"Be compassionate, but draw the fine line." I can hear my teacher in medical school warn us of becoming overly involved with our patients, of exposing ourselves to emotional and spiritual difficulties by suffering with each one of our chronically ill patients and their families.

"Objectivity will diminish to the same degree that intimacy develops between a patient and a doctor," he concludes. "Do not cross the fine line between these two."

It is Saturday morning. I easily find the neat, well-kept house located in a blue-collar neighborhood. At the top of the wooden ramp a man in his fifties, dressed in a warm red sweater and jeans, greets me. The inside of the house is as well-appointed as the outside. I hear a child's voice, and notice a little fellow spying on me around the corner of the wide hall. His grandmother, gray haired and erect, greets me and invites me into the kitchen. We have coffee, the first of innumerable cups we will share; she starts to tell me why they called and what they expect of me.

Their only daughter, Terri, has multiple sclerosis. She was diagnosed shortly after she gave birth to her son. Hers has been a steady downhill course and it has become difficult to take her by car and wheelchair to the neurologist who cared for her for the past four and a half years. He will not make house calls; therefore she needs a new doctor. She lives with her parents. Her mother, Mrs. Brown, has left her teaching job to take care of Terri and grandson John.

I ask about their daughter's husband. With anger, Mr. Brown replies: "He left as soon as Terri needed a wheelchair and is suing her for divorce and custody of John." He pours coffee all around and empties his cup quickly; then he motions to his grandson and nestles him on his lap. John is a beautiful child, blond, with dark brown eyes and a lithe body. Obviously both grandparents adore him.

Mrs. Brown tells me that Terri can no longer tolerate the wheelchair. She sleeps well, but is troubled by constipation. Mrs. Brown quizzes me about my experience and training. Will I make regular house calls? Apparently my answers are satisfactory.

Mrs. Brown says: "Let me go see if Terri is awake." She returns and beckons me down the hall into a large bedroom with an attached porch. The windows open to a fenced yard where forsythia bloom. A rocking chair sits at the foot of the bed with a rainbow-colored throw. John, who has followed us into the room, now curls up in it and rocks slowly, rhythmically. His eyes focus on his mother who is lying in a double bed under blue sheets. My eyes seek her out, and I introduce myself. She is very thin, blond, pale, and has an almost beatific smile. I will soon learn that she has an excellent sense of humor, wanted to teach and write, but was unable to complete her education because of her illness.

Her parents leave with John. We are alone. Terri talks to me of the sadness, of the pain that the divorce is causing her. She is trying to understand her husband's priorities. He is young, ambitious, and her disability hangs like a chain around him; he cannot go forward. She wonders: "Why couldn't he wait until I die?" She is worried about the burden her parents have taken on—moving her into their home, their bedroom. She is not sure if they can manage financially with one income, nor whether her mother will be able to continue to lift and turn her.

As we talk, I acknowledge a strong empathy for this beautiful, frail young woman. She is about my age, with a son about the age of my son. I realize that the first strands of friendship that draw two people together are forming. As a physician should I keep these strands from becoming taut, strong, interwoven, by meticulously adhering to my teacher's instructions to pull back, retreat, stay objective?

On leaving I tell Terri and her parents that I will arrange for visiting nurses and will find some sitters to make it possible for Mrs. Brown to occasionally leave the house. I tell Terri I will return every Saturday.

I think about Terri all week and am impatient to visit her again. I bring her daffodils and the news that I found a college student who will read to her twice a week. This time we talk about her physical discomfort and about her fear of dying and leaving her son. She tells me it is hard for her to contain her anger at being completely dependent on others, at having to die young, at feeling guilty because she can no longer adequately mother her son. We discuss the relief from anger that she used to get by running or playing tennis, catharsis denied her now. We play a game: we both imagine crumpling paper, erasing a blackboard, even spitting, all in anger, and we admit there is mitigation of the intensity of the rage. We try to find solace, equanimity by listening to music, reading poetry, and sitting together silently, meditating.

Terri's plight touches me deeply. I am becoming her friend as well as her doctor.

Spring becomes summer, we open all the windows in the bedroom and listen to the birds. I read to John, who is curled in his rocking chair. Terri can still make all of us laugh with her puns and funny remarks.

At the end of the summer it is clear that she is becoming weaker and more short of breath. We talk again of how much medication she wants if she gets pneumonia, pyelitis, cystitis. Does she want a respirator? Does she want to go into the hospital? She wants to stay home, near John, for as long as possible. By now my emotional involvement has transgressed from the usual doctor-patient relationship to that of deep mourning at seeing my friend, my patient, die.

The actual end comes over Thanksgiving. Her parents and I take turns sitting with Terri, talking to her. I do not want to let her go, but I will do nothing to delay her dying. Her funeral is simple. John stays at home with me during the service. He withdraws, is confused by the many visitors. He wants his mother.

The loss I feel at Terri's death is more acute, my grief more enduring than what is usual for me when a patient dies. Perhaps, when objectivity is no longer essential, when the doctor's armamentarium is empty and the patient expects control of discomfort rather than cure, the doctor-patient relationship can become less distant and approach friendship.

The bond that Terri and I established is rare, as true friendship is rare, and does not happen with every chronically ill patient; from the healer this bonding requires emotional energy and causes pain. It also enriches life because it permits participation in another's life, another's suffering, in a deeper comradeship than the doctor-patient relationship usually allows. There are times when it is permissible to cross the fine line that divides objectivity from intimacy.