As an infectious disease specialist, Dr. Constance Pachucki has spent her entire professional life with HIV/AIDS patients, including three decades at Edward Hines Jr. Veterans Administration Hospital in Chicago. She most recently has become the medical director at Open Door Clinic in Aurora/Elgin.
When Pachucki, a straight ally, entered medical school there weren't that many women doctors but that didn't stop her from pursuing her dream of becoming a doctor. Pachucki faced obstacles that male doctors didn't including pressure to hold off on getting married/starting a family and was even asked that question during her internship interview.
Pachucki's journey began in 1976 when she graduated from the University of Illinois School of Medicine and began her three year residency in internal medicine. After completing her first year as a resident, Pachucki interrupted her training to do a residency in epidemiology. Doing the residency in epidemiology helped Pachucki decide to change her focus and do an infectious disease fellowship at the University of Illinois from 1980 to 1982 after she finished her residency in internal medicine. She joined the staff at the Hines VA Hospital as an infectious disease consultant in 1983.
"I came into the infectious disease specialty prior to the HIV/AIDS epidemic. We took care of the same things we do today; hospital acquired infections, pneumonia, blood infections, endocarditis, fungal infections, infections in people who are immune compromised, MERS, parasitic infections and many others," said Pachucki. "One of the reasons why I got into infectious diseases is because I loved to see people get better. A lot of internal medicine is chronic medicine like heart and lung disease and that didn't appeal to me. When I got into infectious disease, I saw a definite response to the treatments we gave these patients and I really liked that part of it. Then infectious disease changed with the emergence of HIV/AIDS."
Although Pachucki's reason for switching to infectious disease was her excitement when her patients got better that didn't stop her from working with HIV/AIDS patients even though it was a chronic unrelenting disease. "HIV/AIDS infected patients clinical care is complicated and very challenging and I really like that. They can be a puzzle," said Pachucki.
This was during the early years of the disease when there was still a stigma attached to helping those infected with HIV/AIDS. In the early 1980s, Pachucki and her colleague Dr. Joseph Lentino opened a clinic at the VA dedicated to HIV/AIDS patients. "We started to advocate for them because of the public's fear. They were wasting away and dying protracted deaths. You couldn't diagnose it," said Pachucki. "As healthcare professionals we deal with blood so health care workers and the public in general were afraid of these patients. This wasn't a battle that was isolated to where were worked. It was a battle that many of the infectious disease doctors fought across the country. ... Many of the infectious disease professionals became advocates and took care of the HIV/AIDS patients that came to them. That's what Dr. Lentino and I did. We embraced them and they were our patients until they died. Dr. Lentino and I worked together for 30 years at the VA. He's retired now and serves on the board of directors here at the clinic."
Pachucki and Lentino knew that it was important to be leaders and educate people about HIV/AIDS patients as well as advocating for them. "I think about some of the nurses that supported us early on and people saw that. It's how you act not what you say," said Pachucki. "We mentored a lot of people including the residents, We taught them the biology as well as the humanity of taking care of patients. We were glad when we finally got the medicine."
One of the things that came out of their work at the clinic was the home IV program that Pachucki and Lentino started. The program, which had never been done before, was for dying patients who only needed IV fluids and didn't want to spent their last days in the hospital. "We got people to help us at the grassroots level," said Pachucki.
After 30 years of service, Pachucki retired from the VA; shortly after that, she got the opportunity to come onboard as Open Door Clinic's medical director. She has been charged with getting the clinic certified as a patient-centered medical home and building a medical team consisting of medical assistants, registered nurses and nurse practitioners—meaning the clinic will be able to offer comprehensive care for their HIV patients. Prior to Pachucki coming on board, the clinic hadn't had a physician for awhile and was run by nurse practitioners and Dr. Marsha Huston, who is only at the clinic every other week for half a day.
Open Door Clinic is also in the process of transferring to a larger building which they purchased in May 2014. The 9,000-square-foot facility on the West Side of Elgin, 1665 Larkin Ave., will have its first official day of operation on March 2. The new space will allow the medical staffers the ability to provide holistic care for their patients.
