The problem might be solved by long-acting local anesthetics. Berde and his colleagues at Harvard and the Massachusetts Institute of Technology have patented time-release beads that contain a commonly used drug, bupivacaine. Injected into a surgical incision, the microscopic beads may block pain for a week, possibly reducing or even eliminating the need for opiates. The hope is that they will enable patients to recover sooner. The beads are being tried on patients overseas, and Berde expects testing in the U.S. to begin soon.

He is also working with other researchers to develop long-acting local anesthetics from toxins found in some fish, shellfish and algae--the same toxins that cause poisoning victims to feel numb and weak all over. Berde is pursuing the toxins because they work for two or three days and seem free of the side effects of existing drugs, which occasionally cause convulsions or disturbances in heart rhythm.

Important as research is, Berde does not let it keep him from taking care of patients. "One of the best things he does is care for kids who are dying," says Pauline Scopton, a nurse who has known Berde for 17 years. "He is a master of the chemistry, of mixing the drugs to keep them comfortable." For families who wish to keep a dying child at home, she has known him to spend hours on the telephone with pharmacists and home-care nurses to come up with the right pain medicines.

Berde questions the widely held belief that doctors and nurses become inured to their patients' suffering. "You don't distance yourself," he says. "It's not realistic, the notion that you don't develop a connection. Do I get sad? Yes. It's sad when a kid dies. But feeling that I can do something for them helps. At times it's hard, but that doesn't make me not want to do it. Having my own kids makes me understand the impact of illness even more, and I admire the courage of these families even more."