I was late, but he camouflaged his impatience. Every question I asked him, he answered with the soldierly addition of "Sir" to the end of each sentence. I extracted the history of his present illness painfully. I would ask a question, only to hear him rephrase it and minimize the answer.

"Yes, Sir. I may have lost some weight, Sir."

"How much do you think you may have lost?"

"Over how long, Sir?"

"How much have you lost over the last 2 months?"

"Oh, I'm not sure. Probably 30 or 40 pounds, but I needed to lose some of it, Sir. I was getting a bit heavy."

His past medical history was even more global and even more brief. "I was involved in some trauma back in '66," he explained when I asked about the obvious disability he had acquired from his many broken bones.

A little frustrated, I moved to the physical exam. A screaming eagle glared at me from its tattooed perch on his right shoulder while I examined his axillae for adenopathy. I recognized it as the unit crest of a U.S. Army infantry division, and I wondered when he had served. The esprit implied in that eagle stood out in sharp relief on his deformed and cachectic arm.

I scheduled several scans for the following morning. I walked through the radiology department that same morning, timing my visit to when I hoped the results would be available. Instead, I found my patient, standing as rigidly at attention as his deformed limbs would allow, at the hub of a helpless circle of radiology personnel. He had fixed his eyes on a focal point far away.

"Sir. I will not get back into that box," he said as I walked into the room.

"He's claustrophobic," I explained pedantically to the group. "The confining dimensions of the scanner must frighten him." With humiliating doses of sedatives, I made him sleep through the scans.

Back in my office the following day, he had no memory of the scanner incident. He listened intently while I explained the diagnostic implications of anemia, adenopathy, fevers, sweats, and weight loss. He acknowledged my treatment recommendations as if they were operations orders for some military mission. His eyes, once again, disengaged briefly.

"Let's get started," he said.

Over the next few months, an uninterrupted spiral of therapy, followed by toxicity, followed by tumor recurrence whittled relentlessly at his pride. During the last of several hospital admissions, he developed an agitated delirium. Mistaking his intravenous tubing for shackles, he exhausted himself with efforts to "escape and evade." He tried to defend himself from a nurse who startled him while administering his medicine. The delirium cleared slowly and without explanation. Emotionally exhausted after that experience, he decided to forego any further chemotherapy. I did not argue with him.

During one of his last visits to my office, he brought two documents for me to read. The first was an article published in a small-town newspaper in June 1968. The yellowed pages announced, LOCAL HERO RETURNS AFTER FOURTEEN MONTHS IN A PRISONER OF WAR CAMP. A fellow prisoner had described for the reporter an occasion during which their captors punished my hero by isolating him in a small wooden box. With his knees to his chest, and his arms wrapped around his broken legs, he survived, inexplicably, for days. When finally released, he vowed to his comrades that he would die before enduring "the box" again.

The second manuscript was a notarized copy of his living will. It outlined the usual legalistic points concerning tube feeding, mechanical ventilation, and cardiac resuscitation. He had additionally directed, in meticulous print, that his body be cremated and the ashes scattered from the arches of an ancient bridge spanning a tributary of the Tennessee River.

He watched me, intently, until I finished reading. His eyes locked on mine as he folded the papers and put them in his briefcase.

"Don't let them put me in a box, Sir," he said.

In a flash of understanding, the many times I had unwittingly caused him to relive the horrors of that prison camp passed vividly through my mind.

"At ease, Soldier," I said. "It's the least I can do."