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A Piece of My Mind
April 10, 2018

A Third Option

Author Affiliations
  • 1Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA. 2018;319(14):1437. doi:10.1001/jama.2018.3169

I was used to seeing two types of patients in the intensive care unit (ICU)—the young after an overdose and the old after multiorgan failure. You were neither young nor old. We were only a few years apart, I remember thinking. Chance had struck you with an unforgiving malady that turned your previously pliable lungs stiff and fibrotic. A roll of the dice, and I could have been the one lying in the hospital bed you now occupied.

You were wheeled into the corner room. Because lying flat made it hard to breathe, you used the automatic controls to turn the bed into a makeshift recliner. From your nostrils hung plastic tubing that forced oxygen down your nose and into your lungs. I glanced at the oxygen concentrator next to your bed. I had never seen oxygen flow that fast. Yet it was not enough, so we added a mask over your nose and mouth. You didn’t look any more comfortable, but at least your numbers looked better.