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A Piece of My Mind
October 22 2008

Remembering Earl

JAMA. 2008;300(16):1853-1854. doi:10.1001/jama.300.16.1853

It was easy not to like him.

The first time I saw Earl was in the ICU and he looked emaciated, flat, and distant. What little he spoke consisted of short sentences, and his lips moved slowly, revealing rotting, blackened teeth that peered out from behind his short, unkempt beard. At about 6½ feet, his thin frame barely fit the hospital bed, and he resembled an ill Ichabod Crane. I already knew his story from one of my partners, who had done the original cardiology consultation the day before: increasing shortness of breath and a 30- to 40-pound weight loss over several months. Earl hadn't seen a physician in years, since being treated for a spontaneous pneumothorax. No, he didn't know he had a heart murmur, and no, he didn't use intravenous drugs.

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