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A Piece of My Mind
November 28, 2007

It’s Simple, Really

Author Affiliations

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

JAMA. 2007;298(20):2351. doi:10.1001/jama.298.20.2351

Even before I entered Mr D's room, I knew what to expect. Mr D had been an alcoholic for many years and was now in end-stage liver failure, laying all his hopes on a transplant that he would almost certainly never receive. He was here for an evaluation to rule out spontaneous bacterial peritonitis, an infection of the fluid that had been building in his belly over the past four years as his liver gave out. His story was told to me briefly, with even more than the usual dose of hospital cynicism. As I would come to learn, Mr D was an archetype of sorts; patients with liver failure were far from a rare occurrence here. As I heard the details I could already picture him, the jaundiced skin sprinkled with burst capillaries, the swollen belly rising like a perfect half dome beneath the sheets, and the sad, watery, yellowed eyes. He would look just like my father did the last time I saw him.

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