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A Piece of My Mind
June 23/30, 2015

I’m Sorry

Author Affiliations
  • 1Medical Services, VA Palo Alto Health Care System, Palo Alto, California; and Department of Medicine, Stanford School of Medicine, Palo Alto, California
JAMA. 2015;313(24):2427-2428. doi:10.1001/jama.2014.6507

The resident arrived in the team room reading a text page—Mr Smith was not feeling well. Mr Smith had been admitted five days earlier with recurrence of congestive heart failure. He had multiple problems that were exacerbated by his desire to eat salty foods and foods with high sugar content. He would often decide that he did not need the medications necessary to control his CHF or his diabetes. These decisions routinely led him to the emergency department and from there to the medical floor or even the intensive care unit. This time he was admitted to my medical service. After admission and over the next five days, Mr Smith progressively improved through careful adherence to his medications and a reasonable diet. We restarted his home medications, including a β-blocker, and simplified his medication regimen to try to maintain his improving health. He seemed ready to return home. He made a commitment to improve his dietary habits and his medication adherence, and we had a plan for his discharge. On the morning of his planned discharge, I saw him walking the halls and he looked weak, fatigued, and even short of breath. He did not look like he was ready to go home.

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