Principles and Practice of Hospital Medicine 2Nd Edition Edition Sylvia C Mckean All Chapter

Principles and Practice of Hospital
Medicine 2nd Edition Edition Sylvia C.

Mckean
Visit to download the full and correct content document:
https://ebookmass.com/product/principles-and-practice-of-hospital-medicine-2nd-editi
on-edition-sylvia-c-mckean/
Principles and Practice
of Hospital Medicine
NOTICE
Medicine is an ever-changing science. As new research and clinical experience broaden our
knowledge, changes in treatment and drug therapy are required. The authors and the publisher
o this work have checked with sources believed to be reliable in their e orts to provide in orma-
tion that is complete and generally in accord with the standards accepted at the time o publica-
tion. However, in view o the possibility o human error or changes in medical sciences, neither
the authors nor the publisher nor any other party who has been involved in the preparation or
publication o this work warrants that the in ormation contained herein is in every respect accu-
rate or complete, and they disclaim all responsibility or any errors or omissions or or the results
obtained rom use o the in ormation contained in this work. Readers are encouraged to con irm
the in ormation contained herein with other sources. For example, and in particular, readers are
advised to check the product in ormation sheet included in the package o each drug they plan to
administer to be certain that the in ormation contained in this work is accurate and that changes
have not been made in the recommended dose or in the contraindications or administration. This
recommendation is o particular importance in connection with new or in requently used drugs.
Principles and Practice
of Hospital Medicine
Second Edition
Editors
Sylvia C. McKean, MD, SFHM, FACP
Deputy Editor or Editorial Projects, UpToDate
Formerly:
Leave o absence:
Associate Pro essor o Medicine,
Harvard Medical School
Hospitalist
Brigham and Women’s Hospital
Boston, Massachusetts
John J. Ross, MD, CM, FIDSA

Assistant Pro essor o Medicine
Hospitalist Service
Daniel D. Dressler, MD, MSc, SFHM, FACP

Pro essor o Medicine
Director, Internal Medicine Teaching Services
Emory University Hospital
Associate Program Director
J. Willis Hurst Internal Medicine Residency Program
Co-Director, Semmelweis Society
Emory University School o Medicine
Atlanta, Georgia
Danielle B. Scheurer, MD, MSCR, SFHM

Chie Quality O icer and Hospitalist
Associate Pro essor o Medicine
Medical University o South Carolina
Charleston, South Carolina
New York Chicago San Francisco Athens London Madrid Mexico City
Milan New Delhi Singapore Sydney Toronto
Principles and Practice o Hospital Medicine, Second Edition
Copyright © 2017 by McGraw-Hill Education. All rights reserved. Printed in the United States
o America. Except as permitted under the United States Copyright Act o 1976, no part o this
publication may be reproduced or distributed in any orm or by any means, or stored in a data
base or retrieval system, without the prior written permission o the publisher. Previous edition
copyright © 2012 by The McGraw-Hill Companies, Inc.
1 2 3 4 5 6 7 8 9 DOW 21 20 19 18 17 16
ISBN 978-0-07-184313-3
MHID 0-07-184313-2
This book was set in Myriad pro by Cenveo Publisher Services.

