What the Patients Ordered
A dedicated HIV doctor opens up about the job he loves and how he faced one of the most difficult decisions of his life
by Chip Alfred
Photos by Lorelei Narvaja
[dropcap]W[/dropcap]hen we talk about HIV/AIDS, we focus a lot of our attention—and rightly so—on the experiences of people living with HIV and AIDS. But what about the healthcare providers who treat people living with HIV? What motivates them? What sacrifices do they make? I sat down with one of them, Dr. Joseph Metmowlee Garland, an HIV specialist at Philadelphia FIGHT, for an in-depth conversation about his passions, his patients, and what he might imagine in a perfect world.
When I first met Joe Garland, thirty-seven, with his Ivy League pedigree and understated charm, he came across as soft-spoken and professional. But after spending some time with him, I saw a selfless, unassuming man who lives to care for others. “Joe is a superb clinician with both the temperament and intellect to care effectively for the most challenging HIV-infected patients,” says Dr. Karam Mounzer, FIGHT’s medical director. “He is very compassionate, incredibly conscientious, and a true humanist. He always goes the extra mile to make sure his patients are connected to whatever they need.”
The son of Tony, an American-born small-town New England physician, and Noi, a pharmacist and immigrant from Thailand, Garland dreamed about following in his father’s footsteps. “The model of medicine that I grew up with was my dad with his square country doctor glasses and the doctor’s bag going on house calls and being a pillar of the community,” he reflects. “I always thought I wanted to be a doctor when I was young, but my mom fought actively against it. Dad worked very hard, and was on call all the time. She worried about that life for me.”
Garland put thoughts of a career in medicine aside until after he graduated from Harvard. “That’s when I realized this is what I really wanted to do.” His interest in medicine was spawned by his desire to work with immigrant populations, which led him to pursue a specialty in infectious diseases. “I was interested in HIV,” he tells A&U, “especially because of the way it affects marginalized populations both in this country and abroad.”
He graduated from Harvard Medical School, then moved to Philadelphia for his residency at University of Pennsylvania. Garland did a rotation at Philadelphia FIGHT’s HIV clinic, the Jonathan Lax Treatment Center, and decided that was where he wanted to work. He started as a staff physician in 2010, and hoped to spend the rest of his career there. Garland was drawn to the community-based setting and the breadth of resources available at FIGHT. “You can see just how well patients facing seemingly insurmountable odds can do when they have a good support system,” he says, citing as an example the case of a female patient he saw several years ago. She was homeless, newly diagnosed with HIV, and struggling with mental illness and addiction. “By the time she left our office, she had been connected to our substance abuse program and to one of our mental health providers,” he recalls. “She met with a case manager to help sort out insurance, and also found an emergency place to sleep that night.” With the assistance of the on-site pharmacist, the patient was able to start on medications that day.
“The better you know people, the more it becomes a partnership working toward a common goal.
Being a doctor gets more and more enjoyable the longer you are seeing your patients,” Garland asserts. “The reason I love medicine is the relationships you build over time with your patients.”
Earlier this year, Garland had to make a difficult choice between his relationships with his patients and the most important relationship in his life—his marriage to Philip, his partner for fourteen years. When Philip, a cardiologist, was offered a position at Rhode Island Hospital, the teaching hospital of Brown University’s medical school, Garland had to do some serious soul-searching, asking himself the question, “How much do I love my job and how much do I love my husband?” Of course the answer was clear. The couple had spent five years on different continents while Philip studied at Oxford, and neither of them wanted to be apart again. Brown offered Garland a position as well, as Principle Investigator of Brown’s Ryan White grant, and working in their HIV clinic, which serves a diverse population, including many uninsured, underinsured, and low-income patients. “I want to care for a population that needs assistance and where I feel my skills are useful,” Garland affirms. “It makes me feel like the work that I do matters.”
His work does matter to his patients. He shares the story of one of his patients, an ex-offender, getting
choked up after a visit with the doctor and a case manager. “I never thought when I was in prison or the halfway house that I would ever get treated this kindly again,” the patient admits. Another patient wrote the doctor an unsolicited letter of recommendation when he learned about Garland’s impending departure. “In all the times I have gone to see Dr. Joseph Garland he has taken the time to listen to my concerns and to include me in the decisions affecting my treatment,” the patient wrote. “Today it is indeed rare for a doctor to show such concern and consideration not only physically but emotionally for his patients.”
Despite having “such a heavy heart” about leaving his patients at FIGHT, Garland looks forward to continuing his work with marginalized populations and building bonds with a new group of patients. In his new role, Garland will also be working with the medical school’s global health program and hopes to carry on his work caring for immigrant populations. For the last eight years the busy, bilingual physician has volunteered his time one night a week at Puentas de Salud (Bridges of Health), a neighborhood clinic serving South Philadelphia’s Latino immigrant community.
As to Garland’s hopes for people living with HIV, at the top of his wish list is finding a cure. “I firmly believe we will have one. I always joke with my patients that I’m hoping I will be out of a job soon,” he says with a smile. “I’m not all that worried. There are plenty of other things doctors can and should do.” Until that day comes, Garland stresses the importance of fighting the biggest obstacle in the battle against HIV—stigma. “The way we must address much of the stigma and discrimination in this country is by people knowing people who suffer discrimination, understanding their stories, and seeing their humanity,” he remarks. “If we stop blaming the individual and start looking at the problems that can be associated with HIV as problems of our society, then we might actually shift the national conversation.”
In the meantime, this devoted doctor will keep on doing what he does best—taking care of the people who need him most. “I like the idea of establishing a role in patients’ lives and being able to carry that forward for many years, hopefully for the rest of a lifetime.”
For more information about the Philadelphia FIGHT Community Health Centers, visit www.fight.org.
For more details about the Division of Infectious Diseases at Rhode Island Hospital, log on to www.rhodeislandhospital.org.
Chip Alfred, A&U’s Editor at Large, is the Director of Development and Communications at Philadelphia FIGHT.