On Call: A Doctor's Journey in Public Service

“The nuns of the order of Saint Dominic were in charge of Our Lady of Guadalupe School and introduced me to the experience of tough love. They were strict disciplinarians but taught us excellent work habits. Not that I needed this. My mother was keen on striving for excellence and held high expectations for my performance in school. She constantly bought books for me or borrowed them from the public library for me to read. Although my father was extremely bright, he left the academic pushing to my mother. I soon realized on my own how much I enjoyed school and learning even without outside pressure.”

In this reflection, Fauci illustrates how early discipline and high expectations shaped his academic drive. The education received from the Dominican nuns, combined with his mother’s emphasis on excellence, fostered a sense of responsibility and self-motivation in him. Fauci also underlines the intrinsic enjoyment of learning, which became the core of his educational pursuit. Fauci was always at the top of his class and graduated as the first one in his year from Cornell University Medical School.

“I felt numb, but for the first time I was thinking about my mother both as a son and as a physician. What next? She needed surgery for a definitive diagnosis, so the attending surgeon, Dr. Henry Mannix, did an open biopsy. Again, a call that I kind of expected: ‘Tony, your mother has a liver full of tumor, and the prognosis is really very bad.’ The only thing to do for my mother was to keep her comfortable. I was training to be a physician, and here I was, helpless. I took the subway to Brooklyn and told my father. It was one of the most painful moments in my young life. He was crushed.”

Here, Fauci confronts the intersection of his roles as a son and a medical professional, grappling with the helplessness of facing his mother’s diagnosis. Despite his medical training, he finds himself unable to change the outcome, illustrating the limitations and vulnerability that come with being a physician when loved ones are involved. This moment marks a shift in Fauci’s journey, as he navigates the personal impact of medicine beyond clinical expertise, pointing to The Challenge of Maintaining Emotional Composure in Medical Practice.

“My years of internship and residency training were when I truly found myself. I felt as if I were doing what I was born to do. I was most challenged and comfortable diagnosing and treating the sickest patients who came into the hospital with every possible disease. Even at that early stage in my career, it was obvious to my mentors that I had what they referred to as ‘instinctively good clinical judgment’ where I could analyze with a clear mind all the complexities of a desperately ill patient and map out a well-thought-out strategy to diagnose and treat. I had a natural capability to remain calm and in control even under the most stressful life-and-death circumstances. All of this prepared me for an unprecedented medical and public health challenge that would come several years later and whose dimensions I could not possibly anticipate.”

In this quote, Fauci reflects on his formative years in medical training, where he discovered the alignment between his work and sense of purpose. This blend of clinical acumen and calm demeanor served as a foundation for his career, preparing him for unforeseen, high-stakes challenges in medicine and public health. Fauci’s realization of his vocation foreshadows his capacity to handle the crises that would define his legacy.

“We were stationed at a makeshift clinic inside a small church just north of the Mall. After tending to several people with a variety of medical conditions, from poorly controlled diabetes to heat exhaustion, we heard that a group of demonstrators had been tear-gassed and a guy about my age with severe asthma was in distress. His clothes reeked of tear gas when a pickup truck dropped him off in front of the clinic. I was focused strictly on his breathing, and with tears flowing from my irritated eyes, I brought him inside to treat his asthma. Really bad idea! Within seconds, the tear gas that had permeated his clothing had contaminated the inside of the church, causing us to evacuate for about half an hour. There is always something to learn in clinical medicine. If I ever had to take care of a tear-gassed person again, I would remember to take off their clothes before bringing them inside.”

In this passage, Fauci recounts his experience from his fellowship when he cared for activists amid the Vietnam War protests. The anecdote reflects both the adaptability required in clinical practice and his evolving medical judgment—qualities that would shape his future approach to public health. Fauci also illustrates his closeness to protesters and activists, with whom he had a tense relationship later in his life.

