If anyone imagines Roy Romanow is not feeling the extraordinary pressure of next week's release of his long-awaited 393-page health-care commission report, get this: Last week, the exhausted commissioner got sick. He then (uncharacteristically) had to cancel meetings in Toronto and Ottawa with -- among other notables -- three premiers. One could see the headline: "Health Care Commissioner Unwell; Report Delayed."

Pressure? What pressure? Give the guy some sleeping pills! He only has the future survival of our health-care system on his broad, weary shoulders. An eager nation has visited his commission Web site a remarkable 24 million times. Today, in Winnipeg, he delivers a major speech on values, his and Canada's.

Last week, at home in Saskatoon, steeling himself for the onslaught of questions and criticisms his report is bound to evoke, the royal commissioner admitted to laying awake, worrying not only about how his report will be received, but whether he's got it right.

"I wake up in the middle of the night, virtually every night, extremely concerned that I've missed the mark on [the report's] recommendations; worried whether I'll be able to understand the criticisms and outrages that will be expressed. Someone once said courage is 'tamed fear.' Eventually, I get back to sleep." This from a 63-year-old man who fractured his left elbow five weeks ago, and pressed on with his calculated speaking tour of three American East Coast universities. The tour -- known to some as the battle of the front pages -- pitted Mr. Romanow against his senatorial competitor, Michael Kirby. Score: Romanow, 1; Kirby, 0).

Mr. Romanow has sundry reasons to panic in these dark nights of his soul. Here's a partial list of his opposition: cynics who believe adamantly that our health-care system is unfixable and that we cannot afford to repair it; some Ottawa mandarins (and at least one provincial premier) who have knives sharpened and ready to slice his report to shreds; much of Toronto's Bay Street; Canadians who are jaded about royal commissions in general, not to even mention voters who are fed up with a rudderless federal Liberal government. Add to that the distractions of Kyoto and a looming war, and Mr. Romanow needs his old constitutional-war buddy -- Jean Chrétien -- to hang in long enough to get the report's recommendations acted upon, say through the end of May.

On the bright nights of his soul, the indefatigable and passionately committed commissioner has some profoundly consoling forces on his side. Take, for example, the virtue of mercy, by which we mean "the willingness of someone to enter into the chaos of another in the hope of easing their suffering."

Roy Romanow heard this definition in April, at Ottawa's Chateau Laurier Hotel, during a discussion of palliative care. It would, metaphorically, define his 18-month, million-mile journey. "Is there a limit to mercy?" he wondered.

That's what your $15-million Commission on the Future of Health Care in Canada will report on, he was told.

Last week, I asked Mr. Romanow (an occasional backup singer in a country and western band called "The Text Pistols") his own question, a query that clearly troubles him. Is there a limit to mercy?

"That is a very difficult question to answer. Many times, I've agonized over this," he said. "If mercy involves compassion, caring and loving . . . there probably are no limits, or there should be no limits, especially in a time of illness . . . leading to dying and death. I debate this constantly."

Roy Romanow cannot answer his own question directly. But his final reckoning, next Thursday, has to. His report is a moral obligation to Canadians because if we define ourselves fundamentally as a civil and just society, medicare is the one compassionate thread that makes us unique (or used to, before it became knotted and ravelled) from, say, North Koreans or Americans. In other words, in our "civilized" society, Mr. Romanow's report must answer not only how to fix a badly wounded and limping health-care system, but why.

No wonder he doesn't sleep at night. He knows we are counting on him to provide expansive and comprehensive leadership on the very survival and future of health care. And I think he will.

Why? Simple: He gets the mercy stuff; it haunts him. It's been in his bones since that fateful day when, as a college student at the University of Saskatchewan (premedicare days) his father, a CN railway worker, suddenly had a heart attack. Mike Romanow was admitted to a hospital, run by the Sisters of Charity, and was cared for until he died three weeks later.

"I was destroyed by his death, by his illness, by his suffering," Mr. Romanow says. "Goodness knows, it's hard enough to get by in life even when you're healthy, but when you're ill, it's hard enough to worry about the challenge of illness without having to also worry about whether I [could] keep the other aspects of the family together."

Roy Romanow got a part-time job at a radio station to pay his university fees. His mother, having to find work, found a job in Saskatoon, cleaning washrooms in technical schools.

"If you're a compassionate, caring society, a merciful society, we should be sharing this kind of feeling. So, do I feel a moral obligation? The answer is yes."

Roy Romanow's conscience -- his moral compass -- has been moved and tendered, to the point of tears, as he's listened to the voices of the courageous individuals who have known loss and illness. Since the moment he symbolically opened the commission's hearings in Saskatchewan -- the birthplace of the original medicare -- then flew northeast to Canada's newest territory, Nunavut, he has listened and learned. The sheer vastness of the northern reaches, punctuated with little villages whose inhabitants deal with illness as a spiritual matter, was one thing; the North's lack of doctors and hospitals and basic accessibility to primary medical care was another. And this was what stayed with the commissioner, broadening the moral imperative of his mandate.

Those voices from Pangirtung, Nunavut and other aboriginal communities he visited, never left him. In listening to their narratives, Mr. Romanow comprehends now, that they were the same voices that also encompass all the silent waiting rooms, say, in palliative-care units, in big city hospital emergency rooms, in the slim bedrooms of for-profit, extended-care facilities, in any intensive care unit you want to name.

Mr. Romanow's report on the future of health care is not just about money, supply and demand statistics, political willingness, and one province's opting-out clause. It's about human stories and voices speaking to him about panic and loss and dying.

The British poet Philip Larkin wrote: "What survives of us is love."

What must also survive of us, and medicare, is mercy.
Nancy Southam, author of Remembering Richard, a profile of Richard Hatfield, is currently writing a book remembering Pierre Trudeau.