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Chapter One

The Desire to Heal

His erection startled me. At first, it seemed merely to point me out, acknowledging my part in the simple and various human desires present in our encounter: the desire to be loved and to be healed, the desire to be naked before another and thus to be utterly understood and to be wordlessly explained, the desire for a life beyond this one, the desire to represent what is the truth. What could be more natural than that I was there, a witness to another man's ailing body. For a fleeting moment, I too wished to be naked, to be as available to him in his suffering as he had made himself to me. The sheer exclamation of the pleasure in one person's touching the body of another--I have been a doctor long enough to know what joy and power there is in the laying on of hands--must have frightened me, so explicit and insistent it was in this form. Gradually, I let myself become aware of my stethoscope, my white coat, my cold hands in their latex gloves as they all continuously emitted their signals. The entire milieu of my chilly, fluorescently lit office seemed to be warning us both of my very great distance. I watched as if from behind a surveillance camera of my years of medical training as I mutated into an alien space scientist, studying and cataloging a curious life-form on a forbidding planet. Then I excused myself abruptly, saying in an oddly flat voice that I needed to get more liquid nitrogen to finish burning off the warts. I let the door slam shut loudly, definitively, behind me.

In considering later what had occurred between this patient of mine and me, I found myself revisiting what had drawn me to medicine in the first place. Before I was completely aware of it, I had begun to write feverishly at my cluttered desk, allowing myself to feel the presence of his body again, to touch his fragrant skin--I suddenly recalled his spicy cologne--without the barrier of my rubbery gloves. Whether it was another poem, or a long love letter, or the beginning of this book, I cannot be sure. What I do know is that in the act of writing I encountered again the shocking, empowering energy of a great desire. A desire that I have always known belongs to all of us.

My earliest conscious recollections of disturbances within my own body are those of the minor bumps and bruises whose pain was alleviated by my parents' kisses. Kissing was the most potent and intoxicating of all elixirs. Pure physical contact had the power to cure. My body, before I was capable of truly hurting myself, could be reconstituted with my mother's moist breath in my ear as she sang me a comforting song. The pleasures I felt, more intelligible to the child's mind than my parents likely suspected, are in great part what led me later in life to the healing arts. I desired to be made well in their eyes, to be acceptable, to be beautiful, to be kissed. My desiring of my parents had a good deal of its expression in the ritual of the tearfully extended, oftentimes exaggerated "boo-boo," presented for their fastidious attention. To be well meant to be well loved.

Music and magic, and particularly their expression and absorption in the physical body, were the primary modes of healing recoverable in the bits and shreds of Cuban culture that I encountered as a child. My grandmother's dark bedroom, its windows covered by thick red velvet draperies as if to keep out the weak winter light and the images of scrawny trees, seemed a shrine dedicated to the various saints before whom she lit candles as offerings. I would hear her praying or singing quietly in Spanish, believing perhaps that she was restoring health to an infirm relative back in Cuba whom she would never see again. Though I could not understand most of what she said, I let my heart be carried by her evident hope that her words could reach across the oceans. In her songs, my mind was transported all the way from sickly Elizabeth, New Jersey, and its bleak refineries and landfills, to the verdant, lush Cuban countryside I imagined was her real home. Healing had a voice, and seemed rooted in a most potent physical longing, a longing to be with the ones you loved. Later in childhood, my family's Venezuelan maid Bonifacia would make special potions from tropical juices and other secret ingredients for me and my brothers. Some potions caused laughter; others could restore friendship or ease the pain of a lost pet. I still believe in the inherent magical properties of her concoctions, just as I understand the placebo effect: she too taught me that healing is a consequence in some measure of what the mind desires.

As I grew older, the connections multiplied between doctoring and desire. At around the age of eight, my cousins, friends, and I began "playing doctor." This enactment of adulthood was all the permission we needed to examine our own and each other's genitals freely and without shame. Though the myriad implications of our sexual acts were not yet within the realms of our conscious imaginations, we did guess capably at what might fit where. Fingers to vagina, penis to anus, mouth to nipple, each combination we employed shedding more light on the body's functions and sources of pleasure. Listening to the heart, ear pressed to the bare chest of a playmate, was the opening of a vast interior world. What did another person contain? The ingredients listed in our nursery rhymes-- sugar, snails, spice, and puppy dog tails--seemed unlikely, even impossible. Whatever really constituted a person, the essence of the body felt very, very good.

