Dan Coulston – HIV/AIDS

“The virus hadn’t even been identified.”

Medical school fell into my lap. A series of events made it easy to go to medical school, so I went. I really didn’t have much plans at that point in time. Residency, I thought about a variety of subspecialties, but my primary interest was intensive care medicine—which didn’t exist in those days. [My interest in HIV/AIDS] developed from there.

The first patient who came to Spokane that was identified as potentially having HIV—which still wasn’t really labeled HIV in those days—was in the beginning of 1982. [It] was someone who was sick from San Francisco, who was very sick with a brain infection. I knew someone in San Francisco, who knew me and knew my interest in taking care of sick people, so they sent the patient to me. The patient was from here [originally]. The patient was coming home to live with mom, to basically die.

That index patient started the whole process of recognizing that this was more than just a gay-related immune deficiency. [In the early 1980s], everything was evolving as far as the knowledge base. I became very active in the hospital administrations, in setting up protocols for HIV patients: privacy, what are we doing, how we’re taking care of them, isolation.

[Treatment for HIV/AIDS] was so much in its infancy. The virus hadn’t even been identified at that point in time. So, I learned along with everybody else. Also, I was politically active. I sat on the Washington State AIDS Task Force and I sat on the Governor’s Advisory Commission on AIDS. I had contacts in Seattle with King County Health and Dr. Bob Wood. Everybody was learning at that time; research was starting at the University of Washington. Ann Collier was an STD doc very actively involved in the early on aspects of AIDS research. I was around these people, following what was going on, and information was being shared all the time. It was everything happening at once. There was no formal training of any sort going on. There was nothing in medical school residency [on treating HIV/AIDS], because it didn’t exist at that point in time. It was just happening. I became the focus for a lot of patients. I was the only one who was interested in taking care of [HIV/AIDS] patients. So, you learn by experience.

For the large part, you couldn’t do a lot for patients in those days. We were treating mostly the opportunistic infections and trying to figure out how to do that when there wasn’t an immune system. It became sometimes very short-term, sometimes very long-term, involvement with patients. Following them from beginning to end of things. A lot of people dying in those days.

[Death from HIV/AIDS] was horrible. But you can die, and then you can die. There are ways that people can die better than other ways. We tried to make people die in a less tragic situation.


In a perverse way, the disease is fascinating. It’s so unique in what’s it’s done, not only from a medical standpoint, but a cultural and social standpoint, and how we’ve evolved since then. My formative years—I started high school in San Francisco in the mid ‘60s. So, I always wondered what would’ve happened if HIV had popped up then. The stuff that I was seeing on the streets, and in Haight-Ashbury and East Bay . . . Where would we be now if it had cropped up 20 years earlier? It would be a whole different world.


There was a lot of fear, you know. There was always a certain amount of fear, even on myself. I remember numerous needle sticks, and there was always some worry [of transmission]. But, as science evolved, and we really did start understanding the disease a lot more . . . You had a healthy respect for it, but you also knew it had its place, and you could avoid that place.


Source: Interview with Laura S. Hodgman on 10 July 2013.