In May 2004, Drs Pantilat and Steimle1 introduced
Mr R, a 74-year-old man with more than a decade’s history of idiopathic
heart failure with New York Heart Association classification of II to III
and type 2 diabetes mellitus. Through interviews of Mr R, his wife, and his
cardiologist, Dr J, the authors explored the variety of medications and interventions
that were brought to bear to control Mr R’s distressing symptoms. This
included attending a shared medial appointment with other heart failure patients
and a referral to hospice, from which Mr R ultimately “graduated,”
after his medication adherence and self-monitoring regimens improved dramatically,
greatly enhancing his quality of life. Two years after the initial interviews,
Mr R is enjoying a quiet life. He continues to take his medicines, has not
reenrolled in hospice, has kept to his do not attempt resuscitation order,
and follows up regularly with Dr J. Dr J was reinterviewed by a Perspectives
editor on July 1, 2004, shortly after a regularly scheduled visit with Mr
R.