Open Door Clinic is also in the process of transferring to a larger building in Elgin which they purchased in May of this year. They plan on moving to the 9,000-square-foot facility on the West Side of Elgin this winter. The new space will allow the medical staff the ability to provide holistic care for their patients.
Managing the medical team, seeing patients and directing their care are all a part of Pachucki's job as the medical director. She is doing primary care for the patients not just monitoring their CD4 ( a type of white blood cell that fights infection ) viral load and is working with the nurse practitioners and RN's to provide that coordinated care.
"In my experience patients that have HIV that is being controlled through medicine their HIV status isn't their problem it's other health issues just like everyone else," said Pachucki. "In fact the guidelines for HIV that were published last fall show that what they are looking for now are all kinds of chronic care measures. It's a challenge. Most of the problems with my patients center on other medical issues outside of HIV."
In order to coordinate care and help Open Door Clinic become a patient centered medical home Pachucki is developing teams, implementing an electronic medical records system and partnering with local hospitals including Rush Copley ( where she is on the staff ). She is also working on partnering with Sherman Hospital in Elgin and Presence Mercy Medical Center in Aurora and Elgin.
"I would also like to see the clinic grow so we can service more HIV patients. David [Roesler, Open Door Clinic's executive director] and I would also like to see the clinic be certified as an LGBT clinic and we are working on making that happen," said Pachucki. "We do see LGBT patients in a very limited sense [HIV/AIDS care] but we will be expanding our LGBT services beyond that when we move into the new building."
"I would also like to see the clinic grow so we can service more HIV patients. David [Roesler, Open Door Clinic's executive director] and I would also like to see the clinic be certified as an LGBT clinic and we are working on making that happen," said Pachucki. "We do see LGBT patients in a very limited sense but we would like that to grow so we can service LGBT patients with a variety of health issues outside of HIV."
One thing that has surprised Pachucki the most since arriving at Open Door Clinic is the amount of young people who are coming in infected. Pachucki sites a lack of education about HIV/AIDS for the uptick in young infected people.
"They don't understand that HIV is a chronic medical problem that is annoying and costly, and there are still side effects. The HIV virus, even when it's controlled, changes your life," said Pachucki. "If you are a woman who wants to have a baby, you risk transmission of the disease to your child and for all patients it's a systemic disease that can affect all of your organs, your nervous system, your digestive system. Since people aren't seeing the death that happened in the early years of the disease they are getting complacent. I have never seen so much syphilis in my whole career as I've seen in the last four to five years."
An adjunct professor of medicine at Loyola University, Pachucki isn't actively teaching at the moment; however, she's taught medical students, residents in internal medicine and fellows who are training in infectious diseases. Over a 30-year period, Pachucki has mentored students during clinical rounds as well as delivered formal lectures and managed cases.
"I taught some of the second year medical students formal courses in microbiology and pharmacology. My whole career I've taught and done rounds with the residents and I miss that part of my job," said Pachucki. "Working at Open Door, I don't get to interact with those who are in training to become doctors. I taught many of the infectious disease doctors out here [in the suburbs]. In fact Dr. Huston was in one of my fellowships."
One difference that Pachucki sees with medical students today is how well-traveled and well-rounded they are. Pachucki said the biggest differences she sees are the levels of support and hands-on teaching the students receive from professors, and the amount of students who are forgoing primary care practices and going into subspecialties.
Pachucki's favorite students to work with were the fourth-year medical students who were doing an infectious disease rotation. "They were more fun than the residents because they wanted to be there and learn about infectious diseases," said Pachucki.
As for her current work at Open Door Clinic, Pachucki would like people to know that the facility offers specialized high-quality care in HIV/AIDS. "We welcome and embrace any HIV/AIDS-infected patient," said Pachucki. "The people who work here are incredibly dedicated individuals who are providing high-quality care with very limited resources."
An open house for the new facility will take place June 11. Contact Christine Mitchell at 331-588-4229 or visit www.opendoorclinic.org for more information.
