Kristen Ries received a letter last summer from a former patient, one of the hundreds of individuals with HIV/AIDS she had treated in the 1980s. He’d fallen off her radar ages ago, but he was writing because he wanted to settle his bill. He owed Ries $3,600—$100, he wrote, for every year of his life that she had saved. “He even sent me a picture of the bill, on my old stationary,” Ries says. “He said, ‘You were so kind to me back in those days when I didn’t have any money, you did all my HIV testing for free. Now that I’ve finally gotten some money, I want to pay you.’”

He was not the first patient wanting to settle past-due accounts with Ries ’62 Edu, ’63 MS Sci, professor emerita at the University of Utah’s School of Medicine and a retired infectious-diseases physician. Over the years, many of her former patients have resurfaced with the same wish, even as she has long forgotten about the debts. She has never expected payment—not now, not even when she was treating patients in Salt Lake City in the early days of one of the most challenging epidemics in medical history. Back then, many did not have the means to pay for testing, for treatment, for medication. They had no insurance, they were too sick to work, they had lost their jobs. Ries treated them anyway, charging a token sum of $5 for those who could pay that, or in many cases, nothing at all. Her former patients write to thank her for her graciousness and generosity: the patient who sent the $3,600 asked that she give the money to a charity of her choice; she chose the Utah Pride Center, whose work with LGBTQ youth she admires. They write to let Ries know that they are still alive, and that they have never forgotten her. Because without Kristen Ries, scores of patients who contracted HIV/AIDS when the epidemic devastated the country in the 1980s and 1990s would not have received any kind of treatment at all.

When it was first formally identified in the early 1980s, the disease was poorly understood and its victims highly stigmatized. Particularly in a socially conservative state such as Utah, even many in the medical establishment wanted nothing to do with it or those it afflicted. Maybe it was providence that Ries arrived in Salt Lake City on the very same day in 1981 that the Centers for Disease Control and Prevention released a report on a new illness affecting gay men—or, as Maggie Snyder, a physician assistant who worked with Ries and who has been her life partner since 1990, puts it, it was a consequence of the fact that Utah doctors sent every HIV-positive patient her way. Regardless, for the better part of two decades, Ries was the only doctor in the state treating HIV/AIDS patients.

They were gay men, hemophiliacs, substance users, individuals who’d contracted the illness from a blood transfusion. They came from Salt Lake City, from across Utah, from Nevada and Wyoming. Ries and Snyder went to those who were too sick to come to them, driving over the weekends to far-flung corners of Utah. Hundreds of patients died, but hundreds survived, their immune systems fortified by antiretroviral medication when it became available. Each benefited from the expert medical attention and compassionate care that Ries and Snyder provided. Over time, the duo became a source of immense pride for many in the state, and the subject of a documentary, Quiet Heroes, which received a standing ovation on the first night of its screening at the 2018 Sundance Film Festival.

“It was just serendipity,” Ries says of her life’s work. “I haven’t really thought about it much, but I remember that I just tried to do what I thought was right.”

She insists that it was her burning interest in infectious diseases—how they develop, how they manifest themselves, how they can be treated and eventually cured—that motivated her to treat HIV/AIDS patients when no other Utah doctor would. She also credits her Quaker upbringing; the most important lesson she learned from her parents, she says, was to care for everyone equally regardless of caste or class, creed or color. And she underscores her commitment to the core tenets of the Hippocratic Oath. For Ries, empathy and understanding—talking to patients, and listening to them—are as important as the clinical practice of medicine. “And touch—they need to be touched,” she says. “It’s a human thing.”

Ries never wore rubber gloves during examinations, and she and Snyder willingly and readily hugged their patients. To them, it was a simple, natural gesture—but for individuals whom society treated as pariahs, its magnitude can never be overstated.

Kristen Ries

 

Medicine was always her chosen profession.