The editors were Amanda Fielding and Kim J. Davis.
The production supervisor was Richard Ruzycka.
Project management was provided by Vastavikta Sharma, Cenveo Publisher Services.
The designer was Alan Barnett; the cover designer was Dreamit, Inc.
RR Donnelley was printer and binder.
Library o Congress Cataloging-in-Publication Data
Names: McKean, Sylvia C., editor. | Ross, John J. (John James), 1966-editor.
| Dressler, Daniel D., editor. | Scheurer, Danielle, editor.
Title: Principles and practice o hospital medicine / editors, Sylvia C.
McKean, John J. Ross, Daniel D. Dressler, Danielle B. Scheurer.
Description: Second edition. | New York : McGraw-Hill Education Medical, [2017]
| Includes bibliographical re erences and index.
Identi iers: LCCN 2016022668 (print) | LCCN 2016023825 (ebook)
| ISBN 9780071843133 (hardcover : alk. paper) | ISBN 0071843132 (hardcover :
alk. paper) | ISBN 9780071843140 (ebook)
Subjects: | MESH: Hospital Medicine—methods | Hospitalization | Inpatients |
Hospitalists Classi ication: LCC RA972 (print) | LCC RA972 (ebook) | NLM WX 21 |
DDC 362.11—dc23
LC record available at https://lccn.loc.gov/2016022668
McGraw-Hill Education books are available at special quantity discounts to use as premiums
and sales promotions, or or use in corporate training programs. To contact a representative,
please visit the Contact Us pages at www.mhpro essional.com.
CONTENTS
Editors ...............................................................................................................xi 18 Standardization and Reliability . . . . . . . . . . . . . . . . . . . . . . . 113
Contributors ................................................................................................. xiii 19 Tools to Identify Problems and Reduce Risks . . . . . . . . . . 118
Section Reviewers ..................................................................................xxxix 20 Preventing and Managing Adverse Patient
C
Foreword ......................................................................................................... xli Events: Patient Safety and the Hospitalist . . . . . . . . . . . . . 124
O
N
Preface ...........................................................................................................xliii 21 Principles and Models of Quality Improvement:
T
Plan-Do-Study-Act . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
E
Acknowledgments ..................................................................................... xlv
N
22 The Role of Information Technology in
T
S
Hospital Quality and Safety . . . . . . . . . . . . . . . . . . . . . . . . . . 134
PART I: THE SPECIALTY OF HOSPITAL

MEDICINE AND SYSTEMS OF CARE SECTION 5 Practice Management
23 Building, Growing and Managing a

The Value and Values of Hospitalist Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
SECTION 1 Hospital Medicine
24 Best Practices in Physician Recruitment
1 The Face of Health Care: Emerging Issues and Retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150
for Hospitalists . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 25 Teamwork in Leadership and Practice-Based
2 Value-Based Health Care for Hospitalists . . . . . . . . . . . . . . . 10 Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157
3 Racial/Ethnic Disparities in Hospital Care . . . . . . . . . . . . . . . 18 26 Negotiation and Conflict Resolution . . . . . . . . . . . . . . . . . . 164
4 Comanagement of Orthopedic Patients ............... 23
5 Professionalism in Hospital Medicine . . . . . . . . . . . . . . . . . . 29 Billing, Coding, and Clinical
SECTION 6 Documentation
6 Principles of Leadership . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
27 Professional Coding and Billing Guidelines
Critical Decision Making at the for Clinical Documentation . . . . . . . . . . . . . . . . . . . . . . . . . . 173
SECTION 2 Point of Care 28 Consultation, Comanagement, Time-Based,
and Palliative Care Billing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
7 Principles of Evidence-Based Medicine and
Quality of Evidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 29 Billing for Procedures and Use of Modifiers
in Inpatient Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
8 Diagnostic Reasoning and Decision Making . . . . . . . . . . . . 45
30 Billing in the Teaching Setting and Billing
9 Principles of Evidence-Based Prescribing . . . . . . . . . . . . . . . 56 with Advanced Practice Providers . . . . . . . . . . . . . . . . . . . . 198
10 Summary Literature: Practice Guidelines 31 Hospital-Driven Documentation ..................... 204
and Systematic Reviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
32 Taming the ICD-10 Monster ......................... 210
11 Practical Considerations of Incorporating
Evidence into Clinical Practice . . . . . . . . . . . . . . . . . . . . . . . . 70
Principles of Medical Ethics and
SECTION 7 Medical-Legal Concepts
SECTION 3 Transitions of Care
33 Common Indications for Ethics Consultation .......... 217
12 Care Transitions into the Hospital: Health Care
Centers, Emergency Department, Outside 34 Medical-Legal Concepts: Advance Directives
Hospital Transfers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 and Surrogate Decision Making . . . . . . . . . . . . . . . . . . . . . . 224
13 Care Transitions within the Hospital: The Hand-Off ..... 84 35 Medical Malpractice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
14 Care Transitions at Hospital Discharge . . . . . . . . . . . . . . . . . 90
SECTION 8 Professional Development
Patient Safety and Quality
SECTION 4 36 Principles of Adult Learning and Continuing
Improvement
Medical Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
15 Principles of Patient Safety: Intentional 37 Cultural Competence ............................... 246
Design and Culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
38 Career Design and Development in Academic
16 Patient-Centered Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 and Community Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253
17 Harnessing Data to Make Quality Improvement 39 Mentorship of Peers and Trainees . . . . . . . . . . . . . . . . . . . . 257
Decisions: Measurement and Measures . . . . . . . . . . . . . . . 110
40 Research in the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264
v
41 For Individuals and Practices: Career 65 Management of Common Perioperative
Sustainability and Avoiding Burnout ................. 273 Complications in Orthopedic Surgery. . . . . . . . . . . . . . . . . 437
66 Transplant Surgery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 447
67 Urology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 453
PART II: MEDICAL CONSULTATION
SECTION 1 Surgery PART III: REHABILITATION AND SKILLED

