I sat outside my patient’s ICU room, my eyes glancing from his chart to him and his wife.  The picture was grim.  My patient, Tom, was a 56-year-old man, severely ill from decompensated cirrhosis, was admitted for the third time in a month with hypothermia from sepsis.  Despite antibiotic therapy, he was not improving.  Now his kidneys were failing from hepato-renal syndrome with a combined liver-kidney transplant, the only hope ...

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“Our current guidelines from the hospital and our national societies are if the patient is not at risk for a major cardiac event in the next week we should defer surgery.”  The words hang in the now virtual air of the hospital’s weekly multidisciplinary endocarditis conference.  The young woman whose case we are discussing has bacteremia with two different organisms and a very large infectious mass on one of her ...

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