Growing up on a family farm in Bucks County, Pa., Ries attended elementary school in a one-room schoolhouse. She was a voracious reader, with a particular penchant for literature on epidemics, devouring everything she could find on yellow fever, tuberculosis, influenza, and the bubonic plague. Ries and her siblings—a sister, Anny ’59 H&HD, who died in a car crash in 1975, and a brother, John ’81 Lib—were all first-generation college students, and all of them graduated from Penn State. College was tough for Ries, particularly chemistry, an essential science for a future doctor and one she actually failed her first year because, unbeknownst to her, she was colorblind.

“In the old days, we titrated experiments to color,” says Snyder. “For her, the colors never showed up, and so she failed her chemistry.”

Ries’ colorblindness is a longstanding joke between the two.

“When I’m really mad at her, I’ll mix up her socks,” Snyder says. But for Ries’ 80th birthday in 2020, Snyder indulged her by painting two walls in their house the brightest shades of yellow and orange she could find, and in 2016 she acquiesced to Ries’ purchase of a fluorescent green Jeep.

Fortunately, Ries’ colorblindness was diagnosed early in her time at Penn State, and she got the help she needed to complete her bachelor’s degree in secondary education and, the following year, a master’s in education and biological science. She went on to medical school at the Woman’s Medical College of Pennsylvania—which later became a part of Drexel University—where she completed a fellowship and residency and served on the faculty before moving, in 1979, to take a position with the Indian Health Service on the Rosebud Indian Reservation in South Dakota.

The job was rewarding yet also challenging. “The government gave us very little, [and] we had to work on a budget, but working there I learned that you can do a lot,” Ries says. “You can give people the care they need with very little.”

She did not know at the time just how invaluable that lesson would prove to be.

Ries left South Dakota in 1981 and moved to Salt Lake City. It felt like a small place—“I live in the center of the city, but at the time, it was mostly farmland around here,” Ries says—where people knew each other, and looked out for each other, but also talked about each other. She’d taken a job in the adult medicine division of an HMO, and she wasn’t planning on staying very long. But fate took its course in the first year, when a patient named Joe came to her office. He’d been sick for a while, struck down by illness after illness; his lymph nodes were swollen and painful. Ries examined him thoroughly. Just as she’d read up on the epidemics in her childhood, she was avidly consuming the emerging literature on this mysterious new illness. She knew what was wrong with her patient.

Joe—who is still alive and still in touch with Ries—was her Patient Zero, and one of Utah’s first-known HIV/AIDS cases. Shortly after she began treating him, a doctor she knew who was leaving Salt Lake City sent Ries two more HIV-positive patients. “He was going to Washington for a fellowship, and he kept saying, ‘What am I going to do, no one wants to take them,’ and twisting my arm,” she says. “Finally, I agreed to take the jump. He had two, I had one, and I knew there were going to be a lot more.”

She knew that because, even though Utah authorities were in denial, HIV/AIDS was barreling its way through that state like General Sherman to the sea. Ries knew that the numbers would only increase. She also knew her time at the HMO was limited: like every other practice, it wanted nothing to do with caring for HIV/AIDS patients. If those patients were to be cared for at all, she’d have to find a way to do it on her own.

So Ries set up a private practice next to Holy Cross Hospital, Utah’s first Catholic hospital. It was founded in 1875 and run by the Sisters of the Holy Cross, with whom she had formed a strong bond. That relationship would lead to Ries chairing the hospital’s ethics committee, and to Holy Cross funding and housing Utah’s first—and, for close to a decade, only—ward dedicated to HIV/AIDS patients. The ward was a 10-bed unit that operated at full capacity with just a sprinkling of nurses (most refused to even go near the ward) until the hospital was sold and renamed in 1994.

“We admired her work,” says Sister Bernadette Mulick, one of the Sisters of the Holy Cross who trained as a physician assistant with Ries, worked closely with her for years, and was instrumental in the creation of the HIV/AIDS ward. “Those patients were the lepers of our time, outcasts in our city, but she and Maggie didn’t discriminate against them in any way. They cared for them when no one else would.”

Maggie Snyder and Kristen Ries

PARTNERS IN WORK AND LIFE: Together since 1990, Ries and Snyder were married in 2013.

