Bernadette Stratton Interview, History 150 Spring 2016, Conducted by Breanna Brown, Nursing and the AIDS Epidemic, March 14, 2016.
a. This interview was conducted through FaceTime, and I really did not have to edit the interview much at all. Except for a few brief cuts at the beginning and the end, the whole interview was fairly flawless and could be used without many edits. To set up the interview, I received her cell phone number from my friend Jemma (who happens to be her daughter) and then I texted her explaining how the interview would take place and explained that she could decide whether it would be public or private. I also explained that my grade would not be dependent upon her answers. We then texted and scheduled a time that would work best for both of us (when I had no classes and should have a quiet dorm room to myself and when she wouldn’t be busy), and we decided that FaceTime would be the best medium to have our interview.
b. Bernadette Stratton was born on February 20th, 1961, in Thornton Heath, England. By age 4, she already had an interest in nursing, and at 18, she enrolled in Sir Thomas Guy’s School of Nursing at Guy’s Hospital on the 13th of Feb, 1980. In England, the program is similar to diploma nursing in America, in which they learn vocationally and spend most of their time in the hospitals with minimal time spent in the actual classroom. Therefore, she was active in the hospital patients from 1980 to 1983, and by the third year, she was running a ward herself. She graduated from nursing school in 1983, and spent her remaining time in England working at St. Mary’s Hospital from March to December. At this hospital, she came in contact with her first AIDS patient, and she treated many more in the following months. In January of 1984, she came to America, and began working at the Commonwealth Hospital in Fairfax, Virginia, which was later renamed the Fair Oaks Hospital. At the hospital, she worked in the intensive care unit and came in contact with many AIDS patients from 1984 to 2000. Since then, she has worked various positions within the Inova Hospital System.
c. In 1981, there were 270 gay men reported with having serious immune deficiency, and 121 of them died. In September of 1982, AIDS was first introduced as a term by the CDC and it was defined as “a disease at least moderately predictive of a defect in cell mediated immunity, occurring in a person with no known case for diminished resistance to that disease.” In January of 1983, AIDS was discovered in females who had only had sexual relations with males, which first introduced the idea that AIDS could be passed on heterosexually. In July of 1984, the CDC warned against the sharing of needles, and by 1985 the US Food and Drug Administration enabled the first blood test to detect the AIDS virus. By March of 1989, there were 142,000 AIDS reports from 145 countries, but there was an estimated 400,000 worldwide. There were an estimated 2.5 million people with AIDS worldwide by the end of 1993. However, in 1997, Combivir was approved by the FDA, which is a mixture of antiretroviral drugs that helped people live with HIV. The FDA later approved the first quick HIV that only took 20 minutes and had 99.6% accuracy. In 2003, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) was released by George W. Bush and it invested $15 billion to fight AIDS.
- Taken from:
http://www.avert.org/professionals/history-hiv-aids/overview
d.
BB: Okay so um, first of all, when the aids epidemic broke out, how did the other nurses and health care professionals feel about treating people with AIDS, and how did that differ or match your beliefs?
Mrs. Stratton: Well, when it first started to break out, we really didn’t know how it was transmitted and at first, the belief was we knew that it was probably through blood, we knew that it was through what we called ‘high risk behaviors’ back then which was through iv drug use and probably what we thought was homosexual behavior. Prior to 1985, it was not accepted that HIV could be spread heterosexually, that was the big thing that came in 1985. My first time I took care of an AIDS patient was in England, and in England, nursing is a little bit different in that there is no – you don’t get to refuse to do anything. Because your patient is your patient is your patient. I mean I took care of TB patients; I took care of patients with other kinds of infections. What made AIDS different was we knew so little about it. And there was always the possibility that maybe this blood could do something to us or whatever. I have never known anybody in my entire professional career that refused to take care of a patient with HIV.
BB: Okay cool.
Mrs. Stratton: My belief is, again, your patient is your patient. I was in my hospital when we got an expected Ebola patient, and we had people who refused to take care of that patient. Which I said ‘You can’t. Your patient is your patient.’ Would I say ‘Okay this is what I want to do today?’ No. But if that’s what your assigned to do and someone needs to take care of them, then that’s what you do.
BB: Okay so as far as AIDS, everyone kind of matched your beliefs where they treated everyone, but with Ebola that kind of differed. Awesome. So what kinds of treatments were accessible to AIDS patients and how did that shift with time?
