Mr. Garcia was going to die. His family gathered from all over the Southwest: dark, tanned men in working jeans, cowboy boots, and hats; women in jeans as well; and lots of children. Everyone was uncomfortable in the cool sterility of the hospital, and as I approached, their acute awareness of my presence made them even more uncomfortable. To many people, doctors represent hope and health, but I had to tell this family that this young man—their son, brother, nephew, cousin—was going to die.

I met Mr. Garcia in the hospital; he had Pneumocystis carinii pneumonia complicated by a pneumothorax. After discharge he developed cytomegalovirus esophagitis with superimposed retinitis. His mother cared for him well. She learned to flush and dress his Hickman catheter and to administer ganciclovir every day. Mr. Garcia did well for quite a while. I looked forward to seeing him and his mother each week. Then came severe diarrhea. I could not control it with the usual medications or even with the latest experimental therapies. We tried giving additional IV fluids at home, but the diarrhea continued. Mr. Garcia began to waste away.

During his last clinic visit we had discussed further diagnosis and treatment. Mr. Garcia said he didn't want to enter the hospital because he was afraid he wouldn't get out. I assured him we would do a few tests, begin IV feedings, and send him home quickly. I was wrong.

On the tenth anniversary of AIDS Mr. Garcia died, surrounded by his family. I went to his room as soon as I could get out of the clinic. When I entered, his mother asked if she could flush his Hickman catheter.

"Of course," I said automatically. Why, I wondered, did she want to do this? The nurse helped her through the procedure. Through her tears she described for her son each step she took. As I watched her ritual, its purpose became clear. She performed it perfectly, with gentleness and love. It was both the saddest and most beautiful good-bye that I have ever seen.

As I left the hospital I saw again the headlines and stopped, arrested by the realization that, on the tenth anniversary of AIDS, despite my efforts and our progress, the only thing this mother could do was to flush the Hickman catheter of her dead son.

Dr. Jack Peralta was a dermatologist. Jack had seven sisters and a brother. One of his sisters is a NICU nurse; another, a resident in the hospital where I work. It's difficult to have a physician as a patient. I wanted to explain each test and therapy in the way I usually do but I didn't want to sound condescending. HIV wasn't around when Jack was in medical school, nor does having a disease mean you know about the therapy or outcome, even if you are a physician. Because of these unspoken issues, the doctor-patient relationship felt terribly awkward.

Jack had AIDS with disseminated Mycobacterium avium-intracellulare—MAI—and a vacuolar myelopathy that had progressed to paralysis of his legs. He became wheelchair bound, required frequent transfusions, and took 10 different medicines each day. Malabsorption from the MAI required hyperalimentation. We talked about what he wanted me to do when he got worse, but he never did complete a living will. He developed progressive dementia and was no longer able to participate in his care.

We held a family conference. Around a conference table early one cold morning, his seven sisters and his mother decided that, if he could tell us, Jack wouldn't want IV feedings anymore.

We began a morphine infusion when he couldn't swallow pills. I made home visits every day or two. I met his sisters' husbands. I played with their kids. I wrote notes to employers and airlines so his sisters could be at home. I shared dinners with the family.

The last visit I made was a few hours before Jack died. His family had taken wonderful care of him, turning him frequently, bathing and shaving him, keeping him out of pain. That night his sisters were all around him—seated on the floor and on the bed. We talked about what was happening to Jack. We talked about death. They told me stories about Jack and their childhood. We laughed a lot.

That night, as I held Jack's hand to say good-bye, I felt both gratitude and rage. I felt fortunate to be his physician. I was angry that he was dying. Angry at AIDS. Angry that there was nothing more that I, "the doctor," could do. But I also felt privileged to have been his doctor and to have seen and felt the love of his family.

These were my HIV lessons; lessons beyond the work, beyond the anger, and beyond the pain. These lessons are not about death; they are about life. That night I drove home and wrote a letter to my parents. Then I held my wife as she fell asleep, and I tried to learn these lessons well.