42 Physiologic Response to Surgery . . . . . . . . . . . . . . . . . . . . . 283 NURSING CARE
68 Postacute Care Rehabilitation Options . . . . . . . . . . . . . . . . 463
43 Perioperative Hemostasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286
C
69 Physical Therapy and Rehabilitation . . . . . . . . . . . . . . . . . . 469
O
44 Postoperative Complications ........................ 292
N
70 The Role of Speech/Language Pathologists in
45 Surgical Tubes and Drains . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
T
Dysphagia Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . 476
E
N
46 Surgical Critical Care ................................ 300
71 Incontinence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 482
T
S
72 Pressure Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491
SECTION 2 Anesthesia
73 Patient Safety and Quality Improvement
47 Anesthesia: Choices and Complications . . . . . . . . . . . . . . . 309 in Postacute Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497
48 Perioperative Pain Management ..................... 313 74 Hospice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505
Perioperative Risk Assessment and

SECTION 3 Management PART IV: APPROACH TO THE PATIENT AT
THE BEDSIDE
49 Role of the Medical Consultant . . . . . . . . . . . . . . . . . . . . . . . 325
75 Acute Abdominal Pain .............................. 513
50 Preoperative Cardiac Risk Assessment and
Perioperative Management . . . . . . . . . . . . . . . . . . . . . . . . . . 329 76 Acute Back Pain .................................... 522
51 Perioperative Pulmonary Risk Assessment and 77 Evaluation of Anemia ............................... 533

Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336 78 Bleeding and Coagulopathy . . . . . . . . . . . . . . . . . . . . . . . . . 539
52 Perioperative Risk Assessment and Management 79 Chest Pain ......................................... 547
of the Diabetic Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
80 Constipation ....................................... 556
53 Preoperative Evaluation of Liver Disease . . . . . . . . . . . . . . 348 81 Delirium ........................................... 563
54 Preoperative Assessment of Patients with 82 Diarrhea ........................................... 572
Hematologic Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352
83 Disorders of the Eye . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579
Prevention, Assessment, and 84 Dizziness and Vertigo ............................... 587

