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Adam jumped out and ran. The light changed and the car pulled away.
This wasn't the first time an unwanted advance had left him confused and shaken. Back in grade school, Adam belonged to a Boy Scout troop whose assistant scoutmaster was later arrested for sexually molesting boys. The man had made a pass at Adam, trying to show the boy nude photographs of himself.

Now, years later, Adam stood on the sidewalk warily watching the car drive off, feeling much as he had at the assistant scoutmaster's home. Everything he had ever heard about "homos, fags and fairies" was that they were somehow sick...perverted. His own two experiences had convinced him that what he had heard was true.

He didn't tell any of his college friends about his hitchhiking experience. He didn't want anybody questioning his manhood. He had enough trouble finding time between his jobs to study, much less have a social life.

During the summer, he worked eighty hours a week stocking parts in a factory and serving as an orderly at a hospital in Hackensack, New Jersey. It was on the job there that he became reacquainted with death.

The old man was one of his favorite patients. He had arrived in the United States in the late 1800s from Italy. Now in his eighties, he still spoke with a heavy accent, telling stories about his life as a stagecoach driver while Adam fed, bathed and shaved him.

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.

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Steve Jackson