The Power of Listening: From Candy Striper to the Front Lines of the Early AIDS Pandemic

Get Permission

For the rest of the week I wrestled with my decision to go back, or to become a doctor. But I kept thinking about the old man. Simply listening to him had apparently been a form of medical care. So I went back to the hospital at the end of the week, and for all practical purposes I never left.

— Alexandra Levine, MD, MACP

Alexandra Levine, MD, MACP, the Chief Medical Officer of City of Hope National Medical Center, has traveled to 74 countries, seeking out adventures in some of the world’s most far-flung regions. Her illustrious oncology journey has also been an adventure, from the front lines of the AIDS pandemic to working side-by-side with the storied researcher Jonas Salk, MD. And it all began with the simplest and often most overlooked skill in medicine: She listened to a patient’s story.

Dr. Levine was born in Berkeley, California, and moved with her family to Los Angeles while still in grade school. Her father was a lawyer and although her mother, a multilingual language teacher, thought that her daughter should follow in her footsteps, Dr. Levine found the prospect of repeating lesson after lesson too boring. However, Dr. Levine said that she now relates to her mother’s love of teaching; in her current role as an academic, teaching bright young doctors is a cherished part of her job.

Answering a Call

Dr. Levine embodies the spirit of the doctor who is “called” to medicine. Since grammar school, she had always wanted to be a doctor, but it was volunteering as a candy striper at the Los Angeles County+USC Medical Center when she was 16 years old that confirmed her path to medicine.

Independent at an early age, Dr. Levine drove herself to the county hospital on her first day. After orientation, the volunteers were given assignments. “Mine was to pass out water to patients on a certain ward, all of whom were very poor and disadvantaged. At one point, an elderly African American man asked if I would stop and talk for a few minutes. I sat on his bed and listened to his stories. After a while the head nurse came to shoo me along. I apologized to the man for having to leave, and as I got up to go, he thanked me profusely for helping him,” said Dr. Levine.

Her drive home was difficult. At 16, she had never been intimate with the reality of illness or poverty. “My first day on that ward gave me a big dose of both. For the rest of the week I wrestled with my decision to go back, or to become a doctor. But I kept thinking about the old man. Simply listening to him had apparently been a form of medical care. So I went back to the hospital at the end of the week, and for all practical purposes I never left,” said Dr. Levine.

She added that years later when she applied to medical school, “I wanted to go to the University of Southern California so I’d be able to return to the county hospital where the seeds of my career were sown.” Dr. Levine made good on her internal promise, practicing medicine at Los Angeles County+USC Medical Center for more than 30 years.

Serendipitous Path to Oncology

Dr. Levine said that she was fortunate in that her serendipitous career path in oncology was like walking through an open door that she entered freely, with no preconceptions to cloud her vision. “Throughout medical school and residency, I always wanted to go into ICU care. One day in 1974, the Head of the ICU at Los Angeles County Hospital, Dr. Wayne Wagers, approached me and said that we were getting a new service, something called medical oncology,” said Dr. Levine. Dr. Tom Hall, the new Chair of the Oncology Department was arriving in a month or so, but there was one problem: None of the other residents were willing to switch their electives into this new field.

“Dr. Wagers proposed a deal. If I would switch my elective to oncology for the department’s first month, he would allow me to be an attending in the ICU for a month, which at the time was a dream come true,” noted Dr. Levine.

When Dr. Hall arrived, he went on the oncology consultation rounds with his young resident. Dr. Levine took exhaustive notes, patient after patient. “At the end of the day, Dr. Hall asked me if I had any questions. I said no, and he said, ‘Okay, I’ll see you in 2 weeks,’” said Dr. Levine, remarking that her trial-by-fire job in oncology was “to keep all the patients alive.” Although Dr. Levine still planned on returning to the ICU, after spending 2 weeks talking with cancer patients about their lives and how the disease affected them, she began to nurture a deeper appreciation for the “foreign” new field.

When her husband, an epidemiologist with the Centers for Disease Control, was transferred to Atlanta, Dr. Levine applied for a fellowship at nearby Emory University. However, Emory didn’t have a program for ICU intensivists. “I didn’t know what I’d do in Atlanta for the next few years. But a luncheon arranged by my oncology mentor Dr. Hall with the head of Emory’s oncology program ended with an offer to apply for an oncology fellowship. I did. And from that moment on, I’ve been an oncologist,” said Dr. Levine.

Role in Early AIDS Pandemic

In 1982, a young man who entered Dr. Levine’s office at USC County Hospital would profoundly affect Dr. Levine’s career. “He had very enlarged lymph nodes, and first I thought he had Hodgkin disease or lymphoma, so I arranged for him to have a biopsy. I remember looking at the tissue sample under a microscope with Robert Lukes, MD, the Head of Hematopathology at USC. Dr. Lukes was a renowned pathologist, a cherished mentor of mine, so I was shocked when he looked up and said, ‘I’ve never seen anything like this,’” said Dr. Levine.

She continued, “Considering the reactive process Dr. Lukes was observing, he asked what the young man had been exposed to. I didn’t have an answer, so I went back to the patient and asked him to tell me everything that he’d been exposed to.” It turned out that he was gay. He explained that he went to bathhouses and had had multiple sexual partners. “It was an eye-opener. But I still couldn’t nail down the disease. So I asked if I could follow him as a regular patient in order to determine what was going on with his lymph nodes,” said Dr. Levine.

He agreed. And within a month there would be about 20 young men waiting outside Dr. Levine’s office each morning, all with grossly enlarged lymph nodes. This was, of course, the onset of the AIDS pandemic.

“AIDS was not yet described at the time, instead it was called GRID—gay-related immune deficiency,” said Dr. Levine. As time went on, a connection began to materialize. “They were all gay men with B-cell hyperplasia that was perhaps a reaction to a common exposure, and I hypothesized that given time, the very abnormal hyperplasia could eventually lead to the development of monoclonal B-cell lymphoma,” said Dr. Levine.

She applied for a grant from the National Institutes of Health to study these patients, beginning her entrance into the AIDS era. “The patient who first entered my office was a young man named Mark, and over the years his case taught me what HIV/AIDS was, in a clinical sense,” said Dr. Levine.

Sharing Knowledge

Dr. Levine’s career was also influenced by her time spent working in the laboratory with noted virologist Jonas Salk, MD, a mentor she calls a man of a thousand ideas. “He’d call me at all hours to share his latest brainstorm. Some of his ideas bordered on crazy, but Jonas was alive in a way most people only dream of,” said Dr. Levine. Her rich experience with Dr. Salk helped reinforce “how important it is to keep an open mind, as a scientist and a clinician, but most important as a human being.”

Her current position at City of Hope gives Dr. Levine the opportunity to share the knowledge gained from her diverse and accomplished career. “I spend a lot of energy putting people and programs together. I’m fully engaged in creating the robust milieu that encourages valuable collaboration between bright young investigators so we can move cutting edge research along from bench to bedside,” said Dr. Levine.

In her time off, Dr. Levine and her husband travel the world, seeking out new adventures. She’s also a huge Lakers fan, holding season tickets, and is an avid hiker, a gardener, and a lover of the arts. There’s more, of course. And all this began when a young girl volunteering on a ward full of very sick people took time to sit on an old man’s bed and listen to him for a while. ■