immunity granted by Congress, the Court of Appeals reversed the convictions. The -- immunity is an exchange for waiving a privilege against self-incrimination. No person has to testify and incriminate himself because of the constitutional protection.

But if Congress or the prosecutor give him immunity that prevents the use of his testimony against him, he may be forced to testify. Now, Congress did that.

But it -- and the immunity is worded as though it were just protecting against the use of the testimony he gives, but the courts have construed that to protect him from any prosecution developed by facts which were led to by the testimony he gave. So it's a very dangerous area for a prosecutor to have to deal with.

GROSS: You were in a very strange position during the hearings because you and your staff were not allowed to hear any of the testimony by witnesses who were given immunity -- Poindexter and North -- and those were crucial people to your investigation, and what they were saying was crucial to your investigation. Why weren't you allowed to hear any of their immunized testimony?

WALSH: Well, if we'd heard their immunized testimony, they would claim we were using it against them, and that's prohibited under the Constitution.

But it was very ironic that the witnesses we were questioning had heard it, and they also knew we had not heard it, so they were better prepared, in a sense, than we were. Whereas a prosecutor always likes to be better prepared than the witness he's questioning.

GROSS: Lawrence Walsh is my guest. He was the independent counsel in the Iran-Contra investigation. He's written a new book about the investigation now called Firewall.

Let's take a short break and then we'll talk some more. This is FRESH AIR.

Back with Lawrence Walsh, the independent counsel in the Iran-Contra investigation. His new book is called Firewall: The Iran-Contra Conspiracy and Cover-up.

We were talking about the immunity, and how that hurt your investigation. Something else that hurt your investigation was the national security community's power to, as you put it, "overclassify information to prevent the full exposure of its misconduct."

What are some examples of documents that shouldn't have been classified in your opinion, but were?

WALSH: All right. I think the most obvious one where I can think of -- McFarlane -- the National Security Council and the White House generally had an interior communication system, and -- in which they could take messages back and forth to each other, and these were called "prof" notes -- P - R - O - F notes.

And in one, Weinberger, after the scandal was breaking, sent one to North: "I hope to blazes that somebody has sanitized the files of the National Security Agency." And that's all it said.

And the counsel to the National Security Agency insisted that that be classified, and tried to keep it from going in the trial. We didn't need that so much, but North wanted it in his defense. And even after the case had -- was three-quarters of the way through the trial, she went to Attorney General Thornberg (ph) to get him to block the trial to keep that note out.

Now that just showed an exaggerated concern of one agency to protect its own skirts. There's nothing in there that was going to hurt the country; nothing in there that was telling anybody anything they didn't already know, but it was just an effort to keep the agency from being exposed as having participated in with North and his activities.

And they had assisted North in both arms of his activities -- both in -- by furnishing him with super-secret communication gear for -- in his work supplying the Contras, and also in his work in getting the arms delivered to Iran in the hope the hostages would be released.

GROSS: So you think that the CIA overclassified a lot of documents relevant to the investigation, just to cover its own tracks?

WALSH: I can't see -- you know, let me be fair. Their argument -- the CIA is different from the National Security Agency. There was no justification whatever for what the National Security Agency did.

But the CIA has people posted throughout the world, and they are there by grace of the host country, and the CIA is always concerned that if they disclose something that happened in one host country, that the other hosts may close down on their facilities in the other countries.

So they have -- they are always arguing for deniability -- that even though the facts are known, a government agency -- a United States government agency -- must not confirm them. So, that was their argument.

Now, in one case, we -- the one case we went to trial -- that we tried to -- that we had an indictment in, and were trying to try, and then had to give up was a man named Fernandez (ph), who was the CIA station chief in Costa Rica.

He claimed that he had to disclose the existence of certain bases in Central American countries. Now, these were publicly known -- everyone knew. One had even been burned down by the right -- left-wingers, so that if our enemies knew it, at least our court might know it.

