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And Theophile, he’s walking around begging for cab fare home. You have to talk with Margaret.” I told him I would speak to Margaret, but then I stalled.

Meanwhile, Margaret’s composure was beginning to unravel. Although she wouldn’t admit it, she clearly had more work than one person could manage. Patients sometimes arrived without appointments, having heard about her through the grapevine. They waited all afternoon just to have the opportunity to talk with her and try to make an appointment. Others with appointments waited all afternoon only to be turned away without seeing her, as she was tied up in the hospital ministering “last rites” to one of her dying charges. The housestaff’s gallows humor said if you’re a patient, you know you are in trouble when they call in Margaret as a consultant. Some very cruel colleagues referred to her as the “fag queen.” These sorts of comments, coupled with the criticisms directed at her from the Haitian community, needed only the extra burden of the death of one of her patients to bring her to the verge of tears. On occasion she would blow up at the secretarial staff and then, regaining her composure, apologize. Gwen in pediatrics and Mary Jo in obstetrics were under similar strains—solitary figures fighting a lonely battle against a disease few of their peers wished to face.

Belony declined to the point that he had to be admitted to the hospital. My patient was no longer even recognizable as the person I had started to follow several months before. His hair was almost completely gone, his eyes were sunken and defeated, his skin was excoriated, and his lips were cracked. He was too weak even to acknowledge my presence. He died a few days later. I had followed him for seven months, yet I could not honestly say I had done anything for him. There had been a barrier between him and me that I had not been able to break down. I was not sad at his death. His decline had been so pathetic that death was merely the end of his suffering. But I was disturbed with the possibility that, medically or humanly, I had missed something.

Previlus arrived in my office or in the emergency room approxi-



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