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On Being a Doctor |

A Role in Transition

Eliezer M. Van Allen, MD
[+] Article and Author Information

From University of California, San Francisco, San Francisco, CA 94143-0119.


Requests for Single Reprints: Eliezer M. Van Allen, MD, Department of Medicine, University of California, San Francisco, 505 Parnassus Avenue, Room M-987, San Francisco, CA 94143-0119; e-mail, eliezer.vanallen@ucsf.edu.


Ann Intern Med. 2009;151(6):427-428. doi:10.7326/0003-4819-151-6-200909150-00009
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About 1 hour after another helping of 3-bean chili, I was paged to the emergency department for a new admission. The patient was an elderly woman with dementia and a medical history longer than most. Her knees were pressed against her chest, and her breathing was labored. She had no chief complaint. She had been nonverbal for months, on good days able to answer simple questions with a “yes” or a “no.” However, she was in respiratory distress, she had probably aspirated again, and her condition was rapidly deteriorating. Her family was at her bedside, some tearful, others stern and focused. Her grandchildren were crying. I confirmed her code status and made sure she was intubated (for the third time this year) before allowing my intern to have the first attempt at completing the rest of her work-up. It was an otherwise slow night, and I soon had the opportunity to retreat for some rest.

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