And CIA refused to confirm this. They went as far as they could without doing that, but the judge said this had to come out or -- and he had to be free to discuss it, or he was going to dismiss the case, and he finally dismissed the case and the Court of Appeals affirmed it.

GROSS: Warren Casey (ph), the former head of the CIA, died during the Iran-Contra investigation. What had you hoped that he would reveal?

WALSH: Well, assuming he would tell the truth, he could have revealed the central machinery -- next to President Reagan, he was probably the best informed of what was going on. And he was better informed than President Reagan is by just -- I think he knew the details, whereas the president only knew in a general way what was happening.

So Casey would have been very helpful if he would tell the truth, but he was notoriously able -- very skilled person, and he just -- he would have tried to, I'm sure, bamboozle us the same as he did Congress at times and got Congress quite angry, and that was one of the reasons they shut off aid to the Contras.

But I would -- I think that Casey would have even -- would have ended up either as a defendant or a very key witness.

GROSS: What tools do you feel you needed that you didn't have?

WALSH: Wasn't so much a matter of tools. What we needed was lack of interference by Congress; lack of interference by political -- strong political leaders who were trying to protect the president and his cabinet.

The tool that would have helped most, though, that I -- you know, as I think, is something -- some way of dealing with this problem of classification of documents.

GROSS: The paradox of your position when you were independent counsel was that you were picked by the administration, and then you were prosecuting the administration. Did -- you were a life-long Republican, you know...

WALSH: Yes, that's right.

GROSS: ... an admirer of President Reagan's. Do you ever think that maybe you were picked because they thought you'd be a team player?

WALSH: No, I think they -- the judges who picked me knew me personally, and they knew that that wouldn't make any difference. But it was a -- they knew, certainly, that I wasn't going to try to embarrass President Reagan or any other Republican just for political purposes.

GROSS: Mm-hmm. Are you still a Republican?

WALSH: Yes. I stayed that way. My father was one and all my family's been Republicans. And I just haven't cut the last thread, but there've been times during the last seven years when I've been tempted. I must say, I voted for Clinton twice.

GROSS: Oh, did you? I wonder...

WALSH: That guy Robert Dole was one of my worst critics, and most unreasonable person and I certainly couldn't vote for him, nor did I feel I could vote for...

GROSS: George Bush.

WALSH: ... Bush. Yeah.

GROSS: Right. I'm wondering if you feel that late in life you were forced into becoming more cynical about politics, after you had seen people lie to your face and cover-up -- people at the very top.

WALSH: No, I -- you know, I'd been in Washington before, so cynicism didn't come to me as a shock. I realized that there's a lot of it there. I was shocked that a majority leader of the -- that a Republican leader of the senate would intrude in a criminal case. Politicians, really -- you know, senior politicians -- keep out of criminal prosecutions. They don't try to fix a criminal prosecution.

Whereas Dole just was unabashed in his effort to destroy the case against Weinberger -- making strong public pronouncements against us; calling us "hired assassins." And he continued this right up until the jury had been called in -- had been notified that they were going to try the case.

The case was set for trial in early January, 1993. Jury was notified to appear, and Dole was still pounding us, and who do you think also is turned on us, but the attorney general of the Bush administration. The attorney general was saying that we -- we're getting indictments that we shouldn't have gotten.

It was just an administration -- particularly after Bush's defeat -- they were just running loose. And maybe there was some feeling, I think, that an indict -- that we'd had to clarify an indictment just before the election day, not through any choice of ours.

Now somehow I think that, looking around for someone to blame for his defeat, President Bush had picked me and some of his administration felt that way.

GROSS: Lawrence Walsh was the independent counsel in the Iran-Contra investigation. His new memoir is called "Firewall." He'll be back with us on the second half of the show.

I'm Terry Gross and this is FRESH AIR.

This is FRESH AIR. I'm Terry Gross.

Back with Lawrence Walsh, the independent counsel in the Iran-Contra investigation. He's written a new memoir about the investigation called Firewall.