SECTION 4 Management of Common 85 Dyspnea ........................................... 595
Complications in Noncardiac Surgery
86 Edema . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 604
55 Antimicrobial Prophylaxis in Surgery ................. 361 87 Falls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 613
56 Venous Thromboembolism (VTE) Prophylaxis for 88 Fever and Rash ..................................... 620
Nonorthopedic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368
89 Headache . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 625
57 Postoperative Blood Transfusion . . . . . . . . . . . . . . . . . . . . . 373
90 Hemoptysis ........................................ 636
58 Nutrition and Metabolic Support . . . . . . . . . . . . . . . . . . . . . 377
91 Hypertensive Urgencies and Emergencies ............ 641
59 Cardiac Complications after Noncardiac Surgery. . . . . . . 385
92 Hyperthermia and Fever. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 647
60 Management of Postoperative Pulmonary
93 Hypotension ....................................... 657
Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
94 Hypothermia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 665
61 Assessment and Management of Patients with
Renal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397 95 Hypoxia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 669
62 Postoperative Neurologic and Psychiatric 96 Sleep Disturbance in the Hospitalized Patient . . . . . . . . . 676
Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412 97 Nausea and Vomiting ............................... 689
98 Numbness: A Localization-Based Approach ........... 694
Specialty Consultation—What the
SECTION 5 99 Pain ............................................... 701
Consulting Hospitalist Needs to Know
100 Suspected Intoxication and Overdose ................ 709
63 Surgical Management of Obesity . . . . . . . . . . . . . . . . . . . . . 421 101 Syncope ........................................... 714
64 Common Postoperative Complications 102 Tachycardia ........................................ 729
in Neurosurgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430
103 The Geriatric History and Physical Examination . . . . . . . . 740
vi
104 The Neurologic Examination . . . . . . . . . . . . . . . . . . . . . . . . . 747 136 Pacemakers, Defibrillators, and Cardiac
105 Using Prognosis to Guide Treatment ................. 754 Resynchronization Devices in Hospital Medicine . . . . . 1025
106 Weakness: How to Localize the Problem . . . . . . . . . . . . . . 763

SECTION 2 Critical Care
137 Inpatient Cardiac Arrest and Cardiopulmonary

PART V: DIAGNOSTIC TESTING AND Resuscitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1037
PROCEDURES 138 Acute Respiratory Failure . . . . . . . . . . . . . . . . . . . . . . . . . . 1047
139 Pain, Agitation and Delirium in the Critical
SECTION 1 Interpretation of Common Tests Care Setting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1055
C
140 Mechanical Ventilation . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1065
O
107 Basic Diagnostic Tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 771
N
108 The Resting Electrocardiogram . . . . . . . . . . . . . . . . . . . . . . . 776 141 Sepsis and Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1074
T
E
142 Acute Respiratory Distress Syndrome . . . . . . . . . . . . . . . 1085
N
109 Elevated Liver Biochemical and Function Tests . . . . . . . . 796
T
143 Prevention in the Intensive Care Unit Setting . . . . . . . . 1094
S
110 Pulmonary Function Testing . . . . . . . . . . . . . . . . . . . . . . . . . 805
111 Urinalysis and Urine Electrolytes ..................... 814
SECTION 3 Dermatology
SECTION 2 Radiology 144 Flushing and Urticaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1105

145 Adverse Cutaneous Drug Reactions ................ 1114
112 Introduction to Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . 825
146 Psoriasis and Other Papulosquamous Disorders ..... 1125
113 Patient Safety Issues in Radiology . . . . . . . . . . . . . . . . . . . . 831
147 Diabetic Foot Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . 1131
114 Basic Chest Radiography (CXR) . . . . . . . . . . . . . . . . . . . . . . . 838
148 Venous Ulcers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1138
115 Advanced Cardiothoracic Imaging ................... 853 149 Dermatologic Findings in Systemic Disease ......... 1145
116 Basic Abdominal Imaging ........................... 864
117 Advanced Abdominal Imaging . . . . . . . . . . . . . . . . . . . . . . . 870 SECTION 4 Endocrinology
118 Neurologic Imaging . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 876
150 Glycemic Emergencies ............................ 1171
119 Interventional Radiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . 884 151 Inpatient Management of Diabetes and
Hyperglycemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1178
SECTION 3 Procedures 152 Thyroid Emergencies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1184
120 Vascular Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 891 153 Adrenal Insufficiency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1191
121 Intubation and Airway Support ...................... 895 154 Pituitary Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1198
122 Arterial Blood Gas and Placement of A-line . . . . . . . . . . . . 901