Mrs. Stratton: Well at first there wasn’t any treatment because we didn’t know about HIV until 1984. We knew about AIDS and it was the disease that was first discovered, and that was, I think it was called Kaposi’s Sarcoma – first of the types of infections that they found and then rheumat[ism], and so the treatment was always very reactive and people just died. Because by the time we found out about it, all we could do was to treat the pneumonia, but the problem with nemesis pneumonia is it was so retractable to any kind of treatment. They died of cancer, and the only thing that used to make their death so long was by definition, most of them were very young. When you have the young patient, their hearts tend to be strong. And what keeps you alive is your heart. So we could go and use our extraordinary means to try and keep someone alive; it wasn’t going to change the outcome, but it did keep them – frankly it kept them suffering longer than if they had been older. Being a 22-year-old or 24-year-old, you’re not going to get a no-code order on them. Because no one is going to give up on a 22-year-old or 24-year-old, even though you know its hopeless and futile. And we’ve come a long way in that respect but we still – back then there was no way you were giving up. Then as time changed, the protein inhibitors came. And they’re the ones that when they started – they were like the big cocktail the people started to get, people found out that if you gave it to pregnant women, they decreased the transfer of the HIV from the mother to the baby by 2/3, so that’s the first big push. And the cocktail is what ended up changing it from a complete death sentence to now what has become for many people – if they can get the treatment – that’s the big one because if you can’t get a hold of the drugs then you go into a chronic condition.
BB: Okay. Alright um, so how did legislation impact the outbreak and responses afterwards and how did you feel about the legislation?
Mrs. Stratton: It was slow. It was slow to come about. It was a big fuss because until 1985, and you have to take this in the context of what I’m saying, the way that people perceived it, was it was killing the right sort of people. That is not my belief. Never was. But that was how it was – as long as it was hitting the gay population, or people who were drug addicted, then it didn’t matter. And then, they found out that it could be spread heterosexually. My god, half of Congress probably thought that they were infected. It was a big deal. It also became a big deal because if you are a hemophiliac, and until 1985 we didn’t have a test, to test the blood, and you got HIV positive blood, you have a 95% chance of converting to HIV. Through any sexual transmission, it is actually less than 1%. So if it was (as we used to hear) God’s curse, God’s punishment, whatever, well what did the hemophiliacs ever do? Because that’s the surest way you’ve got of getting HIV. So it was when that kind of education started to filter down, is when you started to see things change. With Raegan, it was 1984-1985, the first time he ever mentioned the word ‘AIDS.’ Because a lot of his friends were dying of it, like Rock Hudson and whatever, but he didn’t want to acknowledge it again because it affected the people who aren’t them. And that’s when it changed. And things started to change after that, Ryan White was a big one, the hemophiliac was burnt out of his house, because he was HIV positive, then he became a big advocate. And you saw things change, 1992 Elizabeth Glaiza spoke at the Democratic convention. And somebody spoke at the Republican convention who was also HIV positive, I just can’t remember who it was. But I do remember Elizabeth Glaiza and she got hers from a blood transfusion during childbirth. And infected both of her children through her breast milk. Again, not that there Is any blame, the virus doesn’t care who or what you are, but they could not argue with the way she got it so therefore it was acceptable to use her as a figurehead. Not saying it’s right, but that was how it was perceived.
BB: Okay, alright. Let’s see…do you think anything could have been done differently to more efficiently treat people diagnosed with AIDS at the time and if so, what?
Mrs. Stratton: Well first of all to admit it was a problem earlier, the early 1980s there was a lot of – they were researching really hard, but because of the stigma, I think that really affected things a great deal, so if people just kind of basically said ‘does it matter’ whether you are homosexual, does it matter if you take drugs, does it matter if you – whatever, you’ve got this horrible disease. It’s like the HPV vaccine, which we now have now. It’s like people said ‘well we don’t want people to get it because they might be promiscuous’ well does it matter? Does that mean that they deserve to get cancer? So this actually happens throughout medicine – what we needed to be different was stop being judgmental, does it matter why someone is sick? It just matters that they are sick. And then of course you’ve got the fact that if you are looking predominantly at a group such as IV drug users, it’s quite possible they don’t have health insurance. Now you don’t have health insurance, you’re not getting access to the drugs. And that’s where places like the Walt Whitman clinic came in, and they were able to help get people drugs when they don’t have the money. So that’s why everything took such a long time.
