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A Piece of My Mind
January 26, 2011

The Tyranny of Reality

JAMA. 2011;305(4):338-339. doi:10.1001/jama.2011.9

I didn't enter medicine expecting to resent mypatients. But late one evening, early in my intern year,I began to suspect that Mrs Xavier (not her real name) was on a personal mission to ruin my night. Too sick to be sent home, too stable for the ICU, this affable elderly woman had been admitted with a straightforward COPD exacerbation for a short course of inhalers, steroids, and rest. Now that she was breathing more comfortably, she pondered at length whether yesterday's tuna sandwich had caused her problems. She had worked out an elaborate theory linking specific foods to breathing. This most recent attack provided vital new data that she felt were essential for me to hear. She easily thwarted my attempts to leave or interrupt her.

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