On a foggy San Francisco day, the ivory candle glowing at the top of the stairway might seem a welcoming beacon. But here at Maitri, it's a symbol of farewell. The candle is lit each time a resident dies.
Next to the candle, staff write the name, date and time of death in a book in black ink. "We had quite a few in the last week," Cecilia Tom says quietly, pausing to look at the record of three who have died in the past five days. For Tom and others, the candle is a reminder of the fragility of life as well as an emblem of the warm environment they work to provide.
Maitri is a residential care facility for low-income patients with HIV and AIDS. Most clients need 24-hour care or have less than six months to live. Others require skilled nursing until they're ready to live independently--although they rarely reach that point. Only six residents have ever moved out after their health stabilized.
The home (pronounced my-tree; Sanskrit for compassionate friendship) had its beginnings 14 years ago when Issan Dorsey, a Zen priest, invited a homeless, dying student into the Hartford Street Zen Center. Since then, it has acquired its own quarters on Duboce Avenue. Maitri now runs on a $2.2 million annual budget and gets more than two-thirds of its funding from the federal government. Corporations and individual donors account for much of the remainder.
The inviting atmosphere of the 15-room residence extends to Maitri's philosophy of care. There is one certified nursing attendant for every five residents, a registered nurse on duty on the weekend and a licensed vocational nurse 24 hours a day. Staff, relatives and friends often gather at the big pine tables in the dining room to share meals. "We consider our office to be in our clients' home," says Bill Musick, MBA '84, who stepped down recently after 3 1/2 years as executive director but still does consulting work for the nonprofit.
Musick, Tom, '93, MA '94, and Holly Crafts, '99, make up a trio of Stanford alumni drawn to working here even if it meant leaving lucrative careers. A fourth, Blake Spears, MBA '85, serves on Maitri's board of directors.
The youngest member of the Stanford crowd, Crafts, who studied film and psychology, was attracted by the nurturing aspects of the job. She says she'd rather work in Maitri's kitchen creating Swedish meatballs, chicken enchiladas and French dip sandwiches than in any of San Francisco's swank restaurants. As she prepares foods, the cheerful, curly-haired Crafts tries to infuse them with healing and goodwill. "You have the same 15 customers every day," she says. "It's like a family."
Still, working here takes an emotional toll: about 70 percent of the clientele have died since the facility opened. Crafts remembers the first time she walked up the stairs and saw the lit candle. "It was this traumatic thing. I cry a lot," she says. "It's definitely hard."
Tom, who recently left her job as associate director of donor relations to recuperate from a car accident, says she fell in love with Maitri from the moment she saw its serene environment. Although she made twice the salary in her second year at an investment banking firm, she wanted to challenge herself, both spiritually and emotionally. "I felt I was a little too smug. I was so sheltered as a child. I always had good fortune, going to Stanford and everything."
Tom found her own ways of coping with the pain she felt when residents died, through meditation and playing drums. "It made me look beyond myself, to see the suffering of these people," she says. "I'm not so focused on my own drama, my own personal issues."
Like Tom, Musick came to Maitri hoping to bring his passion for volunteer work to his professional life. His background included stints as an Air Force lieutenant trained to launch intercontinental ballistic missiles and as a vice president of systems integration at Wells Fargo Bank. He was also director of operations and finance at California Pacific Medical Center, but Maitri brought him closer to patients.
He agrees that dealing with residents' deaths is difficult, but to some extent it goes with the job. "Part of doing this work is realizing that death is a natural part of life," he says, but knowing that "doesn't make it that much easier."
For Spears, a health care consultant and Business School classmate of Musick's, the motivation to serve is simple: "I'm a gay man. My community's been hit so hard by HIV. I've seen so many people die. This seemed to be a good way of tackling one part of it."
Although it's a state-licensed facility, Maitri has none of the fluorescent lights, steel trays and plastic-covered furniture usually associated with a residential-care institution. Traci Teraoka Patel, co-director of the nonprofit Healing Environments, decorated Maitri's tranquil meditation room, then grew so enthusiastic that she filled the entire building with furniture donated by her interior design contacts. Residents seem to appreciate her attention to detail: the carved wooden mantelpiece framing the fireplace; burbling fountains surrounded by potted jade plants, hydrangea, geraniums and bamboo on two outdoor patios; whimsical mailboxes sprouting mosaic tiles, purple feathers and green crushed velvet. "It's like home," says 43-year-old AIDS patient Loretta Wilson.
Like many of Maitri's residents, Wilson spends her days visiting doctors, listening to music in her room, talking with others on the patio or just thinking in the meditation room. Some attend exercise classes, go to museums or catch a movie during monthly outings.
Wilson goes out to elementary, junior high and high schools, telling the story of how she contracted the HIV virus from a boyfriend, who didn't tell her he was infected. She talks about her medication regimen--50 pills a day--and how she went blind when a shingles infection spread to her eyes.
Another resident, who declines to give his name, says he appreciates the level of care at Maitri. The difference between Maitri and his previous nursing home is like "night and day," he says, noting that if he called for a nurse at the other home, "they might not show up until the next day." At Maitri, he says, "I feel very comfortable. I like the fact that they leave you alone until you need them."
It's not easy for low-income people with chronic or terminal illnesses to find affordable accommodations in the high-cost city. Maitri currently has 17 people on the waiting list. Those who can't get in will likely go to a supported-living program, hospice, skilled nursing facility or hospital. "Maitri is a great place, and enjoys a well-deserved reputation in the community," says Mike Shriver, adviser to San Francisco Mayor Willie Brown on HIV and AIDS policy.
Since combined therapies, or "drug cocktails," have given many AIDS patients a new lease on life--and in doing so dulled the public's sense of crisis--Musick sometimes finds himself explaining why Maitri exists. He tells people about the patients who didn't have access to the drugs, stopped taking them because of severe side effects, developed resistance or never even responded to treatment.
AIDS specialist Andrew Zolopa, director of Stanford's Positive Care Clinic, says at least a third of his own patients have developed some drug resistance and 10 percent are fully resistant to all AIDS drugs. Those who do use them risk side effects including elevated cholesterol and fat levels, unusual body fat distribution, diabetes, weakened bones, kidney failure, liver problems and loss of nerve sensation, says physician Robert Shafer, a Stanford specialist in infectious diseases.
Moreover, since the advent of the cocktails in the late 1990s, risky sexual behavior has increased. In San Francisco, considered a bellwether for HIV trends, a Public Health Department-ucsf draft report earlier this year said the rate of new HIV infections among gay men has almost doubled since 1997, jumping from 1.04 percent to a projected 2.2 percent in 2001.
There is still no cure for AIDS on the horizon. Vaccines are being tested, but are at best several years away. For now, Maitri's staff helps patients celebrate each personal milestone with a hug, a Christmas tree or a decadent birthday cake.
"People learn a lot from being around our residents," Musick says. "There are people here who are living life moment to moment."
Deborah Kong is a freelance writer living in San Jose, Calif. is an advertising and marketing consultant in Highland Park, Ill., and the author of four novels.