In your memoir, you say that when it comes to an investigation, you think that the president should basically be cut some slack; that you shouldn't be too overzealous in pursuing the president 'cause the president is in office. So what were your guidelines about that?

WALSH: Well, I believe that he should have every courtesy. The president is the one person in the country who is on duty 24 hours a day every day. He never has any time off. He never has any period for second-guessing. He's always subject to some emergency.

So when a prosecutor comes along and starts looking at this and looking at that, I -- the president, it seems to me, should be protected as much as possible. I never questioned President Reagan until five years after I started.

I needed his testimony to make sure he hadn't authorized North -- make sure he didn't admit authorizing North or Poindexter to do what they did, so they could claim they were acting for him.

And so I -- but I did that by written interrogatories which we served on him and then his lawyer could help him answer it. When I finally did get his face-to-face testimony, it was much later, after I had gotten everything I could from everyone else and he was really the last person I questioned.

I think it's something -- not just out of consideration for the individual, but it's important consideration for the country that the president not be unduly distracted by these things.

GROSS: What do you think is the larger significance of the crimes that were committed in the Iran-Contra story?

WALSH: The crimes were significant because they are -- they attack the basic structure of the Constitution. Congress has the power to control appropriations. It controls the use of government funds.

Congress has the power of oversight over the executive. The executive can -- has very broad powers, but Congress has a right to know what he has done and what he is doing.

And the basic element of the crime that pulls these sort of three interlocked conspiracies together, was an effort to deceive Congress on such a basic and important matter, that it was depriving it of both control over appropriations and control over oversight.

So that was the nature of the crime that I -- I think that makes it so important.

GROSS: How would you compare the Iran-Contra story with the Watergate story, in terms of the magnitude of the crime?

WALSH: In terms of the constitutional importance of the crime, Iran-Contra is the more important. In terms of the personal drama of the involvement of the presidency, Watergate was more shocking because in Watergate, the president was actually corrupting the -- trying to corrupt the flow of evidence into the courts, and I think money was being used in that way.

And it was -- it had -- it sort of had a venal purpose. It did not have any purpose of serving the country. In Iran-Contra, although it was constitutionally much more important, President Reagan didn't think for a minute he wasn't serving the country.

He thought he was doing what he did, not for any personal gain, but because it was important to the protection of the government -- country from a government -- from a communist threat in Central America; and because for humane purposes, he had an obligation as president to get those hostages free.

So he had a high-minded, but willful, purpose. The other had a venal and not so attractive -- and then not a public interest purpose.

GROSS: The Watergate story ends very dramatically: President Nixon resigns and leaves Washington disgraced. Did you wish for an ending that dramatic to the Iran-Contra story?

WALSH: No, frank -- I -- you know, although I was investigating as hard as I could for five years, I never stopped liking President Reagan. I would not have gotten any joy out of seeing him forced to resign or even be disgraced after he left office.

I simply, as a matter of thoroughness, felt that it was wrong to let subordinates suffer for something which a president oversaw, and therefore I -- there was a duty not to stop with the subordinates if there was evidence pointing above it. And I -- the evidence never accumulated to that point that it would have been justified to prosecute the president.

GROSS: In the introduction to your new memoir, you ask yourself if, despite the many defeats, did you ultimately win? And if you won, was it the war you thought you were fighting or one quite different? So let me ask you those questions. Despite the defeats, do you think you won? And did you win something different than what you thought you were trying to win?

WALSH: Yeah. I think we won in the sense that we have established, I think with certainty, that career officers who try to support and cover up a willful president do so at their own jeopardy; that they are going to end up the losers. The president will escape, probably, but they'll be convicted of crime. I think that was the big lesson.

Secondarily, if, in fact, Bush were correct -- that our investigation or anything we did was responsible for his defeat -- I think we did clean government from a cover-up administration. I think the Bush administration was a cover-up administration. They were hostile to the prosecution of their political associates, and even though their guilt was obvious.

So those are two ways of looking at it.