BB: Okay. Let’s see, did your religious views (or lack thereof) impact your feelings or decisions on the epidemic, and how so?
Mrs. Stratton: No, I’m Roman Catholic.
BB: Me too!
Mrs. Stratton: And um, what my religion tells me is that you take care of everyone. I always wanted to be a nurse, there’s…no. There’s never – I have looked after some really unpleasant people. I have looked after pedophiles, I have looked after – and I give them the same care that I would anyone else. Your patient is your patient. Now I will tell you that – and Jemma will tell you this – is I walked out of our church about five or six years ago, because our very conservative priest said that in a sermon, that um, that Africa deserved its rate of AIDS because they were immoral. In the middle of the sermon I got up and walked out and I actually haven’t been back since. Although Jemma keeps telling me that I need to give it a try again.
BB: So pretty much, your religious views helped you to realize that you wanted to treat everyone, regardless of who they were. Okay, awesome. How did you initially get involved in the AIDS epidemic and what role did you play?
Mrs. Stratton: My very first AIDS patient I ever took care of was in 1983 in London, and at that time we knew so little that they had me dressed up like an astronaut. And then I came over to the United States and then we started to see it more and more often; still then, we still didn’t get to see people until they actually had AIDS. Um so what would happen is someone would come in with a pneumonia that we just couldn’t treat, and it has – pneumocystis pneumonia has a special way it looks on the x-ray, so you know they’ve got pneumocystis and if they’ve got pneumocystis we would do the test to go and see if they were HIV positive. It very rarely happened, we knew they were HIV and they subsequently got sick; they would come in with the AIDS. And we just learned. There were just so many. They were just young and you just learned to look after them and to look after the families. And then they also had to go and deal with – because the stigma was so bad – is that they didn’t want their families or friends to know and that’s the other big thing was confidentiality. That came in very quickly. Because we are not, and still not, allowed to tell a significant other that a patient is HIV positive. That has to come from the patient themselves. So we used to get – that was the big dilemma.
BB: Do you agree with that? Personally? Do you mind if I ask?
Mrs. Stratton: No. No, I don’t agree with that personally. I think that there are times that the greater good has to go and win out, and it depends why they aren’t telling. Is it because they are – well especially, as I said now, we get it early enough, we can stop the t cells from dropping, we make this a chronic condition. But, if you know that you are HIV positive, you should – I think there is a moral and a legal obligation. Well there isn’t a legal obligation, but there should be a legal obligation to go and notify your significant other. You can make decisions for yourself; you cannot make decisions for other people.
BB: Right. Okay, what was your most frightening experience dealing with AIDS and everything and your experiences?
Mrs. Stratton: When I was pregnant with my oldest, who is 26 tomorrow, I got stuck by a high risk patient in the emergency room. He was violent, I was six or seven months pregnant, he pulled his – I got stuck by a needle. There was something at that time called a – and we all have it now, called the Dean Consent Law; if a health care worker, police officer, anything like that gets a body fluid, you have – you’re allowed to take samples from the patient to test them. So they took the blood from this patient but they took blood from me, and at that time it took three days to get the results. And there were no protein inhibitors at that time. So I called to get the results and they refused to give me the results over the phone. And to me, by my health care mind – just freaked out. Bear in mind, I was fragile, very hormonal, six or seven months pregnant – freaked out. My husband had to get home to pick me up to take me to the hospital to get the results because I thought that I was going to be told that the patient was HIV positive and therefore I was at risk for it and so was my child. And it wasn’t, they just – it was negative, they just weren’t allowed to tell me on the phone.
BB: Wow, that’s crazy.
Mrs. Stratton: My husband and I have never forgotten that day – I was so frightened.
BB: Oh my gosh. Okay.
Mrs. Stratton: But other wise, taking care of the patients, no.
BB: That’s good. Okay, looking back, what has stuck with you from the experience as a whole and what did your experiences teach you? I guess about life in general or anything like that.