“A huge disruption in the status quo came on June 28, 1969, at the Stonewall Inn, a popular gay bar on Christopher Street in Manhattan’s Greenwich Village. That night police raided the bar (not an uncommon occurrence). However, the results this night were different. Rather than submitting to the police, the gay population fought back. It sparked a series of riots and demands from the men that the violent discrimination against them be stopped. This event triggered a transformation in the gay community’s ability and willingness to express their sexuality in the open, uninhibited, without fear of official repercussions. This was all to the good, but it also had the collateral effect of intensifying a bathhouse culture where gay men could easily participate in indiscriminate sexual activity with large numbers of often anonymous partners over a period of a day or a weekend. The problem was that although this behavior was seemingly innocuous in and of itself, it created the perfect environment for the spread of a sexually transmitted infection, were such a pathogen to be introduced into this subset of the population.”

In this passage, Fauci outlines what he views as the dual impact of the Stonewall uprising on the gay community: a powerful stride toward freedom and visibility, coupled with unintended health risks due to an evolving social landscape. Fauci’s analysis reflects a nuanced understanding of how social and health dynamics intersect with social liberation, though vital and empowering, also creating unforeseen vulnerabilities that would play a significant role in the early spread of HIV/AIDS.

“In my previous decade, I had become used to treating—and usually curing—very sick patients with inflammatory diseases; only rarely did any of my patients die. Those were heady years, and I had been feeling pretty good about myself as a physician. Not anymore. I think of the years from 1982 until the late 1980s as the ‘dark years’ of my medical career. The growing monster of this epidemic did not allow me ever to fully separate from my work. This also affected my personal life. In the spring of 1981, I married a young woman with whom I had had a yearslong relationship. But long-standing tensions in our relationship, compounded by the hours I was putting into my work on the raging AIDS outbreak, which surfaced just a few months after our wedding, unfortunately made the survival of our marriage impossible. We separated around the time of our second anniversary and got divorced amicably one year later.”

In this quote, Fauci conveys personal and professional toll of the AIDS epidemic, which transformed his optimistic outlook on medicine. The intensity of his dedication to combating the epidemic, coupled with the emotional strain, contributed to a crisis that extended beyond medical challenges to affect his most personal relationships. This passage illustrates the sacrifices Fauci made in his commitment to addressing a public health catastrophe that reshaped both his career and personal life.

“Word spread quickly that I was someone who cared about them and that I was willing to be an advocate for them in dealing with the faceless bureaucracy of the federal government. I was no longer the enemy, no longer the ‘murderer.’ I realized that I now embraced two roles, which I enthusiastically welcomed. One was my official job: to conduct my own research and lead NIAID. The other unofficial role was to use my visibility and scientific credibility to influence policy that would address the issues critical to people living with HIV in the United States and, as I would soon appreciate, throughout the world.”

In this quote, Fauci describes his evolving role from a perceived adversary to a trusted ally for people living with HIV, marking a turning point in his relationship with the affected community. By embracing his role of advocate, he aims to bridge the gap between scientific research and public policy.

“I was a scientist and clinician with no political affiliation and with extraordinary access to the president of the United States, and I came to fully appreciate Jim’s very good advice. He was correct. It was exhilarating to talk to the president in the Oval Office, and natural to want to be asked back. It was easy to understand that it could be tempting to tell the president or his staff what you thought they wanted to hear so as not to disappoint them. That is exactly why it was crucial to be truthful and consistent in providing information based purely on scientific evidence and best judgment, and nothing else. That was my rule, and George H. W. Bush was definitely receptive to this approach and continually sought my opinion and advice.”

Fauci reflects on an important moment in his career, when he realizes the potential allure of high-level access but also the ethical responsibility to prioritize objective, evidence-based guidance over political considerations. Fauci’s adherence to this principle illustrates the respect he gained as a trusted advisor—a role that he continued to grapple with through the following decades.

“When Cliff Lane, Henry Masur, and I were taking care of patients with HIV in the early 1980s prior to the availability of AZT, the median survival of our patients was roughly nine to ten months from the time they were diagnosed. This meant that 50 percent of our patients would be dead within that time frame. By 2007, more than ten years after effective combination anti-HIV therapy became available, a modeling study in the United States and Canada found that if a twenty-year-old individual with HIV was put on combination antiretroviral therapy, that person could be expected to live into their early seventies, providing a life expectancy approaching that of the general population. Without a doubt, this represents one of the greatest achievements in medical research and implementation in the history of medicine.”