GROSS: Judge Walsh, thank you very much for talking with us.

WALSH: Oh, it's been a pleasure.

GROSS: Lawrence Walsh was the independent counsel in the Iran-Contra investigation. His new memoir is called Firewall.

Dateline: Terry Gross, Philadelphia
Guest: Lawrence Walsh
High: Former independent counsel in the Iran-Contra Investigation Lawrence Walsh. He's written a new book about un-covering the truth about the Iran-Contra scandal, "Firewall: The Iran-Contra Conspiracy and Cover-up," Walsh is now counsel to Crowe & Dunlevy in Oklahoma City and serves as a legal mediator.
Spec: History; Politics; Government; Middle East; Iran; Scandals; Central America; Nicaragua; Military; Iran-Contra
Please note, this is not the final feed of record
Copy: Content and programming copyright (c) 1997 National Public Radio, Inc. All rights reserved. Transcribed by Federal Document Clearing House, Inc. under license from National Public Radio, Inc. Formatting copyright (c) 1997 Federal Document Clearing House, Inc. All rights reserved. No quotes from the materials contained herein may be used in any media without attribution to National Public Radio, Inc. This transcript may not be reproduced in whole or in part without prior written permission. For further information please contact NPR's Business Affairs at (202) 414-2954
End-Story: Lawrence Walsh
Show: FRESH AIR
Date: JUNE 11, 1997
Time: 12:00
Tran: 061102np.217
Type: FEATURE
Head: Daniel Baxter
Sect: News; Domestic
Time: 12:42

TERRY GROSS, HOST: Dr. Daniel Baxter has treated people with AIDS who have virtually no support system and no community; people who are homeless and often drug-addicted; people who are likely to give their address as the bus terminal. His patients have also included prisoners and illegal immigrants.

His new memoir, "The Least of These My Brethren" is based on his three-and-a-half years as a physician at St. Clair's Spelman Center for HIV-Related Diseases -- New York's largest designated AIDS treatment center.

Although it's in New York, one visitor described it as resembling a third-world infirmary. I asked Baxter to describe the center.

DANIEL BAXTER, AUTHOR, "THE LEAST OF THESE MY BRETHREN: A DOCTOR'S STORY OF HOPE AND MIRACLES ON AN INNER-CITY AIDS WARD": Well, St. Clair's Hospital is a relatively old hospital established in the early part of this century, and it's located on the west side of Manhattan, actually in Hell's Kitchen, the area where the musical West Side Story was based.

And it's really in the middle of a block of tenement buildings, and itself at one time was sort of a hodge-podge or quilt-work of tenement buildings that had been joined together into a hospital. And it consists of -- when I wrote the book -- it consists of 200 beds of which about 100 to 125 belong to the Spelman Service -- the AIDS Service.

GROSS: You describe the walls near some of the patients' beds as looking like splatter art...

BAXTER: Mm-hmm.

GROSS: ... instead of paint splattered on the wall, it was a combination of food and juice and excrement and...

BAXTER: Yeah.

GROSS: ... swished, squished cockroaches.

BAXTER: Yes.

GROSS: And this is really unsanitary stuff. I realize the staff probably wasn't big enough to keep up...

BAXTER: Mm-hmm.

GROSS: ... with the problems, but I mean, how did you think it actually affected the health of the patients?

BAXTER: Probably not seriously, the physical health, at least. In terms of the psychological health and, if you will, spiritual health of the patients it certainly did not help. I refer to room 314 on my unit as the so-called "Valley of Sorrows."

It was a four-bedded room that really was designed for only two beds, and when you have four beds with all of the other paraphernalia -- the suction machines, the bedside commodes et cetera, crammed around each bed, there's very little space.

And the most incredible thing about that room was that it had no private bathroom. Across the hallway was a small, three-by-four-foot closet that had a small commode and a small sink, and as I said, an Amtrak train has far more spacious bathrooms on each car.

