Excerpted from "Waking Up in America," Touchstone Books c 2000. Used with permission.

How beautiful Miami seemed from the bay, the skyline and its shores so magical. I could trace the silver edge of a cityscape in crescendo, a newly emerging skyline of glass-and-steel structures jutting up between ornate relics from another era. There it was, a crisp 1980s landscape etched by all the success stories and shining examples of the achievers of the American dream.

And there I was, one of the dreamers, at the entrance of Jackson Memorial Hospital, one of the most prestigious medical institutions in the Southeast, a Cuban refugee boy, recently married, first child on the way, ready for the first day of his internship. It was June 24, 1984. I now mark that as the day I entered the Miami I never knew.

The elevator opened onto a hallway with three doors; I chose the middle one, which led to the medical intensive care unit. I should have taken it as an omen that it was the back door to the unit reserved for the most desperate cases in a public hospital.

There were eleven patients in eleven beds. This was the place of last chances, where we gave our final and most valiant efforts to save the nearly dead. It was the gentleman in bed 9, an isolation bed, who captured my attention. I leaned forward and studied him as he lay attached to a respirator that didn't stop beeping. There he lay on his back with an endotracheal tube going down his throat and the supportive tape wrapped around his face. His wristband offered an age that seemed to belong to a far younger man than the one before me, and it gave a name he didn't respond to. Below this name and suspected date of birth, it simply read, "No Address." That meant Fire Rescue had found him on the streets of Miami. It was no wonder he looked older than his years, barely surviving on cheap wine and garbage scraps. But here is what stunned me about the patient in bed 9: he was dying of tuberculosis. Tuberculosis. It was 1984 and someone in America was dying of tuberculosis?

Bed 9 isolated not only his body but his soul. No visitors allowed. The technology he was getting was the best in the world, the medical attention even better. He wasn't lacking professional attention. But he was lacking human contact. I tried to communicate with him, but he didn't respond. The only clue to his past was typed on the strip of plastic around his wrist.

Where was he from? Did he have children? Was he a husband? Who kept his pictures, his yearbook, his love letters? Did he have brothers and sisters? Did they even know he was in Miami? Did they care?

I needed answers to these questions. Standing before this patient, I realized I was being tested on a promise I had made four years earlier, when I was a med-school student in the Dominican Republic.

I was studying on the porch on a breezy November night when I heard the telephone ring. "Hello?" I answered.

"Chichi is dead," my mother's voice said softly.

With that phone call my world came to a halt. My little sister, my Chichi, not even eighteen years old, was gone. I felt a cold shiver emanate from inside my body, and later only numbness. She was my baby sister, the one I was supposed to protect and save. It was a duty I had embraced since I was a child, the only boy in a traditional Cuban immigrant family. And there I was, a world away in med school, learning how to save lives, yet could not save one so precious to me. I had failed. Even though there was absolutely no logical reason for me to have felt guilty, I did.

Chichi had been driving home from college to celebrate her eighteenth birthday and Thanksgiving when her car flipped on the highway in Palm Beach. She died instantly. There were three other students in the car--all survived without a scratch. There on a weekday afternoon, on an unfamiliar stretch of road, she died. Our family never had a chance to say good-bye when God called for one of his favorite children.

She was beautiful, loving and energetic. She was also humane and charitable in ways that set her apart from many of her peers. God had created the sweetest soul in the world and he had allowed me to be her brother. Believe it or not, we never argued.

I walked and walked that night, going no place. I knew I would miss her more than anything in the world. My parents were devastated. My older sister was inconsolable. I began to write the eulogy and consider the meaning of her life. It was the indelible memory of her kindness and her spirit that would ultimately yield the answers to my most desperate questions, questions about the direction of my life, questions about my faith.

A few days later, I sat in the car on the way to the cemetery, helpless under the weight of my grief. I was twenty-three and I felt old for the first time in my life. As I rode in the back of the limousine, I was numb, removed. Still, I could trace the subtle, slow-moving process of aging. It was then that I first promised my sister that if I ever became a doctor I would not let anyone die or suffer alone.
For I had learned firsthand the horrible weight a family bears with a death or illness. I made a commitment to her--Chichi would not be merely a memory. She would become the loving spirit that drove my work.