SECTION 5 Gastroenterology
123 Feeding Tube Placement . . . . . . . . . . . . . . . . . . . . . . . . . . . . 905
124 Thoracentesis ...................................... 909 155 GERD and Esophagitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1209
125 Lumbar Puncture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 914 156 Upper Gastrointestinal Bleeding ................... 1217
157 Acute Pancreatitis ................................ 1227
126 Paracentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 918
158 Jaundice, Obstruction, and Acute Cholangitis ....... 1232
127 Arthrocentesis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 921
159 Acute Liver Disease ............................... 1239
160 Cirrhosis and Its Complications .................... 1253
PART VI: CLINICAL CONDITIONS IN THE 161 Acute Lower Gastrointestinal Bleeding ............. 1269
INPATIENT SETTING 162 Small Bowel Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1279
163 Large Bowel Disorders ............................ 1290
SECTION 1 Cardiovascular Medicine 164 Inflammatory Bowel Disease . . . . . . . . . . . . . . . . . . . . . . . 1308
128 Acute Coronary Syndromes . . . . . . . . . . . . . . . . . . . . . . . . . . 929
129 Heart Failure ....................................... 941 SECTION 6 Geriatrics
130 Myocarditis, Pericardial Disease, and 165 Principles of Geriatric Care . . . . . . . . . . . . . . . . . . . . . . . . . 1323
Cardiac Tamponade . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 954
166 Agitation in Older Adults . . . . . . . . . . . . . . . . . . . . . . . . . . 1330
131 Valvular Heart Disease .............................. 965
167 Elder Mistreatment ............................... 1336
132 Supraventricular Tachyarrhythmias . . . . . . . . . . . . . . . . . . . 980
168 Malnutrition and Weight Loss in Hospitalized
133 Bradycardia ........................................ 996 Older Adults. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1346
134 Ventricular Arrhythmias . . . . . . . . . . . . . . . . . . . . . . . . . . . 1003
135 Cardioversion .................................... 1015
vii
SECTION 7 Hematology SECTION 10 Neurology
169 Abnormalities in Red Blood Cells . . . . . . . . . . . . . . . . . . . 1353 207 Coma and Disorders of Consciousness . . . . . . . . . . . . . . 1667
170 Disorders of the White Cell ........................ 1373 208 Intracranial Hemorrhage and Related Conditions ... 1674
171 Quantitative Abnormalities of Platelets: 209 Transient Ischemic Attack and Stroke . . . . . . . . . . . . . . . 1681
Thrombocytopenia and Thrombocytosis . . . . . . . . . . . . 1381 210 Parkinson’s Disease and Related Disorders . . . . . . . . . . 1690
172 Approach to Patients with Bleeding Disorders . . . . . . . 1392 211 Seizures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1700
173 Hypercoagulable States . . . . . . . . . . . . . . . . . . . . . . . . . . . 1399 212 Multiple Sclerosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1712
174 Hematologic Malignancies ........................ 1405 213 Peripheral Neuropathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1719
C
O
SECTION 8 Oncology
N
SECTION 11 Palliative Care
T
E
175 Overview of Cancer and Treatment . . . . . . . . . . . . . . . . . 1431
N
214 Principles of Palliative Care ........................ 1727
T
176 Oncologic Emergencies ........................... 1436
S
215 Communication Skills for End-of-Life Care .......... 1733
177 Approach to the Patient with 216 Domains of Care: Physical Aspects of Care .......... 1740
Suspected Malignancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1443
217 Care of the Dying Patient ......................... 1756
178 Breast, Ovary, and Cervical Cancer. . . . . . . . . . . . . . . . . . 1454
179 Men’s Cancers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1458 SECTION 12 Pregnancy
180 Cancers of the Kidney, Renal Pelvis, and Ureter . . . . . . 1463
181 Oncologic Issues of the Aerodigestive Tract . . . . . . . . . 1468 218 Overview of Physiologic Changes of Pregnancy ..... 1767
182 Gastrointestinal Cancers . . . . . . . . . . . . . . . . . . . . . . . . . . . 1474 219 Medication Management ......................... 1771
183 Immune-Related Adverse Events (irAEs) 220 Critical Care of the Pregnant Patient . . . . . . . . . . . . . . . . 1781
in Cancer Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1477 221 Common Medical Problems in Pregnancy. . . . . . . . . . . 1786
222 Postpartum Consultation for Common Complaints .. 1807
SECTION 9 Infectious Disease
SECTION 13 Psychiatry
184 Fundamentals of Antibiotics . . . . . . . . . . . . . . . . . . . . . . . 1489
185 Antibiotic Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1498 223 Mood and Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . 1813
186 Community-Acquired Pneumonia . . . . . . . . . . . . . . . . . . 1503 224 Combat Stress and Related Disorders . . . . . . . . . . . . . . . 1827
