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November 2016

Going Home, Dying

Author Affiliations
  • 1Department of Medicine, Okinawa Chubu Hospital, Okinawa, Japan
JAMA Intern Med. 2016;176(11):1603. doi:10.1001/jamainternmed.2016.5776

After I had worked a daylong outpatient clinic, a nurse told me that a hospitalized patient of mine had gone home. She was very ill with uremia and septic shock. “Her blood pressure was not measurable; the last intravenous line collapsed,” the nurse told me. She rushed home, dying.

Mrs S was a woman in her 90s with chronic kidney disease. She had been brought in by ambulance to our hospital with fluctuating mental status and fever. When the diagnoses of end-stage renal disease and septic shock were established, she was completely bedridden. Every now and then, she muttered something we could not decipher. Her blood pressure continued to decline day by day, and she required fluids and vasopressors.

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