For many, doctor has been a lifesaver

Sept. 30--NORFOLK -- He's spent four decades tackling viruses and bacteria, from the pesky to the deadly, the rare to the ubiquitous:

Ebola, malaria, pandemic flu, SARS, Lyme disease, typhoid fever, smallpox -- you name it, and Dr. Edward Oldfield III can explain it.

The 64-year-old doctor and professor dispenses information about our most-feared epidemics in succinct, measured tones that calm and educate instead of inflame and confuse.

Wednesday, the expert on all things contagious steps down from his 20-year post as chief of the infectious-disease division at Eastern Virginia Medical School, and as head of infection control at Sentara Norfolk General Hospital.

With two decades each in the Navy and at EVMS, he packed a lot into a career, including a stint as special adviser to the U.S. surgeon general for the Navy.

He has traveled around the globe to study tropical diseases: attended the burial of a tribal chief suspected of having smallpox to get a specimen; screened patients in the 1980s in Sudan, one of whom likely had Ebola; instituted military health protocols; and came face-to-face with every kind of infectious disease known to the halls of local hospitals.

He has enjoyed the work -- like most infectious-disease docs, he thrives on the science and mystery of it -- but he's ready to give up being called in the middle of the night to fight the latest biological warfare.

There is one corner of the medical world where he will still do battle, though -- one he's already left an indelible mark on in Hampton Roads: the clinics where he treats patients with HIV/AIDS.

His career contains the arc of the epidemic in this country. Oldfield treated his first HIV patient in 1982 while chief of infectious diseases at Portsmouth Naval Medical Center. It was the same year the Centers for Disease Control and Prevention coined the term "acquired immune deficiency syndrome" for the mysterious virus felling gay, white men.

In 1994, Oldfield and another doctor founded a system of clinics that now extends from Chesapeake to the Eastern Shore.

The number of patients treated by the EVMS clinics -- called the Center for Comprehensive Care of Immune Deficiency -- has gone from 50 to more than 3,000.

That's in part due to this phenomenon: The patients began to survive.

Oldfield won't quit 75 longtime patients, some of whom thought they would die within a year. He admits that some surprised even him.

"I've followed some of them since the mid-1990s, and we have developed a rapport," said the gray-haired professor, dressed in his usual tie, blue shirt and white lab coat. "I have seen their children grow up. They've taken the pills and put up with side effects, and they get nervous when they hear I'm going away. They don't want to cut the bond."

And neither does he.

At least, not until there's a cure.

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It's a far cry from his first cases.

"Unfortunately, what you learned in the early years was how to help people die," Oldfield said.

At first, Oldfield would attend their funerals. He admits to feeling like there was a spotlight on him as "the doctor who failed." So he began sending families a card, expressing a little bit about his memories of the patient, about how he appreciated the opportunity to care for them.

He'd send it off, then write the patient's name on a piece of paper for himself and date it. He has a stack of them.

"That was my way of getting closure and helping me to move on to the next patient."

In the beginning, he'd write down a name and date probably every month.

"Now I might go six months or even a year. My patients are surviving now. Some have been around a long time. A number of them are in their 70s."

Oldfield is a local boy, a graduate of Norfolk Catholic High School. He can trace an interest in infectious diseases to his sophomore year, when he fetched petri dishes out of dumpsters from behind a medical lab to study bacteria. He landed in internal medicine after getting undergrad and med school degrees at the University of Virginia.

He became enthralled with the study of infectious diseases during Navy stints in Portsmouth, San Diego and Bethesda, Md., where he was dispatched to Egypt, Sudan, Congo and Somalia. By the time he returned to Norfolk to serve as chief of infectious diseases at EVMS in 1993, he'd married a Navy nurse and had a son.

Dr. Alan Wilson had a local practice of about 50 HIV/AIDS patients, and the two of them joined forces in the summer of 1994, opening the first of what are now eight clinics. The clinics run on a combination of Ryan White dollars -- the federal funding stream to help people with AIDS/HIV -- Medicare, Medicaid and private insurance.

By the time the first one opened, antiretroviral drugs were showing glimmers of hope.

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Chris Nicholson arrived in one of Oldfield's exam rooms shortly after he was diagnosed in 1996. He worked in the restaurant industry at the time and assumed he'd die within a year or two.

"I was scared, more than anything," said Nicholson, now 51 and living in Virginia Beach. "Friends were dying, people I had been with every day."

A white, gay male emblematic of the first wave of HIV patients, he had two things going for him: his mother's support, and Oldfield as his doctor.

"He insisted I follow the regimen. There were times when he had to call me out, times when I got back into drinking and hanging out with people who were doing drugs. He and my case manager both said, 'Either get it together or we won't see you anymore. You have to do your part.'?"

That meant sticking with the pills and knocking off the wild life.

He started on 25 to 30 pills a day. Medical advances have brought that down to 10. Some of Oldfield's patients take only one a day.

Nicholson's CD4 count -- a measure of white blood cells that ward against infection -- went from 12 to the mid-300s.

"If you do what you're supposed to do, you can survive."

When his mother died three years ago, Nicholson became depressed, started drinking heavily and attempted suicide.

"Dr. Oldfield took an interest in what was going on," Nicholson said. "He made sure I got in to see a therapist. I wouldn't be alive today if not for him."

