I had simply been trying to get through my tedious daily morning work rounds without a hitch, the hypnotic lines of Madonna's latest hit song, which I had blasted on my car stereo on the way to the county hospital, still pulsing suggestively over and over again in my head: "Just like a prayer/your voice can take me there/just like a muse to me/ you are a mystery..." For the whole of the twenty-minute drive to work that day, I had kept my car's front windows rolled all the way down to let the bracing wind and all of frivolously sun-drenched San Francisco pour unimpeded into me as I sped down Potrero. But the deepening poverty was too obvious to ignore, the Mission district looking more and more like a destitute Latin American country with each passing block. As a last resort, I tried to make myself admire a few colorfully attired hookers still working their street corners at 6 A.M., the dawn for them meaning not the beginning but the end of yet another day. Anything to bring me outside of myself to some kind of an awakening, to shock me into feeling more a part of the kingdom of not dying...

His nurse entered with a gelatinously floppy bag of IV fluid to hang. According to her, my patient had been babbling incoherently off and on for much of the night, yet I felt how unmistakably and clearly these last few words of his pierced me. Pray for him? This patient was a filthy junkie who had bitten another nurse in a squabble over his regular methadone dose; numerous times, I had been paged in the middle of the night and awakened from a precious hour or two of sleep to respond to his incessant demands for other narcotic drugs to treat his "pain," always to arrive to find him resting in apparent comfort amid half-emptied take-out cartons of Chinese food brought in by his rowdy, ponytailed friends. If I could have hoped or prayed for anything, it would have been that he'd be stone-cold dead when I next returned to the ward.

Instead, to my chagrin, each morning he was still there, very much alive and moaning and urinating in his bed, or hurling the occasional intelligible and angry epithet at me. Though nothing was likely to salvage him at this point in his illness, with his terminally low T-cell count of 2, a long history of violence and intravenous drug use, and widespread aggressive lymphoma involving his central nervous system, I was still leery of trying anything new at all--even a begrudged prayer--that might prolong his misery, and thus my own. He was little more than a disgusting chore to me, something akin to mopping up a stubbornly grimy floor. In my view, each new hospitalization he had required, thickening his chart as if only to make it heavier for me to lug back and forth from medical records, was a waste of already scarce public health dollars. This latest crude remark of his was the last straw. I stormed out of his room without even bothering to finish examining him.

By simply going elsewhere in the hospital, however, I could not escape him. I saw versions of him shadily averting their eyes in the elevator, hungrily consuming free food provided by the methadone clinic in the cafeteria, and wildly quarreling in the outdoors smoking area off one of the hospital's main hallways. Wherever I looked, his blunt plea would flood back to me, only to elicit the same reflexive rage. Though one of my intern's strategies for conserving energy was to minimize thinking whenever possible, I found myself obsessively wondering whether I walked around stooped by the heavy burden of some unresolved religious guilt, so that even my most ostensibly faithless and disoriented patients could tell that I was once a Catholic...

My name. I locked myself in a windowless staff bathroom, the only place I could think of where I could be completely alone, if the pungent presence of ammonia were ignored. I wondered: What secrets did a name betray? I regarded it from a distance as if for the first time, quietly pronouncing it over and over to myself; undeniably, "Rafael Campo" was as generically Latino as a colorful street festival for a local miracle-working Virgin, but my actual relationship to the Catholic Church was much cooler than my stereotypically churchgoing family's. I was a hard-core outcast for my supposedly sinful life, and no longer even considered myself a member of any faith. It amazed me that a low-life like this patient, who probably had stolen stereos from cars in the hospital staff's parking lot to pay for the heroin he was known to shoot directly into his IVs, could still consider himself among God's children, worthy of a saving prayer...

