BUYING TIME

In those days, it was accepted medical policy not to tell patients that they'd been diagnosed with cancer. There was little anyone could do except try to keep them comfortable, and the practice kept doctors from having to deal with a patient's fear.

Somehow, though, the old man had discovered he had lung cancer. He tried to jump out the window of his hospital room but was unsuccessful; now he was strapped to his bed. One evening Adam went to check on him. He looked so thin and fragile, and he seemed to be breathing irregularly.

Adam would later learn that this breathing pattern is called chain-stokes respirations and that it precedes death. But all he knew then was that something was wrong. Adam thought the man needed to eat and get his strength back, so he tried to force some soup between his lips.

There was no response. Frightened, Adam left the room and busied himself so he wouldn't have to think about the old man.

When he returned the next night, the bed was empty and newly made. Death had come for the old man, and it was as though he had never existed.

Medical school at the University of Pennsylvania taught Adam how to deal with death: You simply had to look on patients and their troubles as problems to be solved as objectively and unemotionally as possible.

Instructors discussed "cases" with their students as if the patients were not present or conscious--even when they were. Adam learned never to touch a patient except when necessary to perform some medical exam. Even touching the bed, much less giving a reassuring pat on the shoulder, was frowned upon.

The concept of helping patients die with dignity was not part of the lesson plan. That would require getting to know them on a personal level, and, the instructors warned, emotions were too expensive for doctors.

Adam did not object. He accepted that in the most advanced medical community in the history of the world, this is the way it had to be.

He didn't have enough energy for philosophical debates, anyway. He'd married his wife, Judy, after his sophomore year of medical school. The ante went up two years later when Adam Matthew Myers III was born. Adam had to support his family. He had to succeed.

But despite his fears, Adam knew that he was where he was supposed to be. He loved medicine and thanked his mother frequently for her persistence; he sent yearly postcards updating Dr. Simels on his progress.

After graduating from medical school, Adam was working as an intern in the emergency room at the University of Pennsylvania hospital when a poor, young black woman brought in her six-week-old baby. The child was listless, unresponsive and severely dehydrated. Adam took the child, assuring the panicky mother that everything would be all right while privately worried about the possibility that the dehydration had caused the child's brain to bleed.

He called the hospital neurosurgeon at his home in one of Philadelphia's most affluent neighborhoods and said that he thought the child needed a spinal tap to check his prognosis.

"Go ahead and do it," the surgeon said. Adam replied that he didn't feel qualified.

"Just do it," the surgeon repeated and hung up.
Adam was shocked. He couldn't get past the feeling that if this had been a private patient instead of the child of an indigent parent, the surgeon wouldn't have been so cavalier. He took a chance and called the hospital's chief of surgery at his home. A short time later, a rebuked neurosurgeon arrived at the hospital and performed the procedure.

The child survived and was soon returned to its grateful mother. And Adam had learned a valuable lesson about what it meant to be a doctor.

June 16, 1994--Infectious Diseases/AIDS Clinic

At noon the clinic is quiet. A few patients wait: A man sits holding his head stiffly upright because of the bandages on his throat; a blond beach-boy type chews his bubble gum and makes it clear by his stiff body language that he believes he is out of place here; a young, emaciated black sighs and collapses into a chair like an old man.

Myers is distracted, shuffling papers from one spot to another as he waits to begin seeing patients. A friend and fellow physician has just been diagnosed with a particularly malignant form of cancer.

He has managed to pull some strings to get his hands on an experimental treatment program for his friend. It shows some promising results, even remission, in as many as 20 percent of the test cases. Twenty percent isn't much, Myers concedes, but it's better than nothing when you're facing an otherwise universally fatal disease.

And it means that he will once again be able to go on the offensive as an oncologist. This time it will be all-out chemical warfare: doctor, patient and an arsenal of heavyweight drugs against the enemy. Some of the drugs will attack the cancer, others will allow greater doses of cancer fighters than a human body would otherwise be able to withstand, and still others will combat the side effects like nausea and exhaustion caused by such a massive assault.