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A memorable patient: A stitch in time

BMJ 1997; 315 doi: (Published 15 November 1997) Cite this as: BMJ 1997;315:i
  1. Wayne X Shandera, assistant professor of internal medicine
  1. Houston, Texas

    We met James in our former hospital. He was completely British in manner, speech, and affect. Unfortunately, his British genes included a propensity towards severe angina and occluded coronaries would hasten his demise. He was thin but not all his weight loss was coronary cachexia. He was also HIV positive. He claimed that he had acquired HIV through a transfusion after a car accident, an accident in which his wife was killed.

    James accepted his HIV state, but not as readily the coronary disease. He knew his disease processes well, and was often better informed than we were. When angioplasties were performed to the locally allowed limit, he found a doctor 200 miles away who did laser angioplasty. He liked me because I had clerked as a student in cardiology at Hammersmith Hospital. That established my …

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