At around the same time, I began to learn to fear what another's heart might contain. I recall the particular experience of playing doctor with my best friend, and his mother discovering us with our pants down in a hall closet, flashlights pointed at each other's dicks. She screamed, and angrily beat my friend before my eyes with one of the flashlights--the very instrument of our mutual and brief enlightenment. Our happy curiosity and arousal were suddenly transformed and redefined as shameful in a moment's judgment. Our queerness was apparent, revolting, and indisputable. The bandages in which we wrapped my friend afterward were blindingly white, the blood stains that soaked through them were grotesquely real, the iodine made him wince and cry visible tears. The body now bore the imprint of pain, bruises and welts written upon the skin like a language all too terribly familiar. Healing also had its origins in injury and insult, and so was a potentially painful process, not a uniformly pleasurable one. Desire had its consequences.

Just as the body could be made legible by violence, I also came to learn that the body itself could write upon the world. It could remake its very form. My own body changed under the influence of puberty's hormonal surge and lifting weights. On the soccer field, my movements became more purposeful and effective, and my approach to the sport took on the quality of narrative, as if through a game a story could be told, a deeper meaning expressed. Hair and muscle sprang up on me, announcing my sex ever more urgently. I walked differently, advertising myself to other teenagers. My penis enlarged, and demanded much more of my attention. I grasped it like a megaphone, ready to shout at the top of my lungs as I came how unimaginably wonderful it felt. A few of my friends and I masturbated together, boastfully comparing the sizes of our dicks but never daring to touch one another.

It is not surprising, then, that it was during adolescence, as my body began to speak more boldly its language of desire to the outside world, that I also began to understand medicine as a "desirable" profession. My parents, dedicated as they were to ensuring their children's security and success, urged me to consider a career as a physician. As a child of immigrants, I imagined that my white coat might make up for, possibly even purify, my nonwhite skin; learning the medical jargon might be the ultimate refutation of any questions about what my first language had been. Meanwhile, medicine was becoming a force in shaping (or in cleaning up) the culture, through government-sponsored public health messages about smoking, exercise, and drugs that filtered into my consciousness. Dr. Ruth became wildly popular, her strong German accent communicating her scientific detachment and clinical coolness. Gym and sex education classes took on a distinctly wholesome tone, intent on sanitizing our minds and bodies. Stodgy gray-haired physicians who practiced in our upper-middle-class community came to school and gave solemn talks to assemblies in the gleaming multipurpose room about VD and the evils of smoking pot.

I memorized biology homework assignments full of meiosis, gametocytes, zygotes, and stark reproduction: perhaps science could pin down the definition of desire, I thought with a mixture of hope and terror. In Sunday school lessons I had learned about Adam and Eve, and read Genesis; the biblical Eden in which they dwelled was unfailingly depicted as brightly hygienic, obsessively neat, and monotonously sunny. Their secular counterparts were laden with an equally insidious morality, the suburban white couples with emerald green lawns who were my family's neighbors, who shared our near-paradise of flowering trees that bore inedible fruit and sparkling undrinkable chlorinated pools. In science class, alongside their children I dissected frogs and cats beneath the sterile fluorescent lights, and all our instruments were autoclaved at the end of the day. I remember laying open the reproductive organs; how tidy, glistening and clean the pickled genitals seemed. The body, I was taught, was the most immaculate of machines.

When a beautiful young woman in my class with long red hair got body lice, a sort of panic ensued in our high school. It was as though a witch had been discovered, and when her parents burned her favorite jeans and black concert T-shirts, and then had her head shaved, our teachers appeared to be relieved and pleased. The message of this group hysteria seemed to be that the purpose of the body was healthful reproduction, and a relentless self-control over its processes and smallest environments was the only business of life. The pathologizing of not only tobacco and alcohol but also out-of-control, "dirty," and "addictive" consumption of sexual pleasure and food became the other side of the medical coin.

By my junior year my favorite teacher in high school was Mr. H., a middle-aged man with graying temples and an evident passion for his subject matter. He taught Advanced Placement Biology and was building an electron microscope himself. He was not exactly handsome; I recall other teachers commenting once that he was "smarmy." His hands and his veined arms would become covered in chalk dust as he diagrammed anatomical structures. After school, he dirtied himself with black grease assembling his microscope. When he taught us, he engaged us with his entire formidable body, running frantically up and down the aisles, heaving his chest as he bellowed out questions, coaxing answers out from even the shyest of mouths. His lectures were more invigorating and draining than the calisthenics of gym class. Surely no one failed to notice his tremendous bulging crotch, his tight polyester pants stretched almost painfully over his obvious hard-on. He injected a sexual energy into the classroom to which I was unaccustomed and attracted. We learned insatiably from him. He transfused the lifeblood of his risky enthusiasm into our anemic textbooks.

