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A Piece of My Mind
September 19, 2001

Toward Meaning

JAMA. 2001;286(11):1291-1292. doi:10.1001/jama.286.11.1291

When I came on duty at 3 PM, it seemed like the most ordinary of days. At the time I was a senior physician in a high-acuity emergency department at Kaiser-Permanente Medical Center in Santa Clara, Calif, chair of the Peer Review and Quality Improvement Program, and faculty in the Stanford-Kaiser emergency medicine residency program.

I took sign-out from Dr Koscove, who told me, "I've got an 86-year-old woman, Mrs Martinez, in room 17 with nausea, vomiting, and dehydration and a history of metastatic lung cancer previously treated with chemotherapy and radiation. She was discharged from the hospital two days ago for the same thing. I controlled the nausea and vomiting with IVs and ordered a CT scan to look for brain metastases and signs of increased intracranial pressure. I told her you're taking over. You'll need to review the scan, and see if she can tolerate oral fluids, before discharging her."

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