Skip to main content

Main menu

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN

User menu

Search

  • Advanced search
CMAJ
  • CMAJ JOURNALS
    • CMAJ Open
    • CJS
    • JAMC
    • JPN
CMAJ

Advanced Search

  • Home
  • COVID-19
    • Articles & podcasts
    • Blog posts
    • Collection
    • News
  • Content
    • Current issue
    • Past issues
    • Early releases
    • Collections
    • Sections
    • Blog
    • Infographics & illustrations
    • Podcasts
  • Authors
    • Overview for authors
    • Submission guidelines
    • Submit a manuscript
    • Forms
    • Editorial process
    • Editorial policies
    • Peer review process
    • Publication fees
    • Reprint requests
  • CMA Members
    • Overview for members
    • Earn CPD Credits
    • Print copies of CMAJ
    • Career Ad Discount
  • Subscribers
    • General information
    • View prices
  • Alerts
    • Email alerts
    • RSS
  • JAMC
    • À propos
    • Numéro en cours
    • Archives
    • Sections
    • Abonnement
    • Alertes
    • Trousse média 2021
  • Visit CMAJ on Facebook
  • Follow CMAJ on Twitter
  • Follow CMAJ on Pinterest
  • Follow CMAJ on Youtube
  • Follow CMAJ on Instagram
Query

Query

CMAJ October 12, 2004 171 (8) 1006; DOI: https://doi.org/10.1503/cmaj.1040547
  • Article
  • Responses
  • Metrics
  • PDF
Loading
  • © 2004 Canadian Medical Association or its licensors

Clare was 300 pounds, middle-aged and short of breath. She was a longtime smoker who looked as if she'd puffed in the womb. She suffered from a crippling emphysema and was noncompliant with her medication regimen. She regularly missed appointments. In short, she was one of my sickest and — Why do they usually go together? — most recalcitrant patients.

Figure1

Figure. Photo by: Anson Liaw

She wouldn't come to the office mildly short of breath. No, I would see her only when she was in extremis, her chest taking great heaves in flabby, fluttering attempts to move itty bits of breath. Like last night, when she rolled into the emergency room, hacking and horking up balls of phlegm between rapid, jiggling respirations. It's always the same story with her.

When did you last use your puffer?

Ran out. Last week. Forgot. To. Refill.

When did you start getting short of breath?

Days. Ago. Maybe. Not. Sure. Hungry.

A sad fact: she comes to the hospital only when she gets so dyspneic that she can't eat.

As her doctor, I initially tried to save her. I hinted at weight-loss strategies, scheduled once-weekly appointments to reinforce compliance, encouraged her to stop smoking. Over the course of many months I was patient and consistent in urging her in a healthy direction.

I failed, for she ended up in hospital repeatedly. So I changed tack and became blunt, delivering morbid verdicts with a grim certainty:

You will die if you don't lose weight.

You will die if you don't take your medication.

You will die if you don't stop smoking.

This didn't work either, even though what I said was true. She had pathetic spirometry parameters: each additional fat cell and cigarette shrank her chest's ability to move air. Last night she came close to death. I was about to intubate her when, miraculously, she pinked up and her SpO2 increased. She was so sick that there was no opportunity to go through our usual routine, in which I ask questions to which I already know the answers.

Sometimes I wish medicine would develop a cure for stupidity. But when this evil thought passes, I purposely turn introspective and recognize that even the most intransigent and oblivious patients can teach me something.

I admitted Clare as per usual, wrote the orders that were by now rote. Masks, steroids, spirometry ad nauseum. The next day I visited the great heap of her during my rounds. What I saw cured me of my arrogance: Clare's little boy, who had probably heard me browbeat his mother a dozen times, was pulling at her arm, trying to get her out of bed. Over and over he tugged, repeating, Exercise, Mommy!

Clare couldn't. She could barely sit up, let alone take a few steps. The little kid had clearly listened to me give Clare hell in the past.

Who was I to presume that I knew this woman? Medically, I knew she might die if she didn't adhere to my advice; personally, I didn't know what her life was like. Instead of concentrating on last night's vital signs and oxygen saturation values, I sat down on the bed beside Clare, ready to relate to her. Not to lecture, but to start building a relationship that would help me solve the puzzle as to why Clare was the way she was, seemingly wanting to die.

— Dr. Ursus

PreviousNext
Back to top

In this issue

Canadian Medical Association Journal: 171 (8)
CMAJ
Vol. 171, Issue 8
12 Oct 2004
  • Table of Contents
  • Index by author
  • Canadian Adverse Reaction Newsletter (991-1102)

Article tools

Print
Download PDF
Article Alerts
To sign up for email alerts or to access your current email alerts, enter your email address below:
Email Article

Thank you for your interest in spreading the word on CMAJ.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Query
(Your Name) has sent you a message from CMAJ
(Your Name) thought you would like to see the CMAJ web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Query
CMAJ Oct 2004, 171 (8) 1006; DOI: 10.1503/cmaj.1040547

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
‍ Request Permissions
Share
Query
CMAJ Oct 2004, 171 (8) 1006; DOI: 10.1503/cmaj.1040547
Digg logo Reddit logo Twitter logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
  • Responses
  • Metrics
  • PDF

Related Articles

  • No related articles found.
  • Google Scholar

Cited By...

  • No citing articles found.
  • Google Scholar

More in this TOC Section

  • Query
  • Query
  • Query
Show more Query

Similar Articles

Collections

  • Topics
    • Medical careers

Content

  • Current issue
  • Past issues
  • Collections
  • Sections
  • Blog
  • Podcasts
  • Alerts
  • RSS
  • Early releases

Information for

  • Advertisers
  • Authors
  • Reviewers
  • CMA Members
  • Media
  • Reprint requests
  • Subscribers

About

  • General Information
  • Journal staff
  • Editorial Board
  • Governance Council
  • Journal Oversight
  • Careers
  • Contact
  • Copyright and Permissions

Copyright 2021, Joule Inc. or its licensors. All rights reserved. ISSN 1488-2329 (e) 0820-3946 (p)

All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association or its subsidiaries.

To receive any of the resources on this site in an accessible format, please contact us at cmajgroup@cmaj.ca.

Powered by HighWire