It was the late 1980s and young internist Wilbert Warner sat anxiously by a patients’ bedside. The patient had a heart condition and had just been given a new thrombolytic therapy (blood clot busting) drug, something that had never been used before in Bermuda.Dr Warner was anxious because he had only just completed his medical training at Montreal General Hospital in Quebec, Canada.He had brought the new protocol with him from this hospital, but he knew that in Bermuda there were no cardiovascular surgeon on hand (at that time), no catheterisation laboratory and no bypass surgery option available. If the patient started to “bleed out” from the drugs, Dr Warner was on his own. Luckily, the patient survived and became the first patient in Bermuda to be saved by such medications.“He walked out of the hospital a week later,” said Dr Warner. “That patient is still alive today, I think.” Since that time hundreds of Bermudians have been saved by thrombolytic therapy. This month Dr Warner, 57, celebrates 25 years as an internist. He planned to celebrate quietly with staff and family.“The desire to become a doctor crept up on me in high school,” said Dr Warner. “I always loved the sciences in high school. I went to the Berkeley Institute, and then to the Sixth Form Centre, the predecessor to the Bermuda College. It was a natural progression. I did a Bachelor of Science degree in biology. By the time I was 18 or so it crept on me that I wouldn’t mind a career in medicine. My family was very supportive.”He attended McGill University and then went to Montreal General Hospital to train. He tailored his training to do a lot of gastrointestinal work and became certified in endoscopy and dialysis. When he returned home to Bermuda, he was the fourth Bermudian to become an internist. The other internists on the Island were much older than him, with some of them in poor health. This created a demand for his services.“Because I was young, early 30s and energetic, the other internists often said ‘let the young guy handle this’,” he said. “I came into a situation where from day one it was very busy. I saw a whole variety of things. I did a lot of emergency calls. You very quickly build up a vast experience on a variety of things. That is what you train for. The day started at 7.30am and the day finished at 10pm. It was an exciting time to be in medicine, because medicine was changing. Technology was really beginning to come into play with things we could do in the Intensive Care Unit (ICU) setting.”Unfortunately, something else was developing in Bermuda in the late 1980s — the Aids and HIV epidemic. The incidence of the disease peaked in Bermuda around 1988 and 1989.“I arrived back in Bermuda, after training, in the midst of that,” said Dr Warner. “I was the only specialist who had some training in HIV and Aids. Aids and HIV was discovered in 1981, the year I interned. It fell to me to devise what we were going to be doing about it.”Colleagues in Montreal gave him advice and guidance and sent down equipment. At one point, Bermuda had 70 medical beds with 20 taken up with patients with AIDS and HIV. In the beginning there was no treatment; patients who went into the hospital, never came out.“Our first known case was a female, who was married,” said Dr Warner. “There were a group of intravenous (IV) drug users. They would fly to New York for $200 and then go to these shooting galleries where they would share needles. They would return home and often pass the disease on to their significant others. We thought, ‘what are we going to do’.”At first, education was their only option but luckily antiretroviral medication soon came on the scene. Dr Warner and colleagues quietly set up a clinic for people with the disease — quietly because there was still a lot of stigma and misinformation surrounding it in the 1980s. One of his most important moves was convincing the Ministry of Health to provide the medications for free.“That was an important thing that I feel very proud of,” he said. “That made a tremendous impact on AIDS in Bermuda, from 1996 onward. It enabled us to get most of the patients on the medications. The clinic provided other services such as psychiatrists, nutritionists and even financial assistance.“More recently the big studies have demonstrated that to cut down on the spread of the disease one of the most effective things you can do is treat the people who could potentially infect new people. Once you treat them with the drugs they become much less infectious. We peaked around 1989/1990. After we started treating with the new drugs the numbers of new cases dropped. That was presented at the HIV Caribbean Conference in the Bahamas. There were two slides shown about Bermuda, because our experience was so different. In the Caribbean, the numbers were still climbing, climbing and ours had peaked and were coming down.”Dr Warner has also made a difference in the endoscopy area. Today a colonoscopy is a routine part of a medical check-up for people of a certain age. They go into the hospital and are usually out the same day. When Dr Warner started his career patients had to go overseas for a routine colonoscopy.“When I came back the hospital didn’t have a scope (for colonoscopies),” he said. “With the help of a couple of the surgeons, such as the late Dr John Stubbs and Dr Clarence James, we obtained funding for one. Patients donated the money. From there we have grown and now we have seven or eight scopes and an endoscopic unit. Initially, the endoscopies were done in the regular operating room that we had to share. As things grew and progressed I suggested to the hospital that we should have a dedicated space. At first the hospital was resistant, but eventually the powers that be came around. In 1994 when new operating suits were built, the upgrade included a dedicated endoscopic suite.“It was fantastic, fully equipped and modern,” said Dr Warner. “Everything was state of the art.”Today, Dr Warner has no thought of retiring any time soon. He is still helping to make big changes at the hospital as a trustee of the Bermuda Hospitals Board Charitable Trust. He represents the physicians sector and is trying to get all the medical doctors in the community on board with the new hospital.“I think it was a brilliant concept to have an independent body set up whose purpose is just to support the hospital regardless of economics and ensure that hospital development can occur,” he said. “It is exciting to have a new facility. It is certainly going to be more efficient and will raise the quality of care in Bermuda. I am working hard to get all the physicians on board emotionally and economically. That is important for the community to see. It is important for the doctors to be behind it and leading the way.”