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Another patient, Holly, was diagnosed at 24 in 1995. She contracted the virus, she believes, from a boyfriend who was a former intravenous drug user. She was living in Virginia Beach and thought HIV was something antibiotics could cure. The first doctor she saw said she could die in three months.

"I remember crying because my grandmother was crying," said Holly, who asked that her last name not be published. "Everyone else had much more of an inkling than I did. My learning curve was steep."

A friend had a sister who was a nurse with Oldfield, so she made an appointment with him.

She asked how long he thought she had to live. He told her he didn't know.

Then, "I'm going to give you a bunch of drugs, and they're going to make you feel worse before they make you better."

She did get worse, was in and out of the hospital for months with vomiting, fever, aches and kidney failure, feeling so awful that she'd have preferred death. Once, she got so angry, she took a lead pipe to a metal beam in her basement. She threw a "Holly's going to die" fish fry.

She remembers one hospital visit in particular when she believed she was close to death, and seeing Oldfield at her bedside in the middle of the night.

If she was too feverish to appreciate it then, she does now: "Doctors don't have to come to the hospital at 4 in the morning," she said. "I was a baby in his eyes. He seemed to have this responsibility to make sure I survived. I was a kid. I think it was hard for him."

She survived that night, but many HIV patients she met during those early years were not so fortunate.

"I would have never thought that, by the age of 27, I would have buried dozens of people. It's devastating to watch them die, knowing you're up to bat. There was a lot of pain that came with that process."

But by the late 1990s, she began to feel she had a chance, and other people she knew with the disease were living longer, too. Her viral load lessened, and some of the side effects of her medication subsided. She went back to school, got pregnant in 1999, and had two children, both virus-free because of treatment she and her babies were given.

Dr. Ronald Flenner, EVMS vice dean of academic affairs, has worked with Oldfield in the infectious-disease division since 1995. He said Oldfield always made sure the practice used cutting-edge research and medications. Some he had to secure special permission to use for patients who were dying with no options.

Because of that, lives were saved.

Holly, 44, now lives and runs a business in Northern Virginia, but she stays in touch with Oldfield: "I saw him as bigger than life. He never gave up on me. He saved my life -- it's that simple."

Oldfield gives credit to the patients and their willingness to take the pills and suffer the side effects:

"You need to give them a reason to buy in, you have to get them to have a reason to take their medication. I make a big deal of having their viral load go down to an undetectable level. I'll call them on the phone. I want them to know they are in control of the virus."

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The rates of HIV infection and death have gone down overall, but there is still plenty of work to be done. Rates of new infection are still rising in some categories, such as gay males, particularly among blacks ages 13 to 24. A Kaiser Family Foundation survey released last week found that fewer than half of gay and bisexual men are aware that people with HIV should start antiretroviral treatment as soon as they are diagnosed.

"The problem we have now is the people who don't know they have it, or they know and they don't change their behaviors," Oldfield said. "If they're in treatment, you can bring their viral load down so they are less likely to spread the infection."

For years now, Norfolk has been a hotspot of the HIV/AIDS epidemic, usually placing in the top 50 cities by CDC stats. One recent survey from hivplusmag.com pegs Virginia Beach-Norfolk-Newport News 23rd in the country.

The profile of those most at risk has shifted to people such as Leroy Jacobs, a 28-year-old gay black man who lives in Chesapeake and works in the mortgage field.

He was diagnosed two years ago, contracting the virus after having sexual relations with a man who didn't tell him he was HIV-positive. Jacobs vows to be transparent about his status and is trying to become a peer counselor. He doesn't mind his full name being used, although his family has questioned his openness. His message to others: Take the pills and inform significant others.

"I want people to see it's not the end of the world. They don't see successful, young HIV cases. I want to show everyone you do not have to hide it and be stressed out. Lots of people don't want to go to the doctor. They will come ask me. I tell them it's not that serious, anymore. I show them the pills."

That kind of openness is rare, though. Oldfield's concern is that better survival rates could lead to complacency about prevention, testing and taking meds. He also worries about "donor fatigue" and having enough health providers to commit to a fight that's no longer new and headline-grabbing, and a disease that still carries a stigma.

To treat the disease takes more than prescriptions; it involves management of transportation, housing needs and dental care, along with treatment of substance abuse and depression. And now as people are getting older, they're getting other diseases, such as heart problems. He recently coordinated Nicholson's HIV care, for instance, with an oncologist who treated him for colon cancer.

And so Oldfield won't go gentle into that good retirement. Besides treating his longtime HIV patients, he's doing grand rounds at EVMS next month on the subject of Ebola, a disease he has helped Sentara hospitals write protocols to treat in case it spreads to the U.S.

He'll still give infectious-disease lectures to residents and fellows in a fellowship program he designed at EVMS.

And he'll continue to do the paperwork for the Ryan White funding to keep the clinics going. Medicaid expansion in Virginia would have covered a significant part of the clinic caseload, he said, but since that didn't go through, other funding must be secured for meds that can cost $20,000 a year for a single patient.

His wife is a nurse practitioner, and his son an EVMS med student, so Oldfield has to think hard about a new life outside the field of medicine.

But he does: Gardening. He'd like to take a class.

It'll be a chance to grow something non-lethal, outside a petri dish.

Elizabeth Simpson, 757-222-5003, elizabeth.simpson@pilotonline.com

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