Fauci’s reflection emphasizes the transformative impact of advancements in HIV treatment, contrasting the grim survival rates of the early 1980s with the hopeful projections of modern antiretroviral therapy. The dramatic improvement in life expectancy by 2007 represents a milestone in global health, as the development and implementation of combination therapy redefined HIV from a terminal illness to a manageable chronic condition. This progress reflects the power of sustained scientific innovation and commitment in extending and improving the lives of millions worldwide.

“As we emerged out of the tunnel on the way to the first stop at Newark, where the smoke and the glow from Ground Zero were fully visible from the train, I saw an abrupt explosion of smoke, dust, and glow from the site. I thought that another plane might have struck yet another building. I just could not believe what was happening. I sat numb in my seat for the trip to Washington not knowing what awaited me back home. I found out as soon as I arrived that the burst of smoke and dust was the collapse of the forty-seven-story building at 7 World Trade Center, referred to as Tower 7. It had not been hit by a plane, but had caught fire as collateral damage from the explosions, fire, and collapse of the North and South Towers.”

This passage captures Fauci’s first-hand experience of the 9/11 attacks. Fauci’s visceral reaction to the collapse of Tower 7 is a symbol of the confusion and terror of that day, as even a seasoned professional found himself overwhelmed by the unfolding tragedy. Fauci’s account emphasizes the pervasive sense of vulnerability that the September 11 attacks evoked.

“I was thrilled about getting both of these initiatives this far, but it was exhausting me. While I had spent a part of almost every day up to that point either on the phone with the White House or physically in the West Wing working on both Project BioShield and PEPFAR, I had also been dutifully performing my day job as director of NIAID, usually late into the night. I had been functioning on a maximum of four hours of sleep a night, and I had barely interacted with my children in a meaningful way in weeks. Christine was holding things together at home and was a true source of steadiness during this frenetic period.”

Fauci conveys the immense physical and emotional toll of managing two major health initiatives—Project BioShield and PEPFAR—alongside his responsibilities as NIAID director. Fauci’s account reflects the personal sacrifices often required in public service and the essential support of family, especially during periods of unrelenting work pressures—a reoccurring theme throughout the book.

“‘It’s not so much the possibility of another deliberate bioterror attack, Mr. President,’ I said, ‘but more the possibility of a naturally occurring disaster such as a brand-new emerging respiratory virus that has pandemic potential.’ History had taught us and it had always been in the front of my mind that nature was a more likely and more formidable bioterrorist than a human terrorist group.”

Fauci’s advice to the president reflects his awareness of historical precedents, where naturally emerging pathogens have often led to significant health crises. This moment foreshadows the upcoming COVID-19 crisis—a naturally-occurring disease—during which Fauci emerged as a central public-facing figure.

“In the approach to Baghdad International Airport just outside central Baghdad, the air force pilot initiated what the air force personnel told me later was a sharp corkscrew landing that terrifyingly felt from inside the plane as if we had actually flipped over. They explained to us that this was the standard way to lessen the likelihood of being hit by a shoulder-fired surface-to-air missile as well as by sporadic fire from AK-47 assault rifles fired by insurgents. They also said that the airport was randomly attacked by mortars every day. Our air force hosts assured us that these were just pockets of insurgents who rarely hit their targets. I did not ask what “rarely” actually meant in military terms. The real targets were the convoys of troops that accompanied the armored SUVs in which I would soon be riding.”

In this passage, Fauci captures the intense tension of landing in a conflict zone, highlighting the dangers that came with his visit to Iraq. Fauci’s experience underscores the ever-present uncertainty and risk faced by those working in such regions, revealing the reality of navigating a war zone where danger extends beyond the immediate battlefield to civilian and diplomatic activities alike. By recounting his experience, Fauci emphasizes the commitment required of public health leaders, who work to address crises even in hostile environments.

“I had thought that receiving the National Medal of Science from the president was the high-water mark for my professional career. Then the president one-upped me. On June 11, 2008, the White House announced that I would be receiving the Presidential Medal of Freedom for my work with HIV/AIDS and particularly my role in helping to develop the PEPFAR program. I was stunned and humbled, because this was the highest honor that could be given to a civilian by the president of the United States.”