Mr. H. never was the hygienic physician clad in a spotless white coat that Marcus Welby was portrayed to be. His poorly concealed affair with a female classmate of mine was eventually made public by them both, to the young woman's parents and to Mr. H.'s wife (from whom we all later learned he had been long separated). Mr. H. was asked to resign the next day, despite strident protests from the students in his classes. The humiliation and dejection in his eyes was apparent as he made his chaste announcement. Science became an ever more frightening arena indeed, where matters of the heart, excepting of course its laborious physiology, were disallowed entirely and, if pursued, led to the sternest of punishments. Passion could and indeed must be regulated, and especially the excited intercourse between teacher and student, scientist and layperson, and by extension, I began to suspect, between the mythic physician and his vulnerable patient.

In this environment I too became enraged and indignant upon reading the increasingly frequent and prurient reports in the media of chemistry teachers molesting their impressionable students, psychiatrists seducing their hypnotized subjects, and dentists fondling their anesthetized patients. A facile self-righteousness arose in me, paralleling my growing awareness of my differentness from those around me. I began imagining myself as the model physician, for whom desire was forbidden and in fact repellent, which served to defend me from my growing and undeniable sexual interest in other men. I thought I could cure myself of my own emerging identities; perhaps drinking too much guava nectar and listening too intently to merengues had made me too obviously Cuban, or masturbating too much had made me gay. I had nearly come full circle in my beliefs. In my fear of what I might become, and in accordance with what I had been taught, I reinterpreted the body as designed for orderly reproduction and not love or pleasure, for harboring low levels of cholesterol and triglycerides, not the rich voice of the soul. My grandmother, my parents, Bonifacia, and my queer playmates disintegrated in the bright glare of my self-examination.

I lost twenty pounds as a premed during my sophomore year of college; the more I desired anything, especially the man who has since become my lover of the past eleven years, the less I permitted myself to eat. At the same time, I exercised obsessively, so that I was utterly exhausted at the end of each day. Though I studied my premedical course materials frantically, I loathed the thought of visiting a doctor for the worsening pain in my left upper abdomen. After a prolonged period of time around midterms when my increasing intake of Diet Coke and Marlboros precluded that of food--my base appetites were almost completely suppressed--I felt a pain in my left side so sharp I forced myself to dial Campus Emergency. Minutes later, lying naked except for a flimsy gown on one of the Student Health Services examining room tables, I had a fantasy that was almost overpowering in its vividness. My attending physician was an older Mr. H., and though his strong physical presence seemed undiminished, his voice and his manner had grown much gentler. When he spoke, the pain ceased. He examined me without stethoscopes, reflex hammers, or electrocardiographic leads. When he rested his head on my chest, I could feel him listening to my heart and lungs, understanding all that which I had for so long found impossible to say. He then ran his hands over my body, extracting each gossamer toxin that was a shadow of my form and dissolving it in a pool of sunlight. That is when I realized he was naked too, and that I was not ashamed of my urgent erection. Indeed, I felt a certain inexplicable power.

The door opened unexpectedly, putting a rather abrupt end to my dream. Then there was the clatter of a clipboard on a metal countertop, the cold stethoscope, the clumsy, almost punitive lubricated finger. I was given some intravenous fluid and, upon coming more to my senses, was given the diagnosis of a pulled intercostal muscle. Reassurance, it appeared, was the only medicine I needed. I returned to my dorm dumbfounded, and feeling more than a bit silly. It was only much later that I realized what had occurred in those few hours when I feared I was dying, even wished that I might die: I had located an intersection between my own mortality and the world around me, which was named desire. I wanted to live and to be loved, and at the same time I yearned to erase myself from the face of the earth. I wanted the morgue-like steel and chill of the doctor's office, and the warm hands of another upon my body telling me by their touch that I would endure.

Not long after this incident, I made love to my best friend for the first time, confirming what we had known for almost two years. What barrier it was that had been removed by my experience of illness, I could not have articulated then. I can report now, however, the healing I felt in each kiss, each touch, each murmured word. My body belonged to me again, as soon as I had owned its desire. To examine the crossing of this threshold--from bodily illness to mental health, from repressed misanthrope to unabashed queer--I changed my scientific methodology from neurophysiology to prosody, my tools from physics equations to rhyme, my materials from atoms to phonemes. If straight science could not provide the vocabulary I needed, perhaps the mysterious and complex human body could explain itself to me in its own terms.

It is through language, then, that I have found a way to love my patients, to desire them and thus put to work one of the most powerful elements of the therapeutic relationship. Present in my poetry is both the rhythm of my grandmother's praying and the thudding of a flashlight striking flesh. I am healing myself when I write, dancing close to another's body to a favorite Spanish song, allowing my mouth to find another man's mouth, because writing itself is the meeting of two expressive surfaces, that of the mind and that of the page. I can press my ear to my patients' chests in each lyric, and lie down for the long night beside them in each narrative. The pleasure in touching their skin I experience again in the pleasure my hand creates as it brushes against the smooth page. The love I feel for them is in the beating iambic heart of my lyrics.

