I've read that you "almost" wish they'd die, when you care for the desperately sick, and I've thought this a pretty example of American baloney. We "almost" wish they'd die.

With a higher murder rate than the rest of the civilized world -- probably because we are not very civilized -- we might suspect that more Americans wish death on others than do the citizens of, say, Holland or Norway.

Given this national statistic of plain murder, it is unlikely that when faced with the inevitable and prolonged death of the grievously ill, we should suddenly reform and desire indefinite life for them. And we do not.

I know little of other countries but a good bit about America, and I suspect it is the worst place to be dying. Here people do not like to say they have cancer for the simple reason they have noticed (and taken part in) the American distaste for the weak, and they know they'll be written off long before they die in fact.

Americans are like that pope who could not motor through parts of an Indian metropolis because it pained him so to see the poor and the helpless. Of course sensitivity is increasingly prized in America and soon we shall all be like the princess who could feel the pea through six mattresses.

There are those who flame up when they see cruelty, but not many do, and those who fight when they see death, but in general in America we simply turn away from both, taking another route.

You would never have the slightest glimmering, reading a daily paper, that people are dying all around us, in pain and wretchedness. Friends of decades simply tune out; even sons and daughters do. Those who are dying usually have no great right to complain, since they never bothered with the sick, either, when they were healthy, any more than they bothered with the poor or the prisoners. They were all prelates in their time, routing their cars and their lives through agreeable neighborhoods, and most of them, in their own time of despair, know too much to expect other humans to give a damn.

Almost always, however, somebody cares for the sick in America. I don't mean hospitals, which is not my subject, and where care is usually quite brief and well paid for.

I mean those who care for the sick long-term. I knew a woman who cared for a paralyzed husband for 15 years -- he was supposed to die the second night of his illness, according to great specialists flown in for the occasion -- at what cost I do not care to think.

It is one thing to grieve and get it over with -- an enriching and not entirely disagreeable experience, which accounts for our popular delight in other people's terminations of one kind or another, preferably sudden and preferably out of print and out of mind within two days.

It is something else again to hold the spoon, empty the pan, listen to the bitching for 15 years. Such a person, in my observation, does not "almost" wish the patient would die, but prays for it with active fervor.

In the care of the sick, as in virtually every other endeavor, those who know most about it, and who are most faithful and effective in their labor, are not usually those who have the prettiest thoughts and the prettiest sentiments.

In America, where the influence and effect of public glop must be greater than anywhere else, from the White House through the media through the marrow of our bones, we attach incredible importance to how we feel and what our consciousness is. We believe, either secretly or openly, that if we feel good we're on the right track -- like those morons who used to think the smell of roses would cure everything.

The smell of roses cures nothing. Taking another route through Calcutta cures nothing. Feeling compassionate and loving to the unfortunate and the sick cures nothing and achieves nothing, beyond the commonly false glow of feeling just great.

What counts -- and in this alone the Puritans were always right -- is will and a fire that won't go out, and a remarkable capacity for boredom and unpleasantness. Naturally, it came easier for a Puritan, to whom luxurious modes were unfamiliar to begin with and whose aptitude for pleasure was surprisingly slight.

Still, in many cases they did the drudgery of caring for the sick better than the rest of us.

I have not said anything about love. It exists, even among the most luxurious. I suppose there is no less of it than there ever was, we just don't hear much about it. The woman with the paralyzed man was a case of love that came under my observation and, indeed, scrutiny.

My conclusion is as follows. Forget feeling. Forget whether or not you have a bright smile on your face, and forget whether you are fully conscious every day of the loveliness of life, the solidarity of mankind and all that zub, zub, zub.

Make up the mind what the work is, that is to be done, and do it in anger, in disgust, in whatever feeling arises, keeping as firm a control over the expression of these feelings in the presence of the sick as possible. But do it and keep on doing it until the end. That is not what good feelings are about, but it is what love is about, a god who cares almost less than any other what feelings come, and who requires, more than almost any other god, physical presence and the humblest of services, as well as the greatest.

If possible, I guess one should feel loving at all times, cleaning up the john and all the rest of it. The sick man hates it more than his nurse, the loss of physical dignity; and everybody involved is diminished and affronted, probably like the prelate who could not endure the sight of Indian poverty.

When it is not possible to feel always loving, when a tension about the eye registers disgust, this is hurtful to the patient, who tries to understand, and hurtful to the one caring for him, who feels guilty at feelings he cannot suppress altogether. Imperfection is the human lot, and nowhere is it so brilliantly seen as in the care of a long-term invalid who is going to die.

I cannot boast I have ever given such care, but I have seen it and I also know important accounts of it. Plato used to say of men in battle that there's no doubt a guy could often save himself if he just split, and Xenophon pointed out there are some whose feet won't budge, thinking it shameful to run away.

The glory of the human animal is never so resplendent as when the fight cannot be decided in a day, or sustained by emergency chemicals released by almost superhuman glands for half an hour, but goes on indefinitely in the cerdain knowledge of ultimate defeat. Yet surrender's pure white flag is never raised.

Even in prolonged cases, even with boredom and disgust, there are rewards along the way of humor and delight. Good days. There may even be (for some say God is in the plan) Mozart on the day of death, and quiet breathing. Those who have given such care, with all their energy and will and such faltering grace as they can manage, have a reasonable and basalt pride, having given up so many concerts, as you might say, to play gin rummy with those whose minds are failing (down to gin rummy, actually) and whose bodies are a full offense. Except to love. Let's make that (lest it be confused with something less) except to Love.