Fauci celebrates receiving the Presidential Medal of Freedom—an important moment for him, as it recognizes his scientific contributions and his impact on global health through the PEPFAR program, which transformed HIV/AIDS treatment worldwide. Fauci’s reflections on this prestigious moment of recognition for his work emphasize the tension between his achievements and  the significant personal sacrifices required to reach them.

“What happened next was an example of the inscrutability of human nature. Now that the vaccine was available, the long lines were replaced by many people saying that they did not trust the CDC, which was encouraging them to get vaccinated, nor did some trust the safety of the vaccine since it was a new vaccine and they were afraid of possible side effects. This, even though the vaccine had been shown to be safe. Go figure!”

Fauci’s reflections on the paradoxical nature of public response to vaccines illustrates the complexity and unpredictability of human behavior regarding health interventions. Fauci expresses his frustration with this phenomenon, as it demonstrates how psychological and cultural factors can overshadow objective evidence, complicating public health efforts to achieve widespread immunity.

“As I think back to our early painful experiences of caring for people with HIV infection before we had adequate interventions to save their lives, and I see how well equipped we now are to do so, I believe even more strongly that history will indeed judge us harshly as a global community if we do not seize the opportunity within our grasp to end one of the most devastating pandemics in the history of our civilization.”

In this passage, Fauci grapples with the moral imperative to leverage scientific advancements in combating HIV/AIDS, recognizing that progress brings a heightened responsibility to act decisively. Fauci’s statement reflects his deep sense of obligation both to current patients and future generations who will evaluate today’s leaders and society based on their commitment to eliminating HIV/AIDS, framing inaction as not just a missed opportunity but a moral failing on a global scale.

“All my instincts to be empathetic fueled the energy to make sure that for every individual patient I gave everything I had. I felt that I balanced the cold and dispassionate application of science with my strong identification with the humanity of my patients. In addition, and I cannot explain this except to say that it comes naturally, I have what I refer to as a nonpathological form of obsessive-compulsive behavior when it comes to making sure that every aspect of my patients’ care is attended to. […] Even as my responsibilities took me further and further from daily patient care, I never stopped thinking that what I was doing in the lab, running a large biomedical research institute, or explaining complex medical issues to the public through the media was for the benefit of individual patients. To this day, fifty years later, when I think of my identity, it is as Tony Fauci, physician.”

This passage contains one of the few moments in the book when Fauci directly comments on his own identity and his commitment to ensuring optimal treatment, even in the smallest details. Combining self-irony (through self-diagnosis of a “nonpathological form of obsessive-compulsive behavior”) with an awareness of his growing public influence, Fauci roots himself in his dedication to the well-being of individual patients—self-identifying as a physician first.

“A terrific example of the beauty of a democratic society where the peaceful handing over of power occurs on a regular basis with each change of administration took place on January 13, 2017, a week before the inauguration of President-elect Donald Trump. In a show of collegiality, Denis McDonough organized an exercise whereby he invited the soon-to-be-sworn-in cabinet of the Trump administration to the Eisenhower Executive Office Building adjacent to the West Wing of the White House.”

In this passage, Fauci highlights the peaceful transfer of power as a defining strength of democratic society, emphasizing its value in ensuring continuity and stability across administrations. He contrasts this moment with the subsequent period in his career, when he worked with the Trump administration during the COVID-19 crisis—a period marked by instability. In Fauci’s view, Trump failed to prioritize the care of the American people over his own agenda, contrasting Fauci’s own commitment to always putting patients first.

“After the signing ceremony ended and we were walking out, one of the president’s staffers called me back into the Oval Office, where Donald Trump signed a copy of the executive order for me, the D in ‘Donald’ oversize and looping. As I looked on, he remarked to me that he had never received a flu vaccine until he became president. As someone who is zealous about getting his annual flu shot, I was a little surprised. When I asked him why, he answered, ‘Well, I’ve never gotten the flu. Why did I need a flu shot?’ I did not respond.”

In this passage, Fauci continues to emphasize the contrasting perspectives on preventive health measures between himself and President Trump. While Fauci, a staunch advocate for annual flu vaccinations, sees vaccines as essential for public health as a whole rather than simply a personal precaution, Trump’s rationale—avoiding the vaccine due to a lack of personal illness—reveals a more individualistic approach to health decisions. Fauci’s thus hints at the broader challenges public health officials faced during the COVID-19 pandemic in promoting collective preventive care during the Trump administration.