 

Ries met Snyder, a nurse who’d moved to Salt Lake from Houston in early 1982, at Holy Cross. Ries was overwhelmed by the growing number of patients coming to her practice, working around the clock, shuttling constantly between her practice and the Holy Cross ward. She needed help. No other doctor would work with her, so the sisters suggested she approach a nurse about becoming a physician assistant. Ries picked Snyder.

“She just walked up to me one day when I was getting medicines out for a patient, and she says, ‘Do you want to go to PA school?’ And then she’s gone in the blink of an eye,” Snyder says with a laugh. “That is so typically Ries. But it came to me at a good time because I was getting bored with nursing.”

Unexpectedly, their close professional relationship morphed into a personal one. And their love—never overtly expressed, says Sister Bernadette—translated into the kind of care and compassion that would give patients and their families the reassurance they needed. Nothing was too much 

for Ries and Snyder—spending an hour, or two, or however long it took with a patient; talking to patients about life, and  mourning when those futures were not to be; making sure to always schedule the last appointment of the day for the one patient whose pleasure it was to watch the sun set over Great Salt Lake from Ries’ office window; and taking phone calls from distraught patients long after office hours and late into the night.

“She and Maggie were on an island alone and did not receive any support even as they reached out to other doctors to set up a caring network,” says Kim Smith, one of Reis’ former patients. “They went out of their way to provide not only physical care, but very good emotional and loving support.”

Smith, a member of Utah’s Mormon community who contracted HIV in 1989 from her husband, says Ries educated the couple about HIV/AIDS, helped them cope and come to terms with the illness, and discussed their individual prognoses. “We always left feeling uplifted and more positive emotionally when we left her practice,” says Smith.

The support would become invaluable to Smith after her husband died. She credits Ries and Snyder with giving her the strength she needed to cope with the loss and to raise her two children alone. Their gift, Smith says, was simply the act of loving people—people shunned by society who had lost the love of their families or whose families were struggling to understand an illness that, for most at that time, was tantamount to a death sentence. “Dr. Ries practiced medicine—she was up to date with the latest information that came out, she made sure she was up to the job of being able to provide the greatest care,” says Smith, “but she also practiced human kindness in a way that is extraordinary. Her practice gave patients a place to be themselves, to feel loved.”

Holy Cross Hospital in Salt Lake City

PORT IN A STORM: A partnership with Salt Lake City's Holy Cross Hospital gave Ries a base from which to care for AIDS patients. (Photo Courtesy of Quiet Heroes)

 

Those years were far from easy for Ries and Snyder. Almost every day new patients would come to the practice. Ries worked a “back door policy,” well aware of the stigma surrounding HIV/AIDS, respectful of patients’ privacy, their physical state, and the emotional turmoil they were going through. Many had to be hospitalized, many died, their beds vacated and almost immediately occupied by other ailing patients. Nursing help for the ward was skeletal at best, and funds were tight despite the continued support from Holy Cross. It fell to Ries to find ways to keep it all going.

“Once Maggie joined us, I had a staff of five, and I had to pay everyone living wages,” she says. “I had to get a bunch of different jobs that paid me, make money on the side. I became the director of three nursing homes, the medical director for a community nursing service here in town, and a lot of other jobs to keep us going. But I never really thought about it, you know, because we were in a crisis, and that’s what people do in a crisis.”

And once the word spread that Ries was treating HIV/AIDs patients, many abandoned her practice.

“I remember one time an HIV patient’s coat brushed against the knee of a non-HIV patient, and it freaked her out so bad that she left and never came back,” says Snyder. “Eventually, we ended up with what we called the ‘Gays and the Grays,’ the people with HIV and the old folks. To see them connect in the waiting room, talking about what they wanted their death to be like, and the funeral arrangements, and how life had been good to them—it was very heartwarming in some respects, and also very sad.”

On the weekends, Ries, Snyder, and Sister Bernadette traveled to other parts of Utah to care for patients who were too sick to travel to Salt Lake. Those efforts would lead to the creation of HIV/AIDS clinics in places like the southwestern city of St. George, which the Utah state health department would eventually fund, and which is still operational. What little spare time they had, Ries and Snyder would spend educating people—school children, teachers, doctors, nurses, funeral directors—about HIV/AIDS, explaining the science, hoping to break down the stigma surrounding the disease.

