His real name was Claude Louis, but as a resourceful young man trying to get out of Haiti, he had purchased a false passport and successfully completed his illegal immigration under the unusual name of Brignole Brisilien. Or was it Brisilien Brignole? Medical records never could Figure it out, and I was never quite sure myself.

We met one night when I was an intern and he came through Emergency with headache and fever; the eventual diagnosis was cryptococcal meningitis. His grace and intelligence shone through from the start. I liked him, and it bothered me that after 2 days of receiving the correct antifungal agent, he seemed to be getting worse. Why wouldn't he even try to sit up or eat? He explained it to me simply: "Mon Bisket est tombe." He assured me that if it were replaced, he would regain his strength and he could handle anything, even that dreaded underlying diagnosis.

I went down to the cafeteria in search of James, the Haitian man who served behind the counter. "James, what's a Bisket? How does it fall down? How do you put it back?" He explained that a Bisket is a vertebra-like thing in the middle of the body. It can slip or fall out of place after a trauma, such as a physical blow or a fall. Replacing it involves deep abdominal massage using palm oil, "l'huile mascreti." You don't need to be a native healer to do this procedure, but you must have the oil.

The next afternoon, I met James in the cafeteria again. True to his word, he had procured the oil for me. This "huile mascreti" was dark and viscous, like engine oil, and emanated a musty, penetrating odor. I secreted the little jar and finished my rounds, then made my way to Brignole's room. I was grateful now for the hospital's outdated practice of putting patients suspected of having AIDS in private rooms.

"I've come to replace your Bisket," I announced. "I will do my best." I closed the door and silently prayed that neither maintenance nor food service nor nursing would find any reason to enter. Motivated by my own vague fear of AIDS, I put on a pair of gloves. Brignole was flat on his back. I coated my gloves with the heavy oil.

I had given a few backrubs in my day, but the abdominal approach was certainly not in my repertoire. Still, I had to do something. I placed my hands somewhere in the subumbilical area and, pressing deeply and slowly, began moving them in a circle. I didn't know where the Bisket was, what it was, or where it was supposed to go, but never mind. I pressed with slow, continuous strokes and moved a little higher.

It was remarkable that Brignole was able to relax his abdomen so completely. Normally I couldn't push so deeply on a patient's abdomen without eliciting protest. I continued, on and on, a little higher, a little higher. A wave of heat and dizziness passed through me. I was aware of the closed door, my physical effort, the strange odor from the oil, the intimacy of the contact, the silence.

"I'd better stop," I said.

"That's good," he answered. "Of course," he added, after the smallest moment, "it always takes three massages to replace the Bisket."

"Oh," I said. "Yes, of course. I'll be back tomorrow."

I returned the next day and followed the same ritual. Brignole was still not eating, still not getting up. I can't remember if his fever was gone or how his laboratory results looked. I knew that people need to have a will to live to get better, and I couldn't imagine recovery in his current state. I promised to come back for the third massage.

It was a marvel that nobody ever entered the room while I carried out these "treatments." What a reputation I might have gotten had the nurses discovered my activities. But the charmed privacy and the last of my precious oil held out through this final session.

I was pushing so hard that I seemed to touch the anterior surfaces of the real vertebrae. I pressed and manipulated this seemingly imaginary object higher. Brignole offered no resistance. Somewhere a few centimeters below the xiphoid, I knew I was done. At that precise spot, the Bisket seemed to have arrived home. I had a physical sense of completion. There was nothing more I could do. I left.

The next morning, I arrived in Brignole's room with nervous anticipation. Imagine my amazement and delight: The lights were on, the curtains were open, and Brignole was seated in the chair by the window, plowing through an enormous meal brought in by his girlfriend, Ysalie. He gained weight, improved, and left the hospital.

He and I never talked about his Bisket again, but we certainly talked about many other things. Within the structure of the doctor-patient relationship, we became good friends. Thanks to his own strengths and bolstered by zidovudine, Brignole remained healthy for nearly 3 years, except for some aggravating AIDS-related acne and one episode of sinusitis.

I got married at the same time that Ysalie, miraculously HIV-negative, left Brignole for another man. My husband and I purchased our first house just as Brignole was forced out of Ysalie's family home and into a subsidized apartment. I battled the National Health Service Corps for a fair placement, and he battled U.S. Immigration to enable his brothers to visit him here one last time. We both succeeded. Then he got sicker, and I was pregnant. I transferred his care to an AIDS specialty team when I went on maternity leave.

Abigail was born in December. Brignole died in February. Ungainly with postpartum weight, unstable in high heels after 9 months of supportive shoes, I teetered across wooden planks over the muddy cemetery ground to pay my last respects.