Mrs. Stratton: That there’s…I remember a lot of them – some of the patients…I remember the patient, the one that couldn’t breathe and I told him things were going to be alright, and I was the last person he ever spoke to before the breathing tube was put down and then we sedated him and he died a week later. He’s the one who’s family gave us – Jemma may tell you – I have a little glass slipper that he gave to me for that. And I remember the one who we knew had pneumocystis, therefore we did the HIV and I stayed up all night with him talking to him because he was frightened about the result the next morning. He knew what the result was, we knew what the result was, but there’s always that little bit of hope that it was going to come back something else and he couldn’t sleep so I stayed up all night talking; I remember him a lot. And I remember the family. And I think that’s what stays – what I also have learned, is when Ebola came, is that we haven’t changed. Dealing in a hospital that thought they had an Ebola patient, when we had everything shut down, when we had special – and seeing people saying ‘I’m not going to do this, I refuse to do this’ in healthcare, that was frightening to me. Because I don’t think we have that choice.
BB: Right. Okay. Let’s see, what events or situations left the biggest impact on you emotionally and why? I guess it’s kind of similar to what I just asked, but if you have any other experiences that are similar to that…
Mrs. Stratton: Probably the guy that I was with when he was getting ready to go, and the one that I stayed up all night with. Then, there is one – let’s see I have to do this without – there is a patient who came in who we felt – actually this goes to another answer – was HIV positive; had AIDS, and he refused to let us tell his wife. So we had to go, we tried to find a way and the doctor did it in a very roundabout way, and we kept saying ‘you should listen to him’ basically ‘just go to your doctor and get yourself checked’ and this was still at a time…oh and I’ll tell you another one. The twenty-three-year-old girl who got diagnosed with pneumocystis pneumonia who only ever had two sexual partners. And it was from her high school prom date five years beforehand. That’s the randomness of it. You know how they always say ‘if you sleep with somebody you sleep with whoever’ and that was it. She was newly married; she had been married like 3 months.
BB: Oh my gosh.
Mrs. Stratton: That one I remember.
BB: Okay, my final question is what were the biggest obstacles you faced while treating patients? Which, again is kind of similar but I don’t know I guess if you have any other variations of your experiences.
Mrs. Stratton: Well there’s always just trying to get through…the hospital, strangely enough. As unbelievable as this sounds, prior to what we call now Standard Precautions, which is what used to be called Universal Precautions, which is why you see everyone wearing gloves all the time. That came into being in 1987. Two years after we had found out what the HIV virus was. That was a lot of issues with the hospital because they didn’t want us wearing gloves all the time because it costs money. So they things like ‘if you think you’re going to get blood on your hands, you can wear gloves.’ But after that – before that time, we used – I used to be covered in stuff all the time. The irony being, Hepatitis C, Hepatitis B, is far more contagious than HIV is. Hepatitis C is the number one cause of liver cancer. Hepatitis B used to kill us all the time. I never wore gloves. And it was getting the hospitals to see that they had to start giving the staff protective clothing in order to deal with this. Again, fast forward 30 years and you have what happened in Texas, where those two nurses who contracted the Ebola and the fact that the hospital didn’t give them – because that equipment – because I know, I’ve seen it, been taught how to put it on, is very expensive. And it looks like they cut corners with that – two nurses came down with Ebola. Unfortunately, we don’t seem to learn.
BB: History repeats itself. Alright, well thank you so much, I think that’s everything; I really appreciate it.
Mrs. Stratton: I hope it helped.
BB: Thank you!
e. All in all, I think the interview went excellently and Mrs. Stratton was not only compliant and informative, but she was friendly, talkative, descriptive, and incredibly open and honest throughout the interview. Furthermore, she exceeded my expectations regarding her responses to my questions, by being as detailed, descriptive, reflective, and informative as she possibly could, and going out of her way to do so. If I could do it over, I would just remove a few distractions that arose when some of my friends entered the dorm room and were being only slightly disruptive and distracting; their actions didn’t audibly mess up any parts of the interview but it definitely made it hard for me to focus and react appropriately for every question. Though I told them not to come into the room during that time, it is hard to ever be completely isolated on a college campus, and next time I may have to go to a really desolate location in order to avoid that happening again. However, over all the interview flowed excellently and seemed natural, effortless, and comfortable. I didn’t really have a hard time staying on script because most of my questions were related to each other and helped to develop the interview properly. For the most part, the interview also stayed very on track and deviated very little, which was nice because it was organized and easy to comprehend. All in all, Mrs. Stratton was an excellent interviewee and the interview itself was not only successful, but incredibly efficient and meaningful, thus surpassing all of my expectations.