During one of my recent clinics I saw a patient, “Joe,” in follow-up several months after a lung transplant. I had been involved in his care for the better part of 15 years, watching the inevitable progression of the underlying disease as he made the gradual transition from employed, active individual to oxygen-dependent, severely disabled, respiratory cripple. Several times over the years I had raised the question of transplant only to be told that it “wasn’t my time yet.” Then, after a particularly severe life-threatening exacerbation, Joe agreed to enter the transplant process. The surgery was very complicated and probably contributed to the grey hair count of the surgeons involved, but here we were, several months later, joking about how I found it difficult to recognize him without the nasal prongs! Joe commented that, even several months off oxygen, he would reach up to remove the non-existent prongs prior to wiping his nose!
One of the comments made by Joe was how everyone involved in his post-transplant care invariably included a hug in their greeting. Indeed, I had done so as well, and, in reflection, recognized that my reaction was one of joy. Why was I joyful? I think because, this time, we had beaten death, if only temporarily!
Those of us involved in the practice of medicine have an interesting relationship with death. Most often it is seen as an adversary and we strive to snatch our patients from its jaws, with varying degrees of success. Our successes, especially when they occur against the odds, we remember and bring them to mind when we fail. Joe will serve this purpose for me. In other circumstances, death is an ally, relieving suffering when we no longer can. The death of my 89-year-old mother from pneumonia complicating dementia was such a death, bringing relief in addition to the sadness. William Osler, as he so often did, expressed it well: pneumonia is often the “old person’s friend.”
So I bid farewell to Joe, for I really have no excuse to see him again, leaving his care to my very capable colleagues at BC Transplant. However, the memory of the visit and our departing hug will buoy me in the future when such a lift is needed!
Above is the information needed to cite this article in your paper or presentation. The International Committee
of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally
accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
About the ICMJE and citation styles
The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.
An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.
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For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org