Pamela A. Pappas, MD
JAMA. 1986;255(20):2813. doi:10.1001/jama.1986.03370200115041.
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The large brick house sat prominently, an island centered in a wide expanse of green grass. Everyone marveled at the lawn, which was meticulously mowed, raked, watered, and weeded. The man of the house had installed an intricate irrigation system the year before, and now his lawn was safe from drought.

Four gabled windows graced the upper floor, and brisk white paint shone on their trim. Part of the house sported olive vinyl siding. This the family chose for its neat looks and low-maintenance upkeep. It was, when you looked from the street, a pretty house. Even in its largeness, though, it was dwarfed by its neighbors. They were French Provincial mansions with wrought-iron fences. Ladies in tennis garb flocked to the mansions at lunchtime. They laughed warmly among themselves; outsiders could watch but not join. The brick house seemed quiet, even lonely, by comparison. It was a struggling distant


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