As an award-winning photojournalist for more than 30 years, Max Aguilera-Hellweg has captured street gangs, cowboys and rock stars for Esquire, National Geographic, Rolling Stone and other magazines. But his most demanding assignment was one he gave himself: to understand doctors not by taking their pictures but by becoming one.

Q: What stirred your interest in medicine?

A: In 1989 the women’s business magazineSavvy sent me to photograph Frances Conley, a neurosurgeon at Stanford. I watched her operate on a man with sudden-onset paralysis. I was photographing her hands when she stepped aside and said, “Here, take a picture of this.” I was arm’s length from a spinal cord. I was used to having access to incredible people and places, but this was different: It was the most intimate place I’d ever been. I knew that this was where I wanted to be.  

Q: How did you make the leap from photography?

A: By definition a photojournalist is always the voyeur; he always has the secondary experience, never the primary. I’d leave assignments with this emptiness, and it stayed with me for years. I was in a store one day when a man went into cardiac arrest. I had just photographed cardiac bypass surgery the week before, but I couldn’t help keep this person from dying. It was an awful feeling.

Q: So you applied to medical school? 

A: First I needed an undergraduate degree, because I had never gone to college. I started by enrolling in an algebra course at the Borough of Manhattan Community College. I began my undergraduate studies at Columbia University School of General Studies in 1995, when I was 39. I got my M.D. from Tulane University School of Medicine in New Orleans in 2004 and completed my internship and residency in internal medicine at the University of Massachusetts Memorial Medical Center in Worcester in 2006.

Q: What was the most trying aspect of your training?

A: In December 2005 I did my first rotation as an intensive-care-unit resident. In my program, the ICU resident carries the code pager for the entire hospital—when a code is called for a life-threatening event, the resident is responsible. You walk into a situation in which you have seconds to figure out what life-support measures to take. There are times when you have to tell a patient he’s going to die.

Q: How did you do it?

A: I was straightforward, just as I’d seen my attending physician act with patients when I was a student. The experience taught me that straightforwardness and caring are often the same thing. Being vague or offering false assurance would have been more painful. Our culture has convinced us that death is unnatural or avoidable, and society tends to consider it vile or repulsive, but it’s none of those things. It’s a natural stage in life, and everyone deserves a dignified passing. Discussing death with patients wasn’t easy, but I considered it an honor to help them at this turning point.

Q: After all those years of study, you decided not to enter practice.

A: I had intended to practice medicine. But toward the end of my residency, I found myself wondering what specialty to pursue. Just after my first ICU rotation, I got a call from a friend asking me to lecture at the International Center of Photography in New York City. For six years I had been too busy studying to look at my photographic work. As I went through my photographs to prepare for the lecture, I could see where I had been and where I was going. I’m also a writer and filmmaker, and I became flush with ideas, projects I needed to finish.

Q: Couldn’t you practice medicine and follow your creative ambitions?

A: I considered various medical fields that would offer some flexibility—for example, locum tenens, or filling in for a physician on vacation; or becoming a hospitalist, who treats the hospitalized patients of other physicians. But medicine, however you practice it, is all-consuming. No specialty allowed the freedom I sought. I couldn’t go off for three weeks here, six months there. 

Q: So those years were a waste?

A: Not a waste! A great, great adventure. And I accomplished my goal: I am no longer the voyeur; I’ve been to the other side.

Q: Has becoming a doctor made you a better artist?

A: I can’t point to a specific picture and say, “That came out better because I became a doctor.” But art is about defining the human condition, which doctors deal with in its most elemental form. I’ve looked into the face of a grown man fearing his death to his last breath. I’ve sat with families and told them their loved one passed during the night. I’ve prescribed medicines that have eased suffering. I haven’t just observed these things, I’ve done them. I’ve been responsible. How could that not make me a better artist?