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Rewrite of New York Times' Scientific Article "The Instincts to Trust Are Usually the Patient's" by Sandeep Jauhar, M.D.

Rewrite of New York Times' Scientific Article "The Instincts to Trust Are Usually the Patient's" by Sandeep Jauhar, M.D.

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Published by Karyn N. Lewis
Science Article Rewrite assignment in association with 0502-460-70 Science Writing - Rochester Institute of Technology Winter 2008
Science Article Rewrite assignment in association with 0502-460-70 Science Writing - Rochester Institute of Technology Winter 2008

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Published by: Karyn N. Lewis on Jan 22, 2009
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Karyn N. Lewis0502-460-70 Science WritingAssignment #2Winter 20082Rewrite of 
 New York Times
’ Scientific Article“The Instincts to Trust Are Usually the Patient’s,” by Sandeep Jauhar, M.D.Every year, millions of Americans fall prey to real-life medical mysteries—ailments thatgo undiagnosed or misdiagnosed for years—because their instincts are questioned. Their livesare thrown into turmoil and sanity called into question as medical professionals struggle tounderstand their baffling conditions. Remarkably, some patients know they are about to die evenwhen no one else does. This is the situation Long Island cardiologist Sandeep Jauhar, M.D.recently faced when taking care of an elderly man with congestive heart failure—a life-threatening condition in which the heart can barely pump enough blood to the rest of the body.The case of Jauhar’s patient seemed relatively mild up until his health took a sudden andrapid turn for the worse.
His massively swollen legs dripped enough fluid to soak the bed sheetsand puddle on the tiled floor, his blood pressure dropped dangerously low, and he becamedelirious. After just a few days’ stay, the man was certain he wouldn’t make it out of the hospitalalive. “I am going to die here,” he whispered, as if all of a sudden attaining the alleged predictivepowers of Nostradamus and realizing a crystal-clear picture of the future.Roughly 550,000 people are diagnosed with heart failure each year according to theCenters for Disease Control and Prevention (CDC), making it the leading cause of hospitalization in people older than 65. Congestive heart failure usually develops gradually,however, with an exceptionally slow onset and progression of symptoms over time. In somecases, the heart becomes too weak or stiff to fill and pump efficiently, impairing the ventricles’capacity to relax and fill. The kidneys respond by triggering the body to retain water and sodium,causing a build-up up in the arms, legs, ankles, feet, lungs, or other organs.
The treatments used to help improve the function and ease the workload off the heart of Jauhar’s patient—lifestyle changes, medicines, transcatheter interventions—just didn’t work.Strangely, nothing seemed to work. Symptoms emerged, tests were analyzed, and specialistswere consulted, but several days passed and the struggle continued.Jauhar was perplexed by his patient’s precipitous downturn and the lack of treatmentsuccess. “It was as if I was living in a nerve-wrenching episode of 
 Mystery Diagnosis
andexperiencing first-hand a step-by-step medical odyssey—excluding the highly stylizedrecreations and CGI anatomy sequences,” he observed. Instead of the typical
 Mystery Diagnosis
 plot of solving the puzzle due to the patient's relentless pursuit of an accurate and final diagnosis,however, the man died. This “real-life” version of the popular TV drama did not have a happyending.In his work as a critical care cardiologist, Jauhar is often asked to predict how longsomeone is going to live. Such projections can be useful to patients and their families, but thedoctor rarely, if ever, ventures a guess. “My guesses are so often inaccurate. It simply amazes mewhen patients have a sort of sixth sense about their own deaths,” he remarked. “It’s almost likethey feel the impending doom of a catastrophic event about to occur, akin to the Apocalypse andArmageddon obsession, Doomsday hysteria, or Millennium madness. Somehow they are justcertain the end is near, whether the Big One hits, UV rays fry the Earth, a nuclear winter freezesover, the Earth opens up to swallow us all, or heart failure seizes their final breath.”When discussing instinct in medicine, people typically refer to doctors graspingdiagnoses in ways that seem to defy analytical explanation in knowing, almost intuitively, whichdata to focus on and which to ignore. We assume their decision-making is based on experienceand deductive reasoning or evidence, yet it seems almost mystical. Jauhar explains, “I will neverforget the time in medical school when we presented a baffling case to the chief of medicine,who made a diagnosis of primary pulmonary hypertension within seconds on the basis of the

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