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October Days

Peter R. McCombs, MD
JAMA. 1991;265(14):1820. doi:10.1001/jama.1991.03460140048011.
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The telephone call from my father caught me unprepared, since he never asked me for help. Most surprisingly, his call was an appeal to my professional judgment.

He recited a medical history that I recognized instantly. In exquisite detail, he described a pain in his left instep and calf that, 10 days previously, had stopped him as he walked. At first his limit was a quarter mile, later the 100 yards to the mailbox, and eventually the next room. After a week he noticed the same incapacitating pain in his right leg. Now his toes hurt and both feet were cool, blue, and obviously ischemic.

The thought of it chilled me. He had never before had symptoms of circulatory impairment, but the rapid progression of his symptoms predicted disability, arterial surgery, and, possibly, amputation of both legs.

Though he recounted these unnerving events dispassionately, I soon realized how worried he


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