187 Health Care and Hospital-Acquired 225 Assessment and Management of Psychosis ......... 1833
Pneumonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1514 226 Eating Disorders ................................. 1841
188 Intravascular Catheter-Related Infections: 227 The Suicidal Patient . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1848
Management and Prevention . . . . . . . . . . . . . . . . . . . . . . 1519 228 The Difficult Patient .............................. 1853
189 Infective Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1528 229 Approach to the Patient with Multiple Unexplained
190 Clostridium difficile–Associated Somatic Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1861
Disease (CDAD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1537
191 Peritonitis and Intra-Abdominal Abscess . . . . . . . . . . . . 1542 SECTION 14 Pulmonary and Allergy Immunology
192 Meningitis and Encephalitis. . . . . . . . . . . . . . . . . . . . . . . . 1549
230 Allergy and Anaphylaxis . . . . . . . . . . . . . . . . . . . . . . . . . . . 1871
193 Osteomyelitis and Septic Arthritis . . . . . . . . . . . . . . . . . . 1557
231 Asthma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1876
194 Prosthetic Joint Infections . . . . . . . . . . . . . . . . . . . . . . . . . 1564
232 Chronic Obstructive Pulmonary Disease ............ 1887
195 Sexually Transmitted Infections . . . . . . . . . . . . . . . . . . . . 1574
233 Interstitial Lung Diseases/Diffuse Parenchymal
196 Skin and Soft Tissue Infections . . . . . . . . . . . . . . . . . . . . . 1582 Lung Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1898
197 Urinary Tract Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1589 234 Cystic Fibrosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1905
198 Viral Infections ................................... 1596 235 Sleep Apnea and Obesity Hypoventilation
199 Tickborne Infections .............................. 1604 Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1915
200 Tuberculosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1612 236 Pleural Diseases .................................. 1923
201 Candida and Aspergillus ........................... 1618 237 Pulmonary Hypertension ......................... 1932
202 Histoplasmosis, Blastomycosis, Coccidioidomycosis,
and Other Dimorphic Fungi. . . . . . . . . . . . . . . . . . . . . . . . 1625 SECTION 15 Renal
203 The Hospitalized Patient with HIV . . . . . . . . . . . . . . . . . . 1634
238 Acid-Base Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1943
204 Infections of the Immunocompromised Host ....... 1646
239 Acute Kidney Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1952
205 Fever in the Returning Traveler .................... 1653
240 Calcium Disorders ................................ 1961
206 Undiagnosed Fever in Hospitalized Patients ........ 1659
viii
241 Potassium and Magnesium Disorders . . . . . . . . . . . . . . . 1972 SECTION18 Vascular Medicine
242 Disorders of Sodium and Water Balance ............ 1982
252 Venous Thromboembolism Prophylaxis for
243 Kidney Stones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1993
Hospitalized Medical Patients . . . . . . . . . . . . . . . . . . . . . . 2077
244 Secondary Hypertension .......................... 2000
253 Diagnosis and Treatment of Venous
245 Chronic Kidney Disease and Dialysis . . . . . . . . . . . . . . . . 2008
Thromboembolism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2081
254 Anticoagulant Therapy ........................... 2093
SECTION 16 Rheumatology
255 Diseases of the Aorta . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2107
246 Rheumatologic Emergencies. . . . . . . . . . . . . . . . . . . . . . . 2017 256 Acute and Chronic Lower Limb Ischemia . . . . . . . . . . . . 2115
247 Gout, Pseudogout, and Osteoarthritis 2023
C
.............. 257 Vasculitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2121
O
248 Systemic Lupus Erythematosus .................... 2033
N
T
249 Rheumatoid Arthritis and Other Inflammatory Online Chapters
E
N
Arthritides . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2046
T
e1 Global Health and Hospital Medicine
S
SECTION 17 Toxicology and Addiction e2 The Economics of Hospital Care
e3 Principles of Medical Ethics
250 Drug Overdose and Withdrawal . . . . . . . . . . . . . . . . . . . . 2057 e4 The Core Competencies in Hospital Medicine
251 Addiction of Prescription and e5 Bioterrorism
Nonprescription Drugs . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2070
Index ................................................. 2129
ix
EDITORS
Sylvia C. McKean, MD, SFHM, FACP
Daniel D. Dressler, MD, MSc, SFHM, FACP
xi
CONTRIBUTORS
Numbers in brackets refer to the chapters written or co-written by the contributor.
Samer Abdel-Aziz, MD Daniel A. Anaya, MD

