Interview with Dr. Christine Grady

This is an oral history interview with Dr. Christine Grady about the National Institutes of Health’s response to AIDS. The interview was conducted on 30 January 1997 in her office in the Clinical Center at the NIH. The interviewers are Dr. Victoria Harden, Director, NIH Historical Office, and Dr. Caroline Hannaway, NIH Historical Consultant.

Harden: Dr. Grady, we would like to start with your growing up. Where did you grow up, and who influenced your decision to go into nursing?

Grady: I grew up in New Jersey, one of five kids in a very close family that is still very close. It is hard to say who influenced my decision to go into nursing, because nobody else in my family–parents, grandparents, aunts, uncles, nobody like that–is medical or in any way related to health fields. When I was little, I had the usual range of “what I want to be when I grow up” kinds of things. But when I was fairly young, I thought I wanted to be a nurse, and my mother encouraged it the most, even though she was not one herself. She thought nursing was a noble profession and a good thing for me to do. So she encouraged that.

Harden: Tell us about your college experiences. Did you go straight to nursing school?

Grady: Interestingly, I applied to several colleges–I cannot remember the number any more–but only one was a nursing school, and I got early admission. It was Georgetown, and I decided to go there. There was at least one juncture during the course of my four years there that I tried to switch out of nursing and was convinced by the then secretary to the dean not to.

I guess I was finishing my sophomore year when I decided I wanted to go to medical school, and therefore I needed to take some courses that otherwise would not be available to me. This particular woman, who in many respects was the heart of the nursing school, convinced me that I should do both. She said, “Why not do both? You can do it. Just take a few extra credits. Do the hard sciences, keep the nursing. You might be glad you did.” So I did.

I finished with a double major, nursing and biology, and I did apply to medical school when I graduated from college. But that first time around, I did not get into medical school anywhere, and I quickly realized, after I started working as a nurse, that I was very happy doing what I was doing. I never did go back and apply to medical school. I was encouraged to work for a year, take a few more courses, and so on, but I never did reapply. In those days, it was much more difficult for women to get into medical school. Also, it was actually–unfortunately, this is true–counted against me that I had a nursing degree.

Harden: Did it? Why was that, in your opinion? The point of view?

Grady: No, it was just the status, for lack of a better word, of nurses. A college degree was one thing, and I had the double major, but it did not matter. The fact that I had been prepared and trained as a nurse throughout my college years, I think, I was sure of it, counted against me.

Harden: Looking at your curriculum vitae, we could see that you were active in various theoretical issues, such as the rights of the mentally ill, in addition to your bedside nursing responsibilities. How did you develop these kinds of interests?

Grady: Many of those were in my college days. I think some of it came from the orientation that my parents gave me. When we were children, I can remember at young ages going on civil rights marches and things like that, because my parents took us there. We did not know what they were really about, because at the time, although I was older than some of my brothers and sisters, I was not that old. Some of those things did not register directly then, but I think they had an impact later on. So I have always been interested–again, there was my parents' influence–in social issues.

When I got to college–of course, I was a product of the 1960s and 1970s, so some of that was a cultural time situation as well–there were several issues that interested me. I was very interested in women's issues and did many things in college that were related to women's interest groups. Then I became involved in a public interest research group which was just beginning in the early 1970s. It has since evolved into a much more widespread and formalized institution than it was in those days. In those days, it was a very grassroots organization. It was open to any issue. The particular group that I was hooked up with happened to be doing a project on the rights of the mentally ill. So I did not select the topic, I selected the group. Nonetheless, I found it very interesting in terms of what the project was about.

I spent some time during those years at St. Elizabeth's [Hospital] interviewing people, both patients and staff, and I worked with a couple of lawyers who were most interested in issues relating to voluntary and involuntary commitment.

Harden: We are always interested in learning how these early experiences led a person to the position that they have now.

Grady: I did not know much about that one, but I bet it had some influence. I am sure it did.

Harden: But at least it gave you experience in certain areas.

Grady: Yes, absolutely.

Harden: What about your two years in Brazil, working with Project Hope. What led you to that, and what did you learn?

Grady: Again, it was probably the sense of social responsibility that I have already alluded to. I remember as an undergraduate hearing about some of these international health organizations and being very interested in that. I had a sense of our responsibility to the rest of the world, and had actually applied, when I lived in Boston, to both the Peace Corps and Project Hope.

Again, the opportunity arose at a juncture in my life when it made sense to do it. I did not select Brazil. They selected Brazil for me. But it was an incredible experience, both in terms of the health perspective and life experience, living and working there.

Harden: Did you speak Portuguese before you went?

Grady: No, I did not.

Harden: You learned the language while you were there?

Grady: I learned it there. And learned it under fire. I had some classes the first month or so that I was there. But then I was thrown into a hospital situation where I was the only English-speaking person, and I was initially put in charge of a group of clinics. There were, I think, 25 clinics altogether. There were a couple of nurses, but primarily there were nurse's-aides-type people. But I had a staff of maybe 30 people that I was supposed to supervise, so I had to be able to speak to them. I learned very quickly.

I also ended up sharing an apartment with a Brazilian woman and learned a lot from her. She did not speak a word of English. In fact, my parents still talk about calling me up on the phone and hearing this panic at this other end when she would answer and say, “I don't know, I don't know,” and get rid of the phone as quickly as she could.

