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Last Updated

15 Jun 2003

Source: San Francisco Chronicle, June 15, 2003

A break from healing the world

CDC's top doctor briefly returns to S.F. General

Sabin Russell, Chronicle Medical Writer

Muhamadou Gaye, a lanky 49-year-old homeless man at San Francisco General Hospital, sat up slowly in his bed and winced as the director of the federal Centers for Disease Control and Prevention changed the dressing on a set of tubes draining fluid from his lung.

"You are a very patient man," said Dr. Julie Gerberding, arguably the most prominent and powerful physician in the world. "You are making progress, for sure."

For the past two weeks, Gerberding has set aside her duties as chief of the CDC to care for the sick and injured at San Francisco's public hospital, where she had worked for 17 years.

Instead of fielding phone calls from the White House and conferring with World Health Organization doctors on the SARS outbreak, Gerberding was scooting about the corridors of a busy urban hospital, reading charts, checking lab results, tending to patients like Gaye. He'd developed a dangerous staph infection in his lung, after his ribs were crushed in a robbery attempt.

Gaye politely asked the doctor in the red dress and white lab coat for more pain medication. "We will tell them that this is a very painful situation. We will let the nurses know," Gerberding assured him.

San Francisco General takes care of the poor. Many of Gerberding's patients over the past two weeks were homeless. They were injection drug users, HIV-infected, diabetic, mentally ill or victims of violence. "As we used to say at San Francisco General," the doctor recalled, "this is as real as it gets."

"It's important to stay connected to clinical care," she added, as she hustled off to a meeting with UCSF malaria researchers. "Trauma, alcoholism, injuries -- these are all problems the CDC is trying to prevent."

Gerberding had trained as an intern and resident at San Francisco General and UCSF Medical Center. She eventually ran hospital infection control programs for both hospitals before taking a job at the CDC in Atlanta. She rose to prominence during the anthrax attack after Sept. 11, and was named CDC director in July.

Since then, she has presided over one health care crisis after another: The West Nile virus produced the worst epidemic of mosquito-borne encephalitis in American history last summer. The Bush administration announced an unpopular crash program to vaccinate health care workers against smallpox this winter. Spring was dominated by the outbreak of SARS, or severe acute respiratory syndrome, from China. Now, disease control detectives are tracking down monkeypox cases from infected prairie dogs in the Midwest.

With her frequent press briefings, Gerberding has become one of the most recognized doctors in the world. She is a key player in implementing the Bush administration's policy toward the prevention and treatment of HIV, the virus that causes AIDS.

But on this Thursday afternoon, Gerberding was just one of the doctors making rounds, discussing cases with medical students and fellow doctors. Trailing her were Jennifer Lee and Mark Neuman, two UCSF medical students; internist Dr. Joel Trambley; and Dr. Chris Hall, an infectious disease specialist, who is on the same fellowship that Gerberding held.

After treating Gaye, it was a brisk walk downstairs to consult with a radiologist on CT scans of a 16-year-old boy, who was paralyzed from a gunshot wound and running a fever. In all, the doctors discussed half a dozen cases where patients were battling not only illness and injury but also infections that were complicating their cases, and, in some cases, endangering their lives.

Today, the biggest problems facing hospitals are the threat of bioterrorism,

the spread of exotic new diseases such as SARS, and the growing problem of hospital-acquired infections of bacteria that are resistant to antibiotics. "This is where problems emerge," Gerberding said.

Reality checks, it turns out, are not uncommon among clinicians-turned- bureaucrats. Dr. Mitch Katz, director of the San Francisco Department of Public Health, has set aside one day a week to see patients at San Francisco General Hospital, as did his predecessor, Dr. Sandra Hernandez.

"You spend your day pushing paper, dealing with budgets, making complicated personnel decisions," said Katz. "At times, you feel completely removed from your profession." Katz believes his time in the clinic works like a tonic. "The rest of my week starts to make sense," he said. "It would be hard to stay in my job if I was not a clinician. I don't know if I would feel strongly enough about the work."

Most of Gerberding's patients at San Francisco General during her two-week stay had no idea that such a high-ranking government official was attending to their problems. Some patients, like a 51-year-old victim of a bicycle accident, were in such serious condition they were unaware of their surroundings.

Gerberding's busman's holiday came to a close on Thursday. She had to deliver a commencement address at UCLA's School of Public Health on Friday, followed by another one at Stanford Medical School on Saturday. Then, Gerberding said, "it's back to monkeypox." For Muhamadou Gaye, it was a stroke of luck to have the famous CDC doctor as his attending physician. He did not realize who Gerberding was until hospital officials told him.

"I know about the importance of the CDC," he said, explaining that he reads newspapers cover-to-cover every day. "It is an honor. God must be on my side."

Gaye was born in the Virgin Islands, and his accent belies his West Indies roots. But he is fluent in French, learned while spending much of his youth in Nigeria, Senegal and Gambia. As he related his life story, he recalled something he'd read in the papers, about the CDC. It was a giant Gambian rat, shipped from Africa to a pet distributor in Texas, that is believed to have brought monkeypox to the United States.

"I just made the connection," he said, his face blossoming into a smile. "What a small world we live in."