Author Affiliation: Department of Family and Community Medicine, University of California, San Francisco.
Most physicians have their stories. Mine dates to one of my first nights
on call as an intern in family medicine at San Francisco General Hospital
in the summer of 1985. I was summoned to the emergency department to admit
a young woman with a presumptive diagnosis of subacute bacterial endocarditis.
For a new intern at that stage of unspoiled eagerness when the very act of
wearing a pager instills a noble sense of professional duty, this type of
call made me hasten to the emergency department in excited anticipation of
encountering a patient with a classic but rare disease. Indeed, the patient
had all the textbook characteristics of the infection: rheumatic fever in
her youth, recent weeks of malaise and low-grade fevers, a holosystolic murmur,
and blood cultures sent from clinic 2 days earlier growing chains of gram-positive
Grumbach K. Insuring the UninsuredTime to End the Aura of Invisibility. JAMA. 2000;284(16):2114-2116. doi:10.1001/jama.284.16.2114