But Brazil was a fabulous experience for a number of reasons. At that point I had had several years of working as a nurse in different situations in the United States and also of teaching nursing, and I had dealt with a lot of what you sometimes think of as crises in the respective jobs that I had. I remember, in fact, very specifically the night that I went to Project Hope for an interview. I had just come off of a day where I ended up doing a double shift because people did not come in. This was in a hospital that was fairly well staffed and had its range of issues, but it was a reasonably well-organized situation.

Then I went for the interview and was given enough information to imagine what Brazil would be like and the lack of resources that I would encounter when I got there. But even then, hearing about it is nothing like experiencing it.

The range of health problems that we were presented with was great. In fact, the large majority of problems were infectious diseases, which was not surprising, but again it was something that you have not thought about very much when you are coming from a hospital in the United States, and some of the areas that I had worked in were quite specialized as well. Often the situation would be complicated by the fact...

The particular hospital where I worked was located on the edge of a city in a very poor state in Brazil, and the majority of the patients came from the interior of the state. Their arrival would be at the end of a five- or six-hour, or sometimes two-day, journey on a bus to this hospital. And that was the first place that they came to, a federally supported hospital that was supposed to service everybody in the state–in the country, really, but in the state.

We were often faced with the problem of physicians who would come in and say, “I am going to see only 10 patients,” and there would be 75 to see. Or a physician would see a patient and prescribe a medication, and the hospital pharmacy did not have it, the patient had no money, and that was the end of the treatment. Or situations where, for instance... I can remember a patient that I knew quite well who had leukemia, and in addition to the medications that she could not get, there were often crises where she bled, and there was no blood available for transfusion. Or equipment. A large part of the equipment that we used was equipment that had been donated over the years, some through Project Hope and some through other organizations.

But one story that I have told many times since is about the syringes, which were disposable syringes. We use them once here in the United States and then throw them away. In Brazil they were re-sterilized over and over again. Presumably the sterilization was adequate, but over time the bluntness of the needle made it a whole different ball game. You needed a different degree of strength when you went to give somebody an injection. I remember after coming back to the United States, that in the first injection I gave here after having spent two years there, I almost went right through the person's bone. I just forgot the degree of difficulty of inserting a blunt needle versus that of a sharp needle.

But there were a number of wonderful, eye-opening experiences about being in Brazil. Brazil is unique in the sense that it is a wonderful place–the people are very special and the area was physically one of the most beautiful places I have ever been. But the poverty was also about as severe as any I have seen.

Harden: At the hospital in Brazil, did you get many tropical diseases that were similar to some of the kinds of problems that AIDS patients get today?

Grady: Yes. There was a huge amount of schistosomiasis, which AIDS patients do not get. But once I came to the NIH and started working in the allergy and infectious disease units, we did have some schistosomiasis patients. The other disease was leishmaniasis, which, again, I had never seen prior to being in Brazil, but have seen here at the NIH since. Those two were quite common.

There was also a lot of Chagas disease, which is pretty much unique to that part of Brazil. There are some other areas in the world that have it. And a large percentage of the infectious diseases were simple things like Ascaris and ringworm and things like that.

Harden: Now, it was during this time, if my memory is correct, that AIDS came on the scene. Before we discuss your coming to the NIH, can you comment on when you first heard about AIDS, what you heard, and what you thought about it?

Grady: Yes. I actually did not hear about it in Brazil. I may have read something in the newspaper, but it did not register at the time. I came back–I do not remember the exact date, I guess it was around the end of 1981–and worked for a while on a per diem basis at a number of hospitals, mostly in Boston but also in one in New Jersey near my parents' home; and that is when I first heard about AIDS. There was at least one patient, actually, in the hospital in New Jersey that people thought probably had this disease. And although there was very little understanding of anything, there was fear, certainly, in that particular environment.

Harden: Can you talk more about that? This was in a private hospital? We have not heard much about this in terms of who was afraid. Was it staff, physicians, nurses, everybody? What kinds of concerns did they have?

Grady: I think it was everybody, although I was more tuned into what the nurses were talking about. I was a temporary staff person, so I was not as hooked in as some were. But I do remember two patients in particular, one a young woman and one a young man, who had these unknown ailments, they had lymphadenopathy and fevers. He actually had something else, although I do not remember any more what it was. But there was just this buzz around the nursing station: maybe they have this new disease, do we really want them here, and what are we going to do about taking care of them. Yet, there was no diagnosis or anything. It was very possible that either one of them could have had something entirely different. Just because they had some of the symptoms and their age and a question mark about diagnosis, they were lumped in this category.

Then I remember more vividly a conversation that I had. I had spent some time that summer, right before I came to the NIH, teaching at a governor's school in New Jersey. It was high school students, but gifted high school students who were selected for this program, and there was a faculty of people from a variety of different disciplines. It was a very interesting program, an interesting experience, and many very intellectual conversations occurred over the course of the month or whatever it was that we were there. This issue of AIDS came up at one meeting. We were sitting around and people were talking about this disease. They were asking, “Wouldn't you be afraid to take care of these people?" Nobody else was a health care professional in this group. I was the only one. At that point I knew that I was coming to the NIH and that I was going to be working in infectious diseases. I guess that at some level I knew there was HIV here, although we did not call it that then. I knew that they were studying this issue here, or they should be. I remember at the time defending this issue by saying that you take care of people because that is your job. You do not worry about what they have. You cannot, or you would not be able to do what you have to do. I was dismissing it pretty offhandedly, probably out of ignorance. I did not have fear, but I probably did not have enough knowledge even to be afraid.

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