Whenever such frustration surfaces I think back to a simpler time, when no family members asked questions. It was August of 1970, and I was travelling to Vietnam. I had finished my year of Chief Residency in July, and had just completed a five-week course in sweltering San Antonio, preparing for a year of practicing "tropical medicine" for the U.S. Army. We were to arrive in Saigon after 24 hours of flight time, tired and anxious, still not really believing that we were about to land in the middle of an unpopular and dangerous war. As our airplane dipped down over the cloud-covered mountains and the lush tropical vegetation of South Vietnam, someone muttered: "Three hundred and sixty-five days and counting!" After a brief orientation, a few of us traveled northward—the first of many helicopter flights—to Danang, and then to the 91st Evacuation Hospital at Chu Lai, a 300-bed hospital in the northernmost part of the country, nestled on the South China Sea, across the bay from the infamous My Lai peninsula.

The senior internist, a future cardiologist from Kentucky, had just a few weeks before he was to leave for home. It didn't take him long to teach the clinical routine: rounds in the morning on 50 to 100 ward patients, then clinic, followed by 10 to 15 admissions, and then evening rounds. The doctors' barracks were just across the dirt road from the Quonset hut wards, so the patients' doctor was always "on." Workups were familiar and usually straightforward: malaria smears, cultures, blood counts, and liver function tests.

While war raged around us, in the oasis of "Chu Lai-By-The-Sea" the ideal doctor-patient relationship flourished. Healthy young people, temporarily very sick, were restored to good health by appropriate treatment and a caring staff. We were actually curing patients—of malaria, typhus, diarrhea, pneumonia, and hepatitis! And, as a fringe benefit, there was a minimum of paper work and no hassle from third parties.

The grim reality of war was more readily seen on the surgical ward or in the ER, whose adjacent helipad brought us each day the maimed and the dying. If these youngsters survived the short flight from the battlefield they were assured of a 95% survival rate. This testified to the skill and efficiency of the battlefield medics, the helicopter pilots, and our surgical corpsmen, nurses, and doctors. But survival was tempered by the fact that many of these young soldiers had terrible loss of function from trauma.

It is the memory of one of these unfortunate victims that now resurfaces, the most unforgettable memory from a year of unique experiences. Barely in his 20s, the robust corporal had gotten out of his helicopter just to stretch his legs, and had not seen the deadly mine. When he arrived at our hospital, incredibly, he was still alive, awake, and without loss of limb. But the abdominal trauma was extensive, and the surgeons repeatedly entered his belly. He became septic. His wounds stopped healing. Despite broad-spectrum antibiotics, over the course of a few weeks he continued to decline. I doubted he would survive. The customary pessimistic letter, written by unknown Army bureaucrats, was sent by headquarters to his family in Tennessee. But what followed was decidedly not "according to regulations"

About a week after the letter had been sent, I received an urgent call from our hospital headquarters. The commander was not available, and his adjutant wanted to know if I could handle this most unusual phone call from Saigon. To our amazement, it was the young soldier's mother on the phone! She had somehow managed, against all odds and regulations, to get a commercial flight from the United States to Vietnam: a civilian landing in the middle of a war zone, without governmental authorization. As she so firmly stated:

"If I made it all the way over the Pacific, I'm not going to let the officials keep me from seeing my son!"

I agreed, and indicated to the officers in Saigon (by this time I was a Major) that the lady was a nurse (luckily) and that we could use her assistance at the hospital.

She arrived later that day, and was taken immediately to her dying son. They talked for long hours. She held his hand while he slept. For the next few days she stayed at his bedside, with only brief visits to the nurses' barracks for a change of clothes. Her presence gave her son a gift more powerful than any we could provide. She reminded us of the hundreds of people whose lives we touched beyond the hospital walls: families and loved ones thousands of miles away, desperate for news and unable to communicate with either our patients or ourselves. She also reminded us, by her presence, of how families' concern for patients often deepens our own concern.

After a few days, as unexpectedly as she had arrived, she announced her intention to depart the following morning.

"I know he's dying. You're doing all you can and I don't want to make it more difficult for you."

Despite our assurance that she had been an inspiration, not an impediment, this gallant lady said goodbye to her son for the last time and left for home. Within a few weeks her son died. He is buried in Tennessee, and his name, along with those of 58 000 other members of his generation, is inscribed on the Vietnam Memorial in Washington, D.C.

His mother had shown amazing strength and courage. She had brought into focus the hopes and fears of all families of my patients.

This nurse from Tennessee had provided us with one of the most meaningful and rewarding moments in medicine.