A Memorial

A Memorial

Over the years, I have encountered many remarkable physicians. Some of those are no longer with us. I find those that died at a relatively young age particularly tragic. Here are my personal recollections of three such remarkable people that made an impact on me. The following stories are in chronological order of their deaths.

Marissa Jackson-Stone MD (died July 5^th, 1999 aged 35)

It was in 1996, and I was a second year resident in Internal Medicine at East Carolina University in Greenville, North Carolina. I was assigned to a new attending physician that had just joined our faculty. She had left a promising career in the Pharmaceutical industry in Michigan to move to North Carolina following her husband. Her husband was a rehabilitation physician who had taken up a job in the nearby small town of Tarboro.

They had two small daughters and were very devoted parents. Marissa was a very academic and smart person. I learnt so much from her in that month. I also got to know her husband. They were a beautiful family.

A few months after my rotation, I learnt that Marissa had left her husband. They went through a divorce and Marissa decided to move back to Michigan. A judge had given her full custody of her daughters.

On July 5, 1999, Marissa went for a jog in the Fort Worth, Texas suburb of Southlake, where she and her daughters were visiting Marissa's now ex-husband's sister, with whom she was still good friends. Her husband had also taken a one way flight to Texas. He had written his will, leaving everything to his daughters and packed his gun. He then ambushed Marissa in the park and fatally shot her. Minutes later, he killed himself.

I still remember being deeply traumatized by this news. I hope her daughters are doing well today as they must be grown women now. I will always have fond memories of Marissa, a great teacher and a great person.

Prashant Priyarajan MD (died March 16^th, 2000 aged 29)

In 1994, I was studying for a Master’s in Public Health at the University of Alabama in Birmingham. I was working on an assignment at our library computer, when a handsome young South Asian man sat beside me and introduced himself. He told me that he was a medical student and he was from India.

I found this surprising as medical school in the United States is very expensive and usually out of the reach of foreign students. He told me that he was on a full scholarship as an MD/PhD student. Now I was very impressed. MD/PhD programs are extremely competitive and very difficult to get in, especially for a foreign student.

He asked me where I was from. I told him that I was born in Pakistan, but had grown up in Nigeria. He then asked me where my parents were from.

I answered that they were born in Bihar in North Eastern India and had migrated to Pakistan after the partition of the Indian sub-continent.

He then jumped up and said, I had a feeling you were from Bihar. He told me that he was also from a small town in Bihar. Despite my being born and brought up elsewhere as well as being a different religion (I was Muslim and he was Hindu), he considered me as his kinsman and we became very good friends.

In 1995, I left Birmingham to start a residency in North Carolina. He had requested to move into my apartment in my place as it was close to the medical school, and I happily obliged. As I got busy in my residency, I lost touch with him.

In 2001, I wanted to get back in touch with my friend and looked up his name online. I was shocked to see an Obituary notice. I was able to contact his brother in India by email. Apparently after completing his medical school, Prashant had started a residency. During his first year there, he was diagnosed with Leukemia and this subsequently took his life. He was just 29 years old.

I felt really sad at his passing, and I felt bad that I had not kept in touch with him. I feel fortunate to have had the opportunity to be his friend.

Terri Ann Loomis MD (died January 22^nd, 2003 aged 36)

It was 1995, and I was a new intern at East Carolina University. I was on call and was asked by the night float senior resident to come to the Emergency room to admit a patient. I was nervous as the senior resident was Terri Loomis.

She had a reputation as being a no nonsense and tough senior. She was a fourth year resident doing a combined residency in Medicine and Pediatrics. I was nervous. The patient was a sick patient with Diabetes and very high sugars.

She asked me if I could take care of this patient. I said I was not sure. She smiled and said, I will teach you. She spent quite a bit of time that night teaching me in detail how to write the orders and take care of the patient. The patient did well. I learnt so much from her and I was very impressed by her.

