I took a deep breath and walked toward his bed. My moment of hesitation stemmed from more than simply not wanting to disturb his tranquil sleep. I was nearing the end of my second straight week of 14-hour-with-no-break night shifts as the lone internist consultant in the ER. Among my fellow residents, this is recognized as a valid learning experience but a dreaded one because of the hours and never-ending flow of work. At this time of day, with my circadian rhythm strongly enticing me to sleep, I was nauseated and cold from fatigue, and the fascinating nature of my work was far from my thoughts.

I had Mr. B. categorized in a split second: He is going to be from a nursing home. He is going to be demented. He will not be able to give me any history.

"Mr. B., sorry to wake you," I said softly. He did not wake up. "Mr. B. ..." I said, touching his shoulder.

He awoke, looked at me, and, before I could introduce myself, said, "Thanks for coming, nurse, I'm very thirsty. Could you get me some water?"

Deep breath in and out. OK, good. Don't overreact because you're tired. This has happened countless times before.

"Actually, Mr. B., I'm the doctor that is going to see you. Here is some water," I replied, handing him a cup of tap water.

After a few sips that were followed by a fit of coughing, he placed the cup on the side of the bed and looked at me expectantly. I started asking him questions about the nature of his symptoms, his medical history, and so on. Perhaps firing the questions would be a more appropriate term, as I was acutely aware that I had many patients still waiting. At least, this is how I justified my rushed, closed-ended questioning to myself.

Mr. B. answered me painfully slowly and hesitantly. He said he did not want to give me incorrect or imprecise answers. It was difficult to keep him focused, as he would constantly go off on tangents. He did not want me to call his wife at their home either, as she would surely be asleep, and any call at this hour would make her panic and think that something was terribly wrong with him. (What? He still lived at home with his wife? Oh yes, they still took daily walks together to buy their bagels for lunch. Please let me be so lucky at his age!)

The history was vague and inconclusive. No matter; quickly on to the physical exam. Vital signs were normal, as was the head and neck exam. I then exposed his frail, thin chest for the cardiac exam.

"I'm sorry, Mr. B., my hands are cold," I warned him.

"Please do whatever you have to, doctor, it won't bother me," he answered serenely.

I rubbed my hands together, to no avail, and then placed my right palm on his parasternal area to feel for a heave. Mr. B. did not flinch when my frigid hand touched his skin. My other hand gripped the railing at the side of the bed. Mr. B.'s arms then started slowly moving toward my body. I thought he might attempt to play with my long hair, as some of my older but to date exclusively female patients have done in the past. Fine, I thought, it will distract him while I complete the exam.

Instead of my hair, he reached out to grasp my resting hand. Then, suddenly, this man, who had until now spoken and moved so very slowly, started rapidly and vigorously rubbing my hand between both of his.

I stopped my exam to stare at what he was doing.

"To warm up you up, doctor. My wife also gets cold when she's tired. This has always helped her," Mr. B. explained, never taking his eyes off his task. "You should be sleeping to take care of yourself instead of old men like me," he added.

When he finished rubbing one hand, he proceeded to do the same to the other. It felt incredibly good, and I continued to watch silently with amazement. He was the sick one, not me. And yet this man, with whom I had been impatient for the past 20 minutes, was concerned about my well-being! My impatience and haste dissipated; I was truly touched by his act of kindness and his words of selflessness. It is impossible to convey the feeling of goodness that Mr. B. gave me that morning, but at that moment, it was clearly the patient rather than the doctor who had the healing touch.