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An excerpt from Chapter 1 of The Desire to Heal: A Doctor's Education in Empathy, Identity and Poetry
by Rafael Campo
Pages 28 through 33

As an new intern on the wards in San Francisco, I too fell prey to fears of AIDS, each emaciated body I encountered seeming a potential version of me. I saw my own face over and over again in their faces, the dark complexions, the mustaches, the self-deprecation. Incapable as I was then of loving my patients, I hated them instead for reminding me that I was no different, that despite my medical knowledge I was not invincible. My well-rehearsed internalized self-loathing dominated my emotional response to them. I wished that they would hurry up and finish dying, all of them in one fell swoop, and that they would take all the dying there was left in the world with them when they did. In time, my heart was gradually pressed out of me, and I blamed my inability to cry on the long, dehydrating hours I spent in the hospital. Instead of making love with my partner on the nights we shared a bed together, I slept fitfully, inhabiting personalized nightmares about AIDS.

In some ways, I know I have been dying of AIDS since the moment I first learned about the virus. Each smooth tube of blood I draw seems to come from my own scarred and indurated veins, each death note I have dictated has my own name and signature at the bottom of the page. Any disease that could erase from the world the bodies of so many people like me, people with whom I had not even had the chance to form the bonds of community, would seem necessarily to take with it small parts of my anatomy; AIDS has cut off the part of my tongue that once made it easy for me to sing, it has laser-ablated my seminal vesicles, it has occluded the blood flow to the area of my visual cortex capable of plainly seeing joy. What I had not been doing during those first few months of internship was trying to love despite the virus, or because of the virus. My healing powers, rudimentary as they were then, were hindered by a superficial wish to know death purely and simply as an enemy.

When I met Aurora, she changed everything. At first she did not speak at all, except with her huge, moist eyes. I had admitted her to the hospital at 2 A.M. one grueling on-call night, with the emergency room diagnosis of "AIDS failure to thrive." (It was not until two weeks later that Aurora told me that she was dying of love, of too much love; cynically, I assumed she was referring to her own licentiousness.) Aurora was a preoperative male-to-female transsexual according to the terms of some of my colleagues; to others, she was a freak. My jittery and bumbling attending physician wondered with a nervous laugh on our formal rounds at her bedside the next morning what "it" had between "its" legs. Aurora just stared at him with her incredible eyes. I had written the order that she be placed in isolation, because her chest X ray was suspicious for tuberculosis. "Consumption," she would murmur to me later, "Yes, I believe I am being consumed by my having loved too deeply" I was too busy to notice then the campy melodrama in her tone of voice; I could barely breathe through my protective fiberglass-mesh mask, and thought only of getting out of her room as soon as possible.

One day she began to flirt with me. "I know you're in there," she purred into my ear one morning as I mechanically examined her. I paused only briefly before I plugged my ears with my stethoscope, with the intention of listening to her heart sounds. Without saying anything, I raised her hospital gown up to her nipples, this time noticing the fullness of her breasts, the rich chocolate color of her nipples, the deep grooves between her delicate ribs. "Do you think I am beautiful?" She brought a crimson silk scarf up to her eyes and peered seductively over it at me. Her eyes were made up in three shades of green, the eyeliner and eyeshadow thickly applied. I had seen her at her mirror only once, hands trembling slightly, as she applied her cosmetics. At that moment I had thought her beautiful, not at all pathetic or threatening or "failing to thrive." She seemed hopeful and human, full of the love she kept so rapturously spilling out to those around her. But I was too busy to give much thought to what I had felt; my job was not to feel but to palpate. Not to love but to diagnose.

During the course of about eight weeks, Aurora gradually deteriorated despite the intravenous fluids and antibiotics. Her cough became more insistent, as though it were finally winning a long, drawn-out argument. She appeared less frequently in her flowing emerald green kimono and stopped putting on her eye makeup. She gossiped less about the other patients and no longer held court in the patient lounge, where she had often been seen pointing out the cute male passersby with her nail file as she manicured herself. I pretended not to see her; I still listened only to her heart sounds and not to her heart. "You know you're gonna be mine," she sang out to me on another day in her naughtiest Spanish Harlem accent, parodying one of the day's popular dance club songs. I rolled my eyes as I left her room. I never said more than a few words to her on my visits. I busied myself instead with collecting the data of her decline: the falling weight, the diminishing oxygen saturation readings, the recurring fevers. "I'm burning for you, honey," she said with arched eyebrows by way of good-bye on the last day she spoke. Again I said nothing.

Expecting her usual chatter more than I ever could have admitted, I strode into her room the next morning without knocking, as was my habit. No salacious remark greeted me, however, no invitation to sit close to her on her bed, no perfume. The silence registered. She seemed to be lying sideways in her bed, with her face half-buried in a pillow. The room's curtains had not been drawn open yet; she remained motionless as I jolted them apart, flooding the bed with sunlight. I glowered impatiently at her from the bedside; still, she did not move. When I rolled her over, seeing her face stripped of all her glittery makeup, expressing not recognition but a deeply subterraneous pain, a primitive and wordless agony, finally I was moved. As I groped for her, finding her body half-paralyzed and oddly limp and angular like a bird that has flown into a windowpane, I began to feel broken myself. I was witnessing the loss of love from the world. Finally in its absence I was hearing her voice, and when I frantically listened to her heart and to her lungs for the first and last time the love in them. I heard my own stifled desire surface for air in my long sobs.

Aurora died later that day, and when she died she left behind an element of herself in me. I -find her voice in mine, like a lover's fingers running through my hair; my voice sounds warmer, more comfortable to me now. I discover her hands on my own body when I examine a person with cancer, or AIDS, searching for the same familiar human landmarks that bespeak physical longing and intimacy. Her glorious eyes return to me when I finally see someone for the first time, or when my own bring forth tears. Her friendship and her love of life return to the world in these words, in the poems I write that I hope might ascend to reach her in whatever realm she may now exist. Instead of giving me AIDS as I had so irrationally feared, she gave me hope.

Science failed to understand her, though it altered her body. Medicine did not love her, though it penetrated her with needles and X rays. Only the act of writing can find her because it is the same journey she has made, from the imagined to the actual, from the transitory to the persistent. From the unspoken to this physical and loving lament.

The Desire to Heal: A Doctor's Education in Empathy, Identity, and Poetry
Publisher: W. W. Norton & Company, Inc.
500 Fifth Avenue
New York, NY 10110

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We wish to thank Rafael Campo for allowing us to post a few pages of his fine book on the Marlboro Review web site.

Copyright ©1998 Rafael Campo. All rights reserved.

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