01 September 2007 02:30 -06:00 GMT

My sleep schedule is all fucked up.

I was on call last night, and it was a benign call. I stayed up until 11 or so, and I was called from about 3 onward...but I got a little more sleep, from before 5 until a few minutes after six. In terms of sleep on call nights, this was the best one of the year so far. And the reason for the calls were small, manageable problems that I could handle.

The nursing staff on the Hematology ward are exceptionally competent. They really didn't need me. Fever followed by acetaminophen, blood cultures, urine cultures, sputum cultures if possible, and a chest X-ray: these were the steps. I knew them, but they were already carrying them out when I got there a few bleary moments after waking from the top bunk, stumbling into my shoes and coat in the darkness, and emerging into the fluorescence of the ward.

One of my patients has acute leukemia. He is 78 years old, and a retired physician. I was, and still am, a little intimidated by treating a doctor that has forgotten much more than I have ever known in my brief career. But he is a gracious patient. He remembers my name, and he takes good care of himself. He had a fever of over 103 degrees Fahrenheit after his induction therapy reduced his white cell count to virtually nil.

Another remarkable point about him is that he was a resident here at this hospital in the 1950s. He trained under Dr. Tinsley Harrison, who has a worldwide following among Internal Medicine practitioners. My patient and I also have a friend in common, in Dr. Jim Pittman. Dr. Pittman wrote a letter of recommendation for me when I was applying to medical school. Dr. Pittman concluded his letter this way: "The two most important questions are obviously: (1) Can this man get though medical school well? And, (2) will he be a good doctor? He is now much more mature and motivated than years ago, and, to me, he is an impressive young man. I think the answer to both questions is, 'Yes,' and predict that if you accept him, you will be glad you did."

I often think of Dr. Pittman's words on my behalf, and I often strive to live up to the faith he placed in me. Those words have come back to me frequently in the last week as I have cared for his friend in hospital.

There was another encounter this morning...yesterday morning really given the ungodly current hour...with the esteemed Dr. Craig Hoesley.

I have never had an unpleasant encounter with Dr. Hoesley, and I admire him tremendously. In years past, I was in charge of a developmental grant program to which he applied for support of a research project. I remember that he was well thought of by the most influential AIDS doctors at this university, which is no small thing. Then as I became involved with AIDS on a more grass roots level, I came to know him a little better as a clinician. I also came to understand his sense of humor.

Hoesley has this expression that comes on his face that portends an intelligent joke. The joke may or may not come out - it usually does - but the anticipation that comes with knowing that look is priceless. You can just see the smile forming, and know that underneath, a brilliant one-liner is on its way, and in that moment of expectation, hilarity rises and infects all who are within range.

I encountered Dr. Hoesley and his Infectious Diseases Consult entourage on my way to the call room to pick up my briefcase. He said, in reference to the consult, "You're killing me, Rob."

"I know," I said.

"I like the tape," he said, indicating toward the white tape I had on the breast pocket of my white coat, serving a dual purpose of covering an ink stain and reinforcing a substantial hole that has developed over the last three years.

I smiled and fingered the bottom edge of the tape, mumbling something as the team laughed. "It adds character," he said, and there was more laughter, mine included. That look of an imminent smile filled his countenance. We discussed the case for which his team was consulting. It is always a pleasure.

I wonder if that moment was a mirror reflecting on itself, but at the same time I feel inadequate. The esteemed Dr. Hoesley is an established  physician who has a strong command of infectious diseases - something that I hope for. At the same time, he represents one of many here that I strive to emulate. In short, I would like to be him in many professional ways. On the other hand, I lack so many things that he possesses with natural ease. Am I looking in a mirror and seeing my future? No, I'm not that good, is my first, sure answer. But there is something in me, something that I have yet to clearly define, that puts me in the same wavelength. I have a long distance to travel to reach his stratosphere.

On Dr. Hoesley's consult team were two of my classmates: Rashi Dhawan and Anna Fountain. It's great fun to interact with my classmates in a clinical setting. Also there was Reesha Shah's younger brother, who is a third year student, I believe. I said hello to him as I entered the call room.