“In my experience, presidents typically listen to advice and do not make a decision on the spot, saying to the advisers around them that they are taking the recommendations under consideration. Only later do you learn what final decision they made. Not so with Donald Trump. At least not always. He often made up his mind as to what he was going to do while I, and others, were sitting right in front of him. But there was a parade of people in and out of the Oval Office, and after we left, the next person to meet or speak on the phone with him might well say something that changed his thinking. I believe that was how President Trump went from agreeing to abide by the thirty-day plan to ‘liberating’ certain states.”

Fauci reflects on President Trump’s decision-making style, highlighting the challenges he and other advisers faced in maintaining consistent public health policies, as initial agreements could be swiftly altered by new influences in the Oval Office. As other leaders express—for example, Angela Merkel her biography The Chancellor—Trump’s impulsivity and his conflicting messaging on social media, created an environment of unpredictability, which was difficult to mitigate, especially during global crises.

“Even though the country was starting to look ahead, I was back in Trump’s sights. At a Mar-a-Lago donor retreat for the Republican National Committee, he sharply criticized me, declaring that I was ‘full of crap.’ […] Representative Marjorie Taylor Greene of Georgia piled on, introducing legislation to fire me. ‘Dr. Fauci was not elected by the American people. He was not chosen to guide our economy. He was not chosen to rule over parents and their children’s education,’ Greene said. ‘But yet, Dr. Fauci very much controlled our lives for the past year.’”

Fauci describes the intense political backlash he faced from President Trump and some members of Congress to illustrate the polarized responses to his role during the COVID-19 pandemic. Greene’s statements reflect a growing distrust among certain political factions, positioning Fauci as emblematic of government intervention, and revealing the challenges scientists face when their roles in crises intersect with politically charged issues.

“‘Fire Fauci’ had become a convenient campaign slogan and a kind of code for a panoply of extremist proposals. More and more FOIAs were coming in from the usual far-right organizations and from the Republican National Committee, now demanding not just my emails but my calendar entries and phone records as well as all of Christine’s. In March, after Russia had invaded Ukraine, a Republican member of Congress in discussing his theory of deaths caused by the COVID vaccines referred to ‘crimes against humanity’ by me, the CDC, and the federal government. Then a bunch of pro-Russian conspiracy peddlers claimed that Moscow’s air strikes in Ukraine were aimed to destroy bioweapon-manufacturing labs where I was said to be creating a COVID-19 sequel. Welcome to my dystopian nightmare.”

Fauci’s experience adds another layer to his discussion of The Intertwined Realities of Public Health and National Security, highlighting a troubling shift in political strategy, where complex health issues are reframed as personal attacks. Moreover, the smear campaign that Fauci describes, has become a strategy of many far-right and autocratic administrations, as Anne Applebaum describes in Autocracy, Inc. The success of such campaigns reflect the population’s deep-seated mistrust in the expertise of public institutions. The escalation to claims of “crimes against humanity” and far-fetched theories linking Fauci to biolabs in Ukraine underscores how public discourse can be weaponized, distorting legitimate debate into extreme narratives.

“The situation was much more complicated in the arena of the public health response to COVID. The United States, the richest country in the world, had many more deaths per capita than we should have had. The reasons for this are complex. First, over many years we had let our public health infrastructure become a low priority. A system that was already stressed was pushed to the breaking point when plunged into a historic pandemic outbreak. Lack of sufficient support, including financial, had led to an attrition in the numbers of local public health professionals, and these vacancies could not be adequately filled as COVID struck. Nationwide, the system itself was antiquated with some local departments still relying on fax machines rather than online communications. This dangerously impaired the federal government’s ability to assist in the emergency efforts of many local communities and kept it from potentially providing them with additional needed resources.”

In this quote, Fauci underscores the systemic weaknesses that left the US unprepared for the COVID-19 crisis. This is one of the few moments in his memoir when he exhibits familiarity with the systemic issues that the US’s health infrastructure faces, such as underfunding, attrition of local health professionals, limited resources, and very slow real-time response efforts. Fauci’s commentary points to a foundational issue: without a resilient infrastructure, even the wealthiest nations can be quickly overwhelmed in emergencies.