This case is complex.1 For undergraduate learning “complex and elaborate examples are likely to be suboptimal as effective teaching tools,”2 but is the same true for postgraduate learners? What do we learn in the midst of complexity? Initially we are caught up in the urgency of lifesaving measures as the desperately ill patient fails to respond to primary interventions, and then when she does respond to steroids we have to ask ourselves why. The authors reflect the frustration of clinicians and patient alike as potential diagnostic clues are followed down blind alleys.

There is rich learning here about our clinical reasoning processes. Now that we know the denouement …