They faced pushback, of course. From the administrators of the Holy Cross hospital, constantly threatening to shut down the ward; from religious groups; from Salt Lake City society; from the medical establishment; from insurance companies that cut Ries out of their networks. “People would line up on the streets and outside the hospital and shout things at them,” says Sister Bernadette. “They were outcasts in the city. But they just kept on going.”

Over time, Ries and Snyder’s outreach efforts, and their dedication to their patients, would result in support from different quarters. Wealthy people organized fundraisers for Ries’ practice and for the HIV/AIDS ward. Others donated privately. Researchers kept Ries apprised of studies and clinical trials she could enroll her patients in. Pharmacists gave her supplies.

“We made a secret account at one of the pharmacies, and every time she got money, she said, ‘Let’s put it in the pharmacy account,’” Snyder says. “Patients never knew we were getting their medication for free, that every time we wrote a prescription, if we put a certain code on it, the pharmacist wouldn’t charge the patient any money.”

When antiretroviral medication became available in 1987, it was a beacon of hope in a bleak landscape, but it was prohibitively expensive. Ries and Snyder helped their patients by recycling medicines, relying on their expertise to thoroughly check the unused drugs of deceased patients before giving them to others who were still alive and desperately needed medication. That was common practice at the time, Ries says, and many doctors treating HIV/AIDS patients had no other choice even as recycling medicines was a federal offense. Snyder chose to bear the burden—she would go to prison if it came to that, she said. It was a frightening prospect, but Ries insists, “I never worried too much, because [the government] needed people to take care of HIV/AIDS patients.” If the government lacked the will to provide such care, Ries figured, “they were not going to take away the licenses of the people who were doing it.”

Kristen Ries

POWERFUL LEGACY: Ries' work continues to inspire new generations of Utah doctors.

 

Both Snyder and Ries can’t help but feel somehow responsible for Holy Cross’ closure in 1994. The hospital was bought by a for-profit group, which swiftly dismantled the HIV/AIDS ward and gave Ries and her patients a mere three months to find another space.

“[The new owners] wanted patients who could pay, and they told us in not so many words that they didn’t want our patients anymore,” Snyder says. “I still feel bad, like we bankrupted the Holy Cross.”

Sister Bernadette won’t hear a word of it. Today, the hospital, the ward, Ries, Snyder, and their patients are seared into public memory as the first, and most important, chapter of the state’s HIV/AIDS history—a chapter immortalized in 13 four-inch binders of memorabilia carefully put together by Snyder and now housed at the University of Utah’s Marriott Library. Among other items, they contain one of the first red ribbon pins ever made; poems written by patients; obituaries; artwork; and a host of other items showcasing the shame and lack of awareness that surrounded the disease, as well as patients’ pain, sadness, and hope.

Through the 1990s, the frenzy surrounding HIV/AIDS abated, and more doctors began treating patients. Ries went on to an illustrious career at the University of Utah’s medical school as a professor of infectious diseases, president of the medical staff for the University of Utah Hospital & Clinics, and clinical director of infectious diseases. Helped by Snyder and Sister Bernadette, she would continue to treat patients in the university’s HIV/AIDS clinic, which opened in 1994. Snyder retired in 2012, Ries in 2013­—the same year the couple married during a lunch break at a medical conference in San Francisco. And in the summer of 2020, Ries finally retired after a 25-year tenure on the admissions committee for the University of Utah’s medical school.

Ben Chan, the school’s associate dean of admissions, invited her back in August 2021 to speak to two groups of incoming students: those just starting their studies, and those who began in 2020 but whom the COVID-19 pandemic had robbed of the traditional White Coat Ceremony. In her speeches, Ries encouraged the students to become proficient in both the science and the art of medicine. She advised them to learn from and emulate doctors who are not just expert clinicians, but who have the highest regard for their patients, who put caring and compassion for patients before everything else. She will never advertise it, says Chan, but Ries was that kind of doctor, and her legacy remains an inspiration for every aspiring doctor to follow.