It was Mr. G.'s third exacerbation of congestive heart failurein the past 6 months. Eighty-three years old, he had New YorkHeart Association class IV heart failure, end-stage coronaryartery disease, and insulin-dependent diabetes. Although hehad never wanted to be put on a ventilator, this time his shortnessof breath was so terrifying that he felt he had no choice. Afterhaving a good response to diuresis, he was successfully extubatedand transferred out of the coronary care unit.
Two days later, a hospitalist suggested to Mr. G. and his wifethat given his advanced disease, he should . . . [Full Text of this Article]
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Dr. Gazelle is a member of the Division of General Medicine and Primary Care at Brigham and Women's Hospital and president of MD Can Help — both in Boston.
An interview with Dr. Timothy Quill, director of the Center for Palliative Care and Clinical Ethics at the University of Rochester, can be heard at www.nejm.org.
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