And there's no denying the fact that conditions were extremely poor in many cases. But I also try, and I think certainly you realize this, the book is not intended as an expose of these conditions, but rather as a story of how despite these conditions, the patients there are able to teach us very life-affirming lessons, and the staff there is able to provide wonderful and supportive care.

GROSS: How much did most of the patients who you treated at the Spelman Center understand how they contracted AIDS?

BAXTER: I would say most of them did. It was -- the one thing that I indicate about many of my patients was that for them AIDS was an episodic event.

It wasn't the central be-all and end-all that say, if many of us were to contract HIV, it would not be the central issue of their life. Their lives were far more complicated and they were facing many daunting problems such as simply obtaining shelter; getting food stamps; trying to avoid drugs.

And for them, AIDS was just one more issue that they had to face, and oftentimes on their list of problems, it was number three or four.

GROSS: Some of your patients were state prisoners. Did you usually know what the crimes were?

BAXTER: It was general policy at Spelman that the healthcare givers not know the crimes that the prisoners committed. However, one particular instance that I recall that I found extremely disconcerting was when this one prisoner I was taking care of, who was basically comatose and dying of AIDS.

I had discussed his case with his mother, who was a very poor lady in South Carolina and I was discussing with her on the phone his condition, and she had not seen him for many, many years. And she wanted me to convey to him that she and her church friends down in South Carolina were praying for him, and she said: "please doctor -- please tell John that I love him."

This wasn't the first time a mother over the phone at great distance asked me to convey this message of love, but when I am asked by a mother to do that, I regard that as one of the most important things of the day for me to do.

So after talking with John's mother, I saw him on rounds and, although he was comatose, one never knows whether someone in coma can hear or not and so I leaned over and told him that his mother called and that she wanted him to know that she loved him.

And I think that he responded -- perhaps he opened his eyes a little -- just briefly. And I felt very good about what I had done, but then as I was leaving the room, one of the physician assistants, PAs that also helped me on the ward, blurted out that he had been talking to one of the guards watching John and the guard had told him that John had committed a terrible, terrible crime eight years earlier -- that he had sodomized a one-year-old girl.

And immediately, I was frozen with a combination of terror and rage and anger. And at that moment, I both loathed John and I loved him and cared about him. Because just a few minutes earlier, I was very desirous of trying to relieve his suffering with the message of love that his mother, whom he had not seen for many years, wanted me to give him.

And there's this constant whip-sawing back and forth, if you will, of emotions that I experience in trying to deal with someone like this, but ultimately I realize that if the life of someone like John, who did this terrible crime but who has his mother that is praying for him. If his life is important and valuable beyond all measure, which it is, then certainly my life, your life, all of our lives are very important.

GROSS: You know, a lot of the people who you treated at this hospital were homeless. If they recovered from the episode that sent them into the hospital in the first place, where would you send them? Back to the bus terminal where they lived? Or to the subway tunnel where they lived?

BAXTER: No. We at Spelman were blessed with wonderful social workers who really could do miracles, if you will, in terms of getting housing for our homeless people with AIDS. Here in New York, we had fairly good municipal backup services to help in terms of housing.

That's been somewhat problematic recently, with all of the various cutbacks both here in the city and also on the state and federal level. But we would be certain that they had either an apartment or, depending on the level of care they needed, either a nursing home or hospice, and definitely would make every effort to keep them out of the shelters and the bus stations.

GROSS: My guest is Dr. Daniel Baxter who has written a memoir about his work on an AIDS ward in Manhattan, and the book is called The Least of These My Brethren. Let's take a short break and then we'll talk some more.

This is FRESH AIR.

Back with Dr. Daniel Baxter. His new memoir, The Least of These My Brethren is about working with people who were poor, often homeless, often drug-addicts, who were in an AIDS ward of a hospital in Manhattan. He worked there for about three-and-a-half years.

The medical staff at this hospital faced a lot of risks. For example, one patient who was a drug addict hid his works in his bedding, and the nurse who was making the bed stuck herself.

BAXTER: Mm-hmm.

