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On Being a Doctor |

A Great Escape

Clayton J. Baker, MD
[+] Article, Author, and Disclosure Information

From Pittsford, NY 14534.

Requests for Single Reprints: Clayton J. Baker, MD, Pittsford, NY 14534; e-mail, baker_reidy@yahoo.com.

Ann Intern Med. 2010;152(12):821-822. doi:10.7326/0003-4819-152-12-201006150-00014
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Mr. Giametti was considered an easy admission. A veteran of World War II, now a regular at the VA, he was well known to us interns. Every month he was scheduled to see Dr. Owen, his oncologist. Every second or third month, Mr. Giametti kept his appointment. He had myelodysplasia, and at age 84 years, he had refused aggressive work-up or therapy. Invariably, between appointments, his hematocrit would dwindle. Mr. Giametti would reappear pale, fatigued, and dyspneic from anemia. Dr. Owen would page the intern, and one of us would admit Mr. Giametti overnight for a transfusion. The whole process had become sufficiently routine that Dr. Owen had developed a simple formula for the transfusions: hematocrit between 20% and 23%, transfuse 3 units. Hematocrit below 20%, 4 units. Piece of cake.





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