A Piece of My Mind
November 27, 2002

Playing the

Author Affiliations

A Piece of My Mind Section Editor: Roxanne K. Young, Associate Editor.

JAMA. 2002;288(20):2516-2517. doi:10.1001/jama.288.20.2516

The sound of a coffin hitting earth is a sound utterly serious. —Antonio Machado, "The Burial of a Friend"

Give wine. Give bread. . . . Sit. Feast on your life. —Derek Walcott, "Love After Love"

I think about him several times a year even now, more than 20 years later. When I do it is with uncomfortable clarity and a surge of briefly incapacitating sadness and guilt. He had come to the office at the age of 68, troubled by exertional chest tightness and dyspnea. Intelligent and gentle, he was the kind of person you would look forward to seeing over the years. His physical examination revealed a long, late-peaking systolic ejection murmur suggestive of severe aortic stenosis. My training, completed just months before, had taught me that it was too risky to exercise such patients to assess whether their symptoms were cardiac in origin. Rather, cardiac catheterization to determine the severity of the stenosis and coronary angiography in preparation for aortic valve replacement were appropriate.

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