Doctor s
career
devoted
to AIDS
By Thomas Clouse
In 1986, Dr. Tom Stalder made a de
cision.
He devoted the rest of his career
to treating people who are dying
from AIDS.
Stalder, who has practiced as a doctor
since 1985, said most of what he does to
treat his patients can be done by any
physician.
“I think at times (the
AIDS patients) need
some highly specialized
care and some special
ized involvement, but
the majority of (the
care) is well within the
confines of what pri
mary care is and should
be,” Stalder said.
“It’s not like you can be a country ‘doc’
out in the middle of nowhere and expect
to do everything,” he said. “But you can
do 90 percent of what (people with AIDS)
need . . . it’s just a matter of being a
doctor.”
Stalder. 36. is part of a group practice
in Lincoln that includes Dr. David Policky,
Dr. Kary Ward and Dr. Jerry Reed.
Few physicians care for people with
AIDS even though the number of AIDS
cases is increasing, Stalder said.
“So some sense of obligation to what I
am doing and to a population in need is
there,” he said.
Stalder said he did not know how
many Lincoln residents were in
fected with HIV. But those who
have contracted the disease are
faced with finding a physician who spe
cializes in AIDS treatment.
“There are three or four people that
are seeing most of the cases and are sort
of identified in some way in as being
involved in (caring for AIDS patients),
Stalder said.
Physicians are less willing to move
into this field because they need to be
“non-judgmental” to work with AIDS
patients, ne said.
“Part of that might be a problem in
dealing with the lifestyles and the sexu
ality,” Stalder said. “I think some of it is
also that it is a relatively new disease and
a new process.
“It is tough to feel competent in some
thing you haven’t been exposed to,” he
said.
Stalder said the epidemics of tubercu
losis and the great plague or Black Death
of Europe during the 14th century both
were historical precedents in working
with diseases that posed risk to the care
giver.
“Not always did organized medicine
shine in those times,” he said. “Some guys
closed shop and took an extended vaca
tion for a while.”
AIDS does not pose the same health
risk as some more highly contagious dis
eases, he said.
“What I do on a day to day basis... witn
these patients, poses minimal if any risk
to me whatsoever,” he said.
Even though HIV is a more localized
infection, StaTder said most doctors peri
odically questioned their motivations for
working with AIDS patients.
“Especially times when you are about
to stick a big needle into somebody who
albeit represents a very low risk to you as
a care giver, it still runs through your
mind that this is an invasive procedure .
.. I need to be a little more careful than I
otherwise might be,” he said.
“One thing that goes through my mind
is what would it do to me if someone in my
office were to get stuck with a contami
nated needle? That would certainly change
the complexions of things.”
As a doctor, it is not uncommon to
treat patients for many diseases
that are life-threatening, but the
death issue seems less immedi
ate, he said.
“Unless something changes drastically
in the next few years — when (people)
find out they are (HIV) positive — their
mortality hits them right square in the
face,” Stalder said. “There's just no way
Greg Bernhardt/D N
Dr. Tom Stalder, an internal medicine physician practicing at 770 N. Cotner Rd., is one of the few doctors in Lincoln
who specializes in treating AIDS patients.
around that.”
Treating terminally ill patients elimi
nates many “trivial aspects” of patient
physician relationships, which is some
times gratifying, he said.
“I don’t enjoy finishing a day feeling
like I haven’t really done much of any
thing for anybody,” Stalder said.
About 15 to 20, or about 75 percent, of
Stalder’s AIDS patients have died.
“I don’t particularly enjoy the death
and dying issues, but I have seen enough
(patients) die in different fashions that I
know there are better ways to do it than
others,” he said.
“And if I can get somebody out of this
world as comfortably as possible,” Stalder
said. “That’s a service, and that is some
thing to be strived for.”
Getting too close emotionally to a pa
tient can be a problem, he said. Especially
after a person with AIDS starts to get
sick.
“I worry about losing my objectivity, in
knowing what’s best for (AIDS patients)
and how best to treat them,” Stalder said.
“At times I find at that point what they
need more is friends and not doctors
anyway.”
He said one of the most difficult aspects
to deal with was watching patients die
who hadn’t had a chance to live a com
plete life.
“Passing is a part of human life, but it
hits you differently seeing someone die
who is 80 versus someone who is 20,”
Stalder said. “There is a difference there.”
A patient’s death puts doctors in a
unique role, he said.
“There are things that strike you as
being particularly poignant, particularly
*
z^
moving or sometimes horrifying that are
sort of the interesting thing about being
a physician and being allowed to get into
people’s lives as mucn as you do.
Comments from AIDS patients’ fami
lies often are surprising, Stalder said.
“You may not have known that you
made any impact on (the family) whatso
ever,” he said.
The family can express how the treat
ment helped the patient, he said, “and
that goes a long way in making^you feel
good about what you are doing.”
Doctors face enough of a battle
fighting AIDS witnout the added
problems created by social la
belling, Stalder said.
“People stillidentify it as a gay disease,
and if I’m not gay then I’m not at risk,” he
said. “That is a real problem.”
That perception has contributed to the
increasing number of heterosexuals con
tracting the virus, he said.
“One of the largest groups that is grow
ing the quickest is females who are hetero
sexuals that have sexual contact with
(intravenous) drug users,” Stalder said.
Increased awareness has resulted from
the disease’s expansion, he said, but a
cure for the AIDS virus never may be a
reality.
A more realistic goal for physicians
would be to palliate the disease, or lessen
the symptoms of AIDS without curing it,
he said.
“Okay fine. I can’t cure you of this
infection, but now can I keep the infec
tion from knocking off your immune system
and killing you eventually?1 I’d be nappy
with that, ne said.
.. , }
The biologic model tor tne aiuo
virus is different from past bio
logic models dealt with by medical .
professionals, Stalder said.
He explained that AIDS is similar to
other infectious diseases, but certain
aspects about the HIV virus make it dif
ficult to kill because the human body is an
ideal host. ' 1
The virus fits into the human biologic
system perfectly, he said, but “from our
perspective, (the virus) is horribly de
structive.”
With no cure, the emphasis must be on
prevention, Stalder said.
The key to prevention is education, but
educating the public is not one of the
medical profession’s strong points, he said.
“You nave to come to grips with educa
tion in the public school system,” Stalder
said. “We as a society have to deal with
those issues in a more up-front manner in
terms of what
your health means and how to protect it.”
The number of AIDS cases is always
increasing, even in Nebraska, he said.
“I think we have slowed down a little
bit the last 12 to 15 months, but before
that we were right on track with national
statistics, which are an ever-rising curve
of the number of cases,” he said.
The disease has increased because of
social repercussions, he said.
“It knows no social boundaries,” Stalder
said. “Obviously most of the people who
are bearing the brunt of the infection are
minority groups, but it’s not restricted to
those groups.*
“It’s impacting many different segments
of our society all at the same time.
It’s going to kill a lot of people across
the world.”