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February 25, 1983

Uncle George

JAMA. 1983;249(8):1013. doi:10.1001/jama.1983.03330320017021

My Uncle George died last week. He was 91 years old. He had lived a long and happy life, so the fact of his death didn't bother me much. But the way he died—well, that's another matter.

Two weeks before the end, Uncle George started passing blood, first as tarry stools and then as dark red clots. By the time he got to the hospital his BP was abnormally low and his pulse rate was rising. Transfusions were given and intravenous cimetidine administration was started. His condition stabilized, and endoscopic examination revealed a large duodenal ulcer with a clot in its base.

So far, so good. A diagnosis had been established and his initial treatment seemed entirely appropriate. If his ulcer had healed he'd have been returned to an approximation of his previous health status at reasonable cost and everyone would have been satisfied. It didn't turn out that way,