Another aspect that troubles me about teaching medical students is lecturing on the clinical manifestations of viral diseases. That's where I am a fish out of water. For me, these diseases are merely descriptions in a book. They have no faces. It troubles me that I lecture on serious illnesses about which I have only read. How can I teach what I have never seen? My own children have not had chickenpox, and although I have, I did not observe the three types of lesions present simultaneously on my skin. Yet I teach it. I teach a lot about AIDS when I have no experiential knowledge of this disease.

For some time I had considered a way to remedy this deficiency. I wrote to an infectious disease specialist, requesting to join him on rounds for a few weeks. But then I set the letter aside. What was I afraid of? Doctors for one thing. I knew what they were really like. Physicians refer to patients by their diseases, not by their names. They are arrogant and abusive to residents on their service. What if they asked me questions? My second fear was just as irrational. I had seldom been around sick people. And the times that I have, I did not conduct myself very well. What if it happened again?

I spent a month mentally preparing myself. At last, I mailed the letter and went to the hospital, finally seeing patients with some of the diseases I had taught about for years. The suffering of patients afflicted with those maladies touched me deeply. This story is about just a few of the patients. It's also a story of my own growth and my glimpse on being a doctor.

On the first morning, I waited in the hospital lobby to meet Dr. Brewer, my stomach in knots. He arrived, we shook hands and I thought, "He seems pleasant; so far, so good." The first patients I saw were in the intensive care unit. We went first to a central work station where the charts were located. As Dr. Brewer reviewed a chart, I looked around at the darkened, glass-sided rooms with beds where people lay attached to tubes and IVs. There was a hum of machinery and a flickering of lights from TV sets families watched in patients' rooms while they waited for a miracle to happen.

Dr. Brewer explained about Mr. Hall, who had been in a car accident and had numerous injuries. He had been on the unit for several months and had had a fever for weeks. His condition was deteriorating. I looked over to the room as Dr. Brewer spoke. Mr. Hall appeared to be in his sixties. Although his eyes were open, he seemed unaware of his surroundings. A man stood over his bed, his son I presumed, speaking loudly, as though the volume of his words could penetrate his father's consciousness.

"You stay with us now," he said, his voice shaking, "You stay with us."

With a lump in my throat, I turned back to Dr. Brewer as he talked of the bacteria they had isolated and the antibiotics he was taking. I thought for the first of many times,

"My God, how do you do this?"

Leaving the intensive care unit, we walked up the stairs discussing Roberto, the next patient we were about to see. Dr. Brewer always told me their names and, often, a few details of their life. It was clear he knew them not just as patients but as people. I began to think that my image of physicians was not entirely correct.

Roberto was the first of many patients with AIDS that I saw. He was hospitalized with pneumocystis pneumonia. Allergic to trimethoprim-sulfamethoxazole, he was receiving intravenous pentamidine and was recovering from the pneumonia very slowly. I wrote all this down in my notebook. By focusing on the facts, I could escape the emotions I was trying not to feel. Roberto was propped up in bed, receiving oxygen. His chest heaved, his nostrils flared, and his sentences were punctuated by gasps every few words. As he talked, he looked from Dr. Brewer to me and back again. He must have thought I was another physician.

"Don't look horrified," I thought. "He thinks you're a doctor! Try to look compassionate. or is it empathetic?"

Our eyes met, I smiled, and thought, "Not that smile, that's the pity smile." Roberto knew it too and turned away.

It was then that I began to watch the way Dr. Brewer interacted with his patients. He had a calm demeanor, and it seemed as if he could look into their eyes and tell them something beyond the words he spoke. I thought that if I just watched him, I could try to give the same nonverbal message he did. It wasn't quite so easy, as I found when I met Adam.

Adam, Dr. Brewer explained, was "a nice young man, a solid citizen." He said that about quite a few people. Brewer told me Adam was a textbook example of what AIDS can do to a person. He had had diarrhea for the past few months and, thus, had lost 40 pounds. We talked about what might be the cause, which had not yet been determined. I knew this stuff! I had read many articles about this! I was thinking cryptosporidiosis or cytomegalovirus or maybe ... . Then I saw him.

Adam Higgens was not much more than a skeleton. The skin was stretched tight over his gaunt face. His large brown eyes were sunk deep into their sockets. Still, his face showed that he had once been a handsome youth. I had a lump in my throat again. My thoughts raced back to 10 years ago. I was a graduate student. Paul Schnurin, one of the faculty members in our department, was hospitalized with a mysterious ailment affecting his entire gastrointestinal system. I visited him shortly after he went into the hospital, bringing some chocolate. That was my first mistake. Weeks become months, and he was still in the hospital. His family and I were members of the same church; I spoke to his wife on occasion. Like so many of us who meant well, I said I was sure he would get better. Everyone was praying. He had to get better. But the robust man I had known as teacher and scientist became horribly thin and frail, much the way Adam looked. Visiting Paul again, I stood at the entrance to his room, horrified. Tears came to my eyes, but they were not tears for him. They were a response to fear. Overcome with shock, I ran from the room. Now as I looked at Adam, those memories washed over me again. This time I could not run.

I had spent 2 weeks at the hospital when I saw Chris. He too had AIDS. Before this latest illness, he was an exceedingly intelligent and successful young man. Now he had neurologic symptoms from lymphoma in the brain and was receiving radiation treatments. The curtains in his room were closed, creating a somber appearance despite the bright summer day. The air was warm and heavy, and I noticed a faint odor of perspiration. Chris was curled on his side in his bed, his hair flattened against his head from sleep. His puffy face made him look childlike. In his arms he held a teddy bear.

Dr. Brewer stood by his bed. The radiation treatments did not seem to be working. "We'll try a few other things," he said, trying to sound hopeful.

Chris said nothing. He stared at the wall, holding the teddy bear tighter, as Dr. Brewer spoke.

I thought of my lecture on neurologic complications of AIDS. I teach about AIDS dementia complex, caused by the virus itself. Lymphomas I include almost as an afterthought. On a darkened stage in front of 160 students, I saw myself lecturing callously about diseases, detached from the people suffering from them. I could hear myself saying stolidly,

"Similar symptoms may be caused by primary lymphomas of the central nervous system."

That was all the time I spent on the subject. Yet here before me was a young man with "primary lymphoma of the central nervous system," one who should have so much more of his life left to live, and he was dying. Part of me wanted to stay with him, so he would not be alone. It occurred to me suddenly that I no longer felt overwhelmed by the urge to retreat from the suffering I saw. I was making progress.

I am back at my desk now, sheltered by books and journals as before. The goal of the weeks I spent on rounds was certainly met—I saw some of the maladies on which I lecture, and now I speak about these diseases with more confidence. But I am not the same. The experience has changed me. I had never before seen people clinging precariously to life. Pain and suffering were a reality whose existence I had tried to deny. Even a brief exposure to these patients' utter vulnerability caused me to lose some of my naivete. I have a fresh admiration for the job of physicians and particularly for my students as I think of them caring for people in physical and emotional turmoil. It is an awesome responsibility.