On another call night, she taught me how to read EKG’s, and then gave me a book of hers on reading EKG’s. I still have the book today, with her name written inside the front cover in her neat handwriting.

After her residency, she did another residency in Dermatology and got married. She started working with a Dermatology group. She had two children, a girl and a boy, but soon after her son was born, she was diagnosed with breast cancer and died from this. She was only 36 years old.

I remember being very sad at the news. I have never forgotten what she taught me about how to treat a diabetic with uncontrolled sugars. I also see her neatly written name on the inside cover of her book every time I wish to look up an EKG.

The Immigrants

The Immigrants

I saw a recent news story that the United States had removed three communicable infectious diseases from the list of diseases that potentially bar immigration into the United States. All potential immigrants have to undergo a medical exam. The law states that certain diseases which if found in the potential immigrant, will make them ineligible for immigration to the United States. The list still includes Leprosy, Syphilis and active Tuberculosis.

HIV infection was taken off the list in 2010. I have seen two patients who were impacted by this change. Here are their stories.

The first story started by my getting a call from another physician. He asked me if I would be willing to see a new patient with HIV. I replied in the affirmative. The patient that came to see me was a recent immigrant from Ethiopia. She was about 30 years old and was accompanied by her husband and a two-year-old daughter.

The husband had applied for immigration to the United States and been approved with his family. During their physical exam, his wife came back positive for HIV. At that time her immigration was halted. The husband tested negative, and came here on his own. He got a job, and the wife remained in Ethiopia with their daughter. A year later the law was changed and the wife was able to join her husband.

When I saw her, she spoke no English and her husband translated for her. Despite her diagnosis, her husband was very devoted to her. As with a lot of immigrants, she had no health insurance. Her tests confirmed HIV infection. She had not progressed to develop AIDS, but needed to start treatment. Unfortunately, the medications would cost thousands of dollars a month. This was money that they did not have.

I was able to arrange for her treatment at the local health department which provided free care for HIV infected patients. They provided this care with a grant from the federal government. The funding for this came from the Ryan White program.

Ryan White was a teenager from Indiana who contracted HIV from a blood transfusion which he required as a hemophiliac. He was expelled from middle school because of his infection. In 1988 he gave testimony to a presidential commission created by president Ronald Reagan. He became the face of the HIV epidemic.

Congress subsequently created the Ryan White program. All HIV infected patients can receive free care through this program. By 1996, we had effective treatment for HIV. Unfortunately, Ryan White died in 1990 at age 19 due to complications from his HIV infection. I have met his mother, who still campaigns for HIV patients.

After arranging for her to go to the Ryan White funded clinic, I never did see my Ethiopian patient again. I hope that she is doing well today.

My second patient was a young man in his early thirties. He also came to see me for HIV infection. He was an immigrant from Myanmar. He had obtained a green card through a lottery program that is run to promote diversity amongst immigrants to the United States. However, his HIV test came back as positive and his immigration was put on hold

This was how he found out that he had HIV. Luckily he was able to get started on treatment in Myanmar. After the law was changed in 2010, he was able to come to the United States and has continued to do well on treatment. His wife was negative and remains devoted to him.

The laws regarding communicable diseases and immigration are not always effective. In 2001, the United States allowed the immigration of 3800 young orphans from South Sudan. These were known as the lost boys of Sudan. I don't know if any of these boys had an immigration physical or not.

During my fellowship training, I once took care of one of these lost boys. He was from the Nuer tribe of Southern Sudan. This patient was unfortunately found to be positive for both HIV and Leprosy after he got to the United States. He had to be sent to the last remaining Leprosy treatment center in Louisiana for further treatment.

I still remember my professor of Infectious Disease telling me that it was challenging for him to write a letter to the airline asking them to allow an active leprosy patient to fly on a commercial flight and convincing them that he would not be a risk to the other passengers.

Communicable infectious diseases will always be able to cross borders, despite the best attempts to control them.

Health screening of immigrants, Ellis Island early 1900's.