Terry Miles entered the eye of the epidemic three years ago to find an AIDS ward where he could nurse patients his way, with healthy doses of compassion, care and dignity.
"I found there was no such thing in New York," Miles said, recalling those days of disillusionment. "And most of the time, I was treated curtly, and I was a registered nurse looking for a job!"So if I was being treated that way, then how were the people needing the care being treated?"
He already knew the answer. He had seen it in the Florida hospital where he'd worked: food trays left outside rooms by nurses and orderlies too frightened to venture in; health-care workers donning mask, gown and gloves just to peek at an AIDS patient through a half-opened door. Four years into the epidemic, people were still being abandoned, starved for human contact because of fear and ignorance.
"It was an agonizing ache within me to do something about that," the 32-year-old Miles said. He was preparing to leave New York when a call came from Kathleen McGuirk, a former colleague who had become nursing director at St. Clare's, a small, aging Roman Catholic hospital tucked into Manhattan's tough Hell's Kitchen neighborhood.
She was planning to open an AIDS ward there, the city's first.
"I came to New York willing and assuming I would be a small participant," Miles said. "I didn't come here with any notion to be a person to create the health-care system for people with HIV infections."
He did it anyway. Less than six months after he arrived, Miles was running St. Clare's new Spellman Services Center, a model for other hospitals.
On Thursday, he and 13 other nurses who care for AIDS patients received awards in Washington from the federal government. Dr. Robert E. Windom, assistant health and human services secretary, called nurses the "unsung heroes" of the AIDS epidemic.
"Looking back on it, I don't think any of us really knew what we were doing, in the sense of how much work it was going to be, how involved we were going to become, how almost three years later, we're still growing and changing and looking like we're never going to finish," said Miles, now the hospital's assistant nursing director. "But this little hospital that could, did - by doing, not by talking the issue to death."
What Miles began as one 15-bed unit has grown to five units with 60 beds, with 25 more by the end of July. The out-patient program sees 250 people a week for a variety of services, including treatment, education and counseling.
Spellman runs a secured unit for state prisoners with AIDS, and a new neuro-psychiatric unit is in the works for people too sick to be out-patients but too well to be in acute care.
Getting this far has been a struggle. From the beginning, many inside St. Clare's were hostile and resistant. Miles, McGuirk and a few other nurses did it alone.
"There were times, literally for days, when (we didn't) walk out of this hospital," said Miles, whose robust blond, blue-eyed good looks bespeak indefatigable energy. "We would take turns sleeping on the table in the staff education room. Because we had to be here."
Ellen Altmann, a nurse who came to Spellman three weeks after it opened in 1985 and now is its clinical coordinator, said Miles held the project together.
"When there were problems on the Spellman unit - and we had many, many problems of people being frightened - the only thing that calmed the staff down was being able to talk to Terry," she said. "He never got annoyed or distraught. And he really did take a lot of abuse in the beginning. We all did. He remained like a rock."
The boy who grew up in small-town Kentucky, the youngest of six children, came to nursing 13 years ago looking for security. English majors were waiting tables; nursing students were getting jobs.
He discovered that nursing fulfilled his need to be needed and nurtured his special gift, an ability to educate people, to break down barriers. The AIDS epidemic has brought Miles into his own: He spends 70 percent of his time teaching, dispelling ignorance about the virus around the country with almost evangelical zeal.
One of the best lessons he has taught his staff, Altmann said, is the importance of touch - the gesture, the hug that can heal as powerfully as any medicine.
"Working with people with AIDS, more than anything else, makes you realize you're working with individuals, not with diseases, not with illnesses, but with individuals," Miles said. "We're here to care about people. And wherever that caring takes us is where we willingly go."
Here is a list of the 14 nurses who were honored by the Department of Health and Human Services to honor all nurses who care for AIDS patients.
-Carol Price, Visiting Nurse Association of Brooklyn, N.Y.
-Mary Boland, director of AIDS nursing at Children's Hospital of New Jersey, Newark, N.J.
-Barbara Russell, Baptist Hospital, Miami.
-Tracey Castleman, Kansas University Medical Center, Kansas City, Kan.
-Christine Grady, National Institutes of Health, Rockville, Md.
-Nancy L. Sears, National Institutes of Health, Rockville, Md.
-Rose V. Thomas, National Institutes of Health, Rockville, Md.
-Terry Miles, St. Claire's Hospital, New York City.
-JoAnne Bennett, St. Vincent's Hospital, New York City.
-Dorothy Ward-Wimmer, Children's Hospital National Medical Center, Washington.
-Brenda L. Staton, D.C. General Hospital, Washington.
-Clifford L. Morrison, Robert Wood Johnson AIDS Health Services Program, San Francisco.
-Helen Miramontes, San Jose, Calif.
-Helen K. Schietinger, California Nurses Association, San Francisco.