I could not be bothered with the plight of others anymore, on any level. As if to protect myself, I focused on the many injustices I felt so acutely in my own life. I had allowed myself to become deeply concerned that my own great potential had been blighted by that one imponderable aspect of myself that I never had wished for or willfully chosen. I was, I had realized long ago, among the not blessed. (Some would say, as I once heard on a religions radio talk show, that I was being used unknowingly by Satan himself!) I imagined my elderly Latina patients cursing me with a serpent's hiss--maldito seas--if they were ever to discover my vice. I was an abomination to the same God they said had created me, and whose forgiveness at the same time was the only hope for salvation. When I tried to conceive of the possibility of redemption, I felt my flesh tearing, my bones popping mutely out of their sockets, my wretchedly human body unable to stretch across the rift growing between me and the withdrawing heavens toward which I reached out. It was the kind of fracture that all my years of medical training would never be able to repair. A queer still desiring and perhaps even needing some form of a relationship with God, I bitterly embodied as deep a schism as any in the Catholic Church's long divisive and blood-soaked history.

So what "prayer" would a misfit like me intone for the likes of him, anyway? Despite my well-groomed hatred and my practiced efforts at execration and denial, I had to admit that I did recognize him. He was my brother, another human being, just as pathetic and frightened, just as despicable and unforgivable as I, and asking for the same soothing words I both craved and actively refused. Even so, he remained as hideous to me as I believed myself to be to my estranged Catholic faith, and so by a strange arithmetic he was unsuitable as the subject for any form of art, even mine. If I had any religion left in me at all, it was only a distorted reflection of Catholicism, it was the potential for a frenzied creation that arises from abjection and loss mixed with a brutally repressed hope of reconciliation. My "visions," my poems, contained some amorphous, nascent, not too-ugly shapes, demanding to exist in spite of what I considered to be their ultimate valuelessness. For me to become a healer and a poet, a healer through the unabashed writing of poetry, seemed an unattainable dream, something that could occur only if Christ would somehow agree to appear less radiant and noble in his suffering than all of the masterpieces of the Renaissance had depicted him.

Or perhaps, I often though, if only I could find the right place to begin. But Adam was always fucking Steve in my stunted garden of Eden; my pitiful pidgin language would always consist only of the words left out of prayers. Certainly, I would always be Catholic to the extent that I could accept what I did not understand as a kind of mystery, from the workings of the body whose interior was as dimly and creepily illuminated as a medieval cathedral's dang reliquary, to the creation of the sibilant voice with its unbounded capacity for healing despite its unimpressive anatomical dimensions. Still, I recalled another face of Catholicism, which decreed that certain things in the world were categorically unacceptable, far less mysterious than they were frankly vile. In the attacks of so many hateful sermons, in the misinformation propagated by so many Catholic thinkers, my enforced and obligatory corruption and its attendant rage had accumulated in me over so many years that at the time it seemed impossible for me ever to reconnect. I was so resigned to what was called my sin, it had become my grinning muse and corrupted master, my terrible fate.

Of course, I remembered learning about other so-called sins as a child in Sunday school; they seemed carefully choreographed and intentionally committed, in contrast to the way my heart spontaneously quickened and lurched with a music my teachers said was abhorrent and unnatural. Adultery, moneylending, and the like seemed somehow more egregious and deliberate than what had been born into me. Yet while at least half of my playmates' investment-banker parents seemed to have been divorced simply because they could not get along, and the blatant two-timers among the other half kept their nice jobs (and usually their nice families), homosexuals were summarily fired, punished, blackmailed, disowned, or beaten to death in back alleys. (It was always the home of the two faceless men who lived together in my neighborhood that the older kids pelted with eggs and draped with toilet paper, their mailbox the one they blew up regularly with firecrackers.) Even the sleaziest of prostitutes and the most recalcitrant of thieves could be pitied and so could redeem themselves in the judgmental eyes of the faithful; the examples of Mary Magdalene and Judas proved it. But there was no conceivable rehabilitation for queers, no biblical provision for anything besides their anonymous incendiary and sulfurous Old Testament destruction--which was partly what I supposed kept them out of the Church, cowering in their closets, or suffering in hospitals....

The above excerpt is from the first 10 pages of this 62-page chapter entitled "Like a Prayer."