GROSS: She could have gotten AIDS that way. Did she?

BAXTER: No, she did not. The risk of needle stick transmission of HIV is relatively low, about a third of one percent.

GROSS: And another -- were there are any of the doctors or health care workers at the hospital who actually got AIDS from contact with patient's body fluids or from needle sticks?

BAXTER: Not that I know of. Generally, the exposure to body fluids has an even lower risk of HIV transmission, and that's why it's interesting.

Probably at a place like the Spelman Center the staff is more acutely aware of this risk and they generally are pretty careful about practicing universal precautions -- wearing gloves when they handle any body secretions and we have a sharps container in each room, where the needles that we use on patients are stored safely.

GROSS: Tuberculosis was a risk, too. You had a number of patients who had TB and there is a drug-resistant tuberculosis that has been circulating. How do you protect yourselves against that?

BAXTER: Well, if we have a suspicion that someone has TB or if we know that someone has TB, the patient is put in a respiratory isolation room, and all visitors to the room, including the doctors and nurses, need to wear masks in order to prevent their inhaling the air that has -- that potentially could have the TB germs in it.

But it -- TB is definitely a major risk in caring for folks such as the ones at Spelman, and a couple of the doctors and PAs actually came down with active tuberculosis.

GROSS: Did they get over it?

BAXTER: Yes, they did. One of them actually had the drug-resistant TB, which requires a more complicated regimen of medications, but that doctor also did get over it, fortunately.

GROSS: You saw a lot of patients who were dying.

BAXTER: Mm-hmm.

GROSS: And you saw a lot of people coping with death and just dealing with death in different ways. What are -- who are some of the patients that really surprised you in how they dealt with their own impending death?

BAXTER: Well, there was one patient who was an ex-prisoner who basically had no family. He had a girl friend that he really did not want us to contact.

And he had both PCP, the AIDS pneumonia, and KS, Kaposi's sarcoma in his lungs, and he briefly responded to therapy. But whenever I would go in and see him and try to provide him emotional support, he would turn the tables on me and end up providing me emotional support.

And he would say: you know, doc, it's all right. It's OK. It's all right that I'm sick and that I'm dying. And this particular patient had an inner serenity and calmness. He wanted to live. He was willing to undergo chemotherapy treatment for his KS. He was willing to undergo diagnostic treatment.

So he wasn't, in a way, throwing in the towel. But on the other hand, he had an acceptance of death. And I remember as he was getting sicker and sicker, and I would go in more to -- to see him -- more to marvel at the acceptance and tranquility that he had. I remember one of his last words were: it's OK, doc. It's OK. You shouldn't fear death.

And it was amazing, because this was someone that ostensibly, you know, did not know the great philosophers, but he had a more centered life than many people have after years and years of psychotherapy, et cetera.

GROSS: There are -- the greatest hope for a lot of people with AIDS now is the new combination drug therapy.

BAXTER: Mm-hmm.

GROSS: It's more effective; it's decreasing the viral load in a lot of patients. But there is a debate over whether "unreliable" patients should get it, meaning patients who are homeless or schizophrenic or who are drug addicts and who are unlikely to adhere to the very rigid schedule that these drugs demand.

You recently had an op/ed in the New York Times in which you said that you thought that treatment should not be withheld from "unreliable" patients. Why not?

BAXTER: Well, because I think that -- first of all, I think that many of the so-called "unreliable" patients, at least in my experience, have turned out to be quite reliable. These folks are very smart.

They're very street smart, and they know that these new drugs, in many cases, do work. And they have clamored for them and, in my experience, I've been very amazed at how they're willing to take a fairly complicated medication regimen because somehow intuitively they know that this is going to work and that it will work.

They see their friends that are on these medications flourishing, and this is another incentive for them to be compliant with their medications.

But there's a larger issue, very quickly, namely that if word gets out on the streets that doctors are picking and choosing who they treat, these people are going to get the medications on the streets in the black market, one way or the other.

