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A Piece of My Mind
September 6, 2006

Swan’s Way

Author Affiliations

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

JAMA. 2006;296(9):1041-1042. doi:10.1001/jama.296.9.1041

I suspect that my memories of internal medicine residency—now more than 20 years ago—are not unlike those of most others who trained in that era; and by now, similarly blurred. I recall some remarkable teachers, a few memorable patients, and many nights with little or no sleep. I trained in Brooklyn; we spent a lot of our time and effort in that period trying to figure out what was, and what to do about, the condition that eventually was called AIDS.

Recently I came across an article about the ineffectiveness of pulmonary artery catheters1 and the accompanying editorial virtually proclaiming the final demise of the Swan-Ganz catheter.2 Reading these articles brought me to a Proustian petite madeleine moment. I recalled years ago standing by the bedside of a dyspneic man dying of end-stage congestive heart failure, trying to explain to him the technique and goals of the Swan-Ganz, wondering if he understood what I was saying, hoping that he would turn it down, and feeling relieved when he shook his head No. The article brought me back to the time when we struggled to obtain useless numbers, applied them with bad results, and deluded our patients and ourselves. These experiences have reverberated through the years, coloring my attitudes to this day.