Stories of gay men in the United States falling victim to a wave of mysterious illnesses were already rife when cases began showing up in 1983 at St. Paul's Hospital in downtown Vancouver. It was the beginning of the AIDS epidemic.
Irene Goldstone had just taken over as director of nursing for the hospital's medical wards. She recalls those days as a terrible, frightening time, with patients and health care providers alike struggling to combat severe symptoms almost never seen in the non-elderly.
"There was this feeling of hopelessness," says Ms. Goldstone, noting the disease was invariably fatal. "We didn't know what we were dealing with."
As the hospital closest to the city's vibrant gay neighbourhoods, St. Paul's quickly became a treatment centre for AIDS patients. And it was there that Rosemarie Riddell, a remarkable nurse with a relentless, no-nonsense drive to improve patient welfare, made her mark.
She came early to the cause of HIV/AIDS patients and stayed with it for nearly 30 years, until forced to leave by illness. When she died July 12 in North Vancouver at the age of 66, Ms. Riddell left a nursing legacy that was exceptional in the challenging field of ministering to those with the devastating virus. Her record was not in the realm of medical breakthroughs or St. Paul's renowned B.C. Centre for Excellence in HIV/AIDS. Hers was at the bedside, where nurses are key, and where the patients she oversaw were among society's most stigmatized.
In bestowing its advocacy award on Ms. Riddell in 2011, the College of Registered Nurses of B.C. cited her unwavering commitment to a vulnerable population in dedicating her professional life "to making a difference for those who otherwise might not have a voice in health care."
In her various nursing roles, Ms. Riddell saw the history of AIDS unfold, from a perplexing, fatal condition that predominantly affected gay men, to a disease miraculously made manageable with the advent of powerful antiretroviral drugs, to one that cut a wide swath among the many lost souls of addicted injection drug users from Vancouver's grim Downtown Eastside.
It was the latter group, as trying a patient cohort as can be imagined, that eventually most occupied and concerned her. She didn't see them as hopeless. She saw them as people who needed help.
A Globe and Mail feature in 1996 singled out Ms. Riddell for her pragmatic approach to the chaos of addicts buying cocaine in the corridors or shooting heroin in washrooms. She advised nurses to be accepting, helped willing patients enter methadone treatment and preached safe injection techniques to others.
A year later, she established a special addiction team at St. Paul's, made up mainly of herself and a co-operative physician. The unit directed care to about 30 patients a day. But Ms. Riddell worked hardest at trying to get users to curb their deadly habit. Harm reduction was one thing, but nothing matched starting a new life, drug free.
She advocated tirelessly for these patients, almost all of whom led jangled lives on the nearby Downtown Eastside, successfully prodding government for crisis grants to allow them to access private recovery facilities. Ms. Riddell also secured funds to provide free television service to addicts' rooms, a huge calming influence for patients on the edge.
Her biggest coup was spearheading a change in benefits for patients on welfare, prompted by a landmark study she conducted with her son Chris.
It addressed a problem that occurred every month at St. Paul's when welfare cheques were issued, a day universally known as Welfare Wednesday. Patients – their treatment unfinished – would simply abandon the hospital to collect their benefits, since they received less if their hospital stay were known.
Not surprisingly, they often returned to hospital in worse shape than when they had left.
"At dinner on a Wednesday evening, my mother would say, 'Guess how many people left today, Chris? It was 16,'" her son, then a young academic, remembers. The two decided to document the issue.
Their published findings not only demonstrated the clear spike in premature hospital departures on Welfare Wednesdays, but also proved that patients who left were far more likely to binge and overdose on drugs.
"This is a troubling result," the Riddells concluded.
After the study was made public, the government stopped reducing welfare for hospital stays.
"It doesn't happen very often that a paper actually changes policy," says Chris Riddell. "This time, it did."
Julie Kille, operations leader for the HIV/AIDS program at St. Paul's, says Ms. Riddell had a deep understanding of the social context of people arriving with highly complex conditions. "She had such a passion for working with very marginalized people, people who needed somebody to be there for them consistently."
Under her care and goading, many patients found their way from the hospital to successful treatment.
"The Lord puts a few people in our lives that touch it in a way no one else can," wrote one appreciative mother, whose daughter Ms. Riddell had helped get clean. "Without your special care, knowledge and time, the hope wouldn't have been there for either of us."
Rosemarie Riddell was born in the southern Ontario community of Lindsay on Nov. 14, 1946. Her early years were not easy. Her mother, Theresa, was a hard-working, French-Canadian from Northern Ontario who had lost her own mother in a fire when she was 12. Ms. Riddell's father was an alcoholic.
Theresa fled her bad marriage and raised her daughter on her own.
There was not much money. Mother and daughter shared a basement suite while Theresa laboured long and hard for meagre pay in a local factory that made plastic bags for packing poultry.
After graduating from high school, Ms. Riddell opted for nursing, one of the few professional options for bright women in the 1960s. She received her diploma from St. Joseph's School of Nursing in Peterborough, Ont., in 1967, followed by a bachelor's degree in nursing from the University of Alberta. In 1996, while still working full time, she earned her master's at the University of British Columbia, writing her thesis on the needs of patients with HIV/AIDS.
During one of her first hospital postings in Kingston, Ms. Riddell met a fourth-year cadet attending the Royal Military College of Canada. The two quickly became inseparable.
Rosemarie and Craig Riddell were married in 1968. After leaving the armed forces, Mr. Riddell became one of Canada's leading labour economists. His academic career eventually brought the couple to Vancouver.
Ms. Riddell joined the staff of St. Paul's in 1983, serving as nursing educator, then as the hospital's clinical nurse specialist for HIV, AIDS and addiction.
She was at the forefront when the hospital set up its pioneering 10C ward, with 20 beds designed specifically for HIV-positive patients, the only one of its kind in Canada. By then, most of those admitted were difficult-to-treat injection drug users.
In 2003, the B.C. Persons with AIDS Society recognized the dedication of Ms. Riddell and the other 10C nurses with their AccolAIDS Award. She was named one of the province's outstanding nurses in 2008.
In addition to her advocacy, Ms. Riddell excelled as an educator, conducting many workshops and authoring numerous papers on clinical practices. This was vital when little was known about AIDS, and fear abounded. "It was a whole new territory of what nurses needed to know to do the job, and she did a brilliant job," says Ms. Goldstone, who worked closely with her. Ms. Riddell was also a regular presenter at AIDS and nursing conferences, understanding the need to communicate beyond the immediate hospital wards at St. Paul's.
Craig Riddell marvels at his wife's embrace of the challenges of AIDS and addiction.
"Before she got into this, Rosemarie knew nothing about the gay lifestyle. She knew nothing about addiction. But she was fascinated by how you deal with it, how you make sure these patients got the best treatment, and that your own nurses are comfortable with it."
Ms. Riddell was diagnosed with pancreatic cancer last spring. She leaves her mother Theresa Marshall, her husband Craig, her son Chris and his wife Angela, and two granddaughters. A memorial service will be held Friday at St. Paul's Hospital.
Stunned current and former colleagues were left to mourn a nurse whose advocacy for the evolving health care needs of HIV patients never wavered.
While far from alone in the AIDS trenches, she was, says Ms. Goldstone, "the right person in the right place at the right time."