GROSS: Have you used the combination therapy with any of your patients?

BAXTER: Oh, absolutely. At Casa Promesa (ph), the AIDS facility in the South Bronx I work at, I would say 40 to 50 percent of our patients are on combination therapy. We have seen, and although this is anecdotal, nonetheless it's really quite impressive -- we have seen many people almost literally take up their bed and walk, if you will, as a result of these combination therapies.

GROSS: Now, how do people who aren't used to following a regimen, watching the clock all the time, deal with the really tight schedule that you have to follow to take the drugs?

BAXTER: Well, they write down, maybe they'll put it on the refrigerator, the exact time that they need to take medications. They'll set their alarm clock. They will -- we will have visiting nurses that will come in to help them in terms of giving them pill containers -- little pill boxes with the time.

It is difficult, but I think that we sometimes can focus in too much on these so-called "unreliable" patients, and realize that many people, including doctors, can't even take one pill four times a day regularly. And perhaps we're holding them to -- these outpatients -- to a little higher standard.

GROSS: What about patients who are homeless? Who don't have alarm clocks or don't have a home where a nurse can come visit them?

BAXTER: Mm-hmm. That is a far, far more difficult problem, and I think that rather than address the issue primarily of their HIV care, the first issue should be their homelessness. Many times, with a lot of the folks that I take care of, trying to treat AIDS first is, if you'll pardon the cliche, putting the cart before the horse.

And that's why we've had so much problem and difficulty in treating HIV disease in the marginalized population in this country, because we throw at them these so-called "wonder drugs" and because they can't take them exactly right and perfectly, we say: "well, you know, you can't have them."

The first and foremost issue should be addressing the far graver and more serious socio-economic and psychological problems that these people have.

GROSS: A lot of the patients, obviously, who you saw when you worked at this AIDS hospital died.

BAXTER: Mm-hmm.

GROSS: Was there a way of memorializing them within the hospital -- to mark their passing?

BAXTER: Yes. Every three months, the pastoral care department at Spelman would have a memorial service in the small chapel at St. Clair's.

And this memorial service where, for about 30 minutes, all of the staff of Spelman, some of the patients' families, although many of them were not able to make it there, would assemble in the small jewel-like chapel of St. Clair's hospital.

And there would be what I called -- what they called "the reading of names" where there would be a list of people that had died on the Spelman service the previous three months. Usually, there would be anywhere from 15 to 25 names called forth from the altar every three months.

GROSS: You stayed at St. Clair's, this Manhattan-based hospital with the AIDS ward, you stayed there for about three-and-a-half years.

BAXTER: Yes.

GROSS: And now you're working in the South Bronx at an AIDS hospice. Why did you leave St. Clair's?

BAXTER: Several reasons: I always like challenge. I like something that is going to, in a way, make my life a little more difficult and challenging. And after three and a half years, I felt that I had a fairly good grasp on in-patient AIDS care. Out-patient AIDS care, which is what I do now in the South Bronx, has its own set of problems and challenges.

Many of the people that I take care of now, although they're the same as the patients at St. Clair's, are actually a little healthier and so they're a little more difficult, if you will, in terms of addressing their HIV-related problems. So I wanted a challenge. I wanted a change.

Also, I frankly needed some distance in order to write the book. So those were the two main reasons. I still keep in touch very closely with the folks at St. Clair's, especially Sister Pasco Conforti (ph), the director of pastoral care there.

GROSS: Dr. Baxter, I want to thank you very much for talking with us.

BAXTER: Thank you.

GROSS: Dr. Daniel Baxter is the author of the memoir The Least of These My Brethren.

Dateline: Terry Gross, Philadelphia
Guest: Daniel Baxter
High: Daniel Baxter, MD, has written a new book about his work, "The Least of These My Brethren: A Doctor's Story of Hope and Miracles on an Inner-City AIDS Ward."
Spec: Cities; AIDS; Health and Medicine; AIDS
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End-Story: Daniel Baxter
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