The image of the page as yet unwritten upon conjures up powerfully an image of my patient Mary, smoothly bald and pale white from chemotherapy. On the bone marrow transplant unit, because most patients stay for such long periods of time, hospital rooms are transformed even more undeniably into their bedrooms; each morning I would visit Mary in hers during my rounds. Our encounters were always preceded by my ritualistic hand washing, obeying the strict rules to prevent infection, as the bone marrow ablation therapy she had undergone left her devoid of the cells responsible for immune function. She could not have been more naked, more available and accessible to others, more beautifully free. As I let the warm water run over my hands, I would begin to forget that soap I was using was bacteriocidal, as the killing of even the smallest of organisms seemed to have no place in our growing intimacy. I imagined at times that I was visiting a secret love, so much urgency did I feel in her desire to live. We spoke in hushed tones, hardly a word about the progress of her cell counts, more and more about silly, temporary things like our favorite Chinese restaurants, how much we each owed in parking tickets, the nurse's new butch haircut. On and on, like teenagers in a booth at a soda fountain. When I'd leave, I feared during the long hours I was away from her that I might never see her again. When I'd cry, she'd tell me to shut up. Wondering whether she felt the same way I did, I'd feel my heart quicken at the slightest intercourse: my ungainly otoscope whispering light in her ears, my slinky stethoscope hearing her heart's demand to live, my stiff penlight prompting the inexplicably delicious constriction of her pupils.

Many doctors must fall in love with their patients, though far, far fewer would likely dare admit it. What else were we to do, one of us dying less quickly than the other, the other less capable of preventing death than the first. So we loved each other in the ways that we could. We listened to each other attentively and held hands. I write about her now, and she is alive. Constrained as we were by our respective worldly roles, as doctor and patient, gay Latino man and straight white woman, still we found the space to make a very particular kind of love--a love that concerned itself less with gender than with transcendence. Highly erotic and deeply pleasuring without our ever having slept together, as commonplace and yet unexpected as life crossing over to death, immortal as each retelling or the act of writing. Both Mary and I left our loving friendship healthier, I think, closer to being cured. She waved to me as she left the hospital, still bald, still beautiful, but more full of life, the life we shared.

However, I remain fearful for the future of this sort of honesty. The so-called personal lives of physicians and patients--as if the organs of emotion could be so carefully dissected in such an acute relationship--are already the subject of a scrutiny that seeks to eradicate the possibility of human connections. One needs to look no further than the cover of a major newsmagazine that appeared not too long ago to see the face of a physician so many now fear; ironically, though it was an image meant to sensationalize, it is a face as exquisite in its beauty to me as those of so many of my patients. The story was about a possibly homosexual dentist with AIDS who allegedly infected several of his patients with the virus, and who had died leaving behind a furor: How did he give it to them? the text of the article insistently asks.

I am certain that the hysteria around the issues of doctors with AIDS reflects at least in part the deep anxieties that come with recognizing the desire inherent in the patient-doctor relationship. Such fears remain pervasive in the culture at large, specifically with regard to the queerness inherent in a profession that in its practice crosses so many boundaries. Suddenly every lurking suspicion could be true, and each resentment is justified. The bespectacled, nerdy older man sticking his colonoscope up your ass actually likes it; worse yet, so might you. The image of sick physician as queer parallels the equation of AIDS = gay man. So it is not surprising that the same old sanitizing tactics have once again become implemented, with rules having been laid down as to which procedures are "safe" for HIV-positive physicians to perform and which are not-- without a single shred of scientific evidence to suggest that the virus could even be transmitted through the contact such guidelines seek to limit.

People with AIDS, of course, were the subject of aggressive attempts at quarantine long before the public at large began to mistrust its physicians. Doctors themselves, it seems, could all too capably imagine the intimate contact they might have with their patients; the preexisting mechanisms for control present in the profession made it even easier for physicians to insulate themselves from people with AIDS under their care. During medical school I often overheard interns, residents, and attending physicians trying to guess which patients were most likely to give them AIDS through some vividly imagined mishap the effeminate patient who squeals and jerks his arm away abruptly during a blood draw and thereby causes a needlestick, the normal-appearing hemophiliac who undergoes emergency surgery for appendicitis, the drug addict who vomits forcefully into the face of the rescuer performing chest compressions during an overdose-related cardiac arrest. In some cases, those patients known to have AIDS would receive less attentive care because of such fears. To this day, some surgeons outright refuse to operate on patients with AIDS, even on those they suspect might harbor the virus. Other physicians simply insist on proof of seronegativity before undertaking any invasive procedure.

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 I heard 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 now, 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.

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The Poetry of Healing: A Doctor's Education in Empathy, Identity, and Desire

0393040097

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