Pain Medicine Fellowship Associate Pro essor o Surgery
Medical College o Wisconsin Division o Surgical Oncology
C
Milwaukee, Wisconsin [99] Michael E. DeBakey Department o Surgery
O
N
Research Scientist
Meredith C. B. Adams, MD, MS
T
The Houston Center or Quality o Care &Utilization Studies
R
Assistant Pro essor o Anesthesiology and Pain Medicine
I
Director
B
Director
U
Liver Tumor Program, Michael E. DeBakey VAMC
T
Pain Medicine Fellowship Baylor College o Medicine
O
Medical College o Wisconsin Houston, Texas [55]
R
S
Milwaukee, Wisconsin [99]
Douglas S. Ander, MD
Aaron W. Aday, MD Pro essor o Emergency Medicine
Division o Cardiovascular Medicine Emory University School o Medicine
Department o Medicine Atlanta, Georgia [121]
Boston, Massachusetts [255] Eddy Ang, MD
Instructor in Medicine
Bhavin Adhyaru, MD Harvard Medical School
Emory University School o Medicine Division o Gerontology
Atlanta, Georgia [10] Beth Israel Deaconess Medical Center
Kush Agrawal, MD Boston, Massachusetts
Advanced Endovascular and Structural Interventional Fellow Department o Medicine, Hebrew SeniorLi e
VIVA Physicians Roslindale, Massachusetts [68]
El Camino Hospital Kelly Armstrong, PhD
Mountain View, Cali ornia [101] Senior Clinical Ethicist
Mikhail Akbashev, MD Memorial Health System
Assistant Pro essor o Medicine Adjunct Assistant Pro essor
Emory University School o Medicine Department o Medical Humanities
Atlanta, Georgia [11] SIU School o Medicine
Spring eld, Illinois [34]
A saneh Alavi, MD, MSc, FRCPC
Department o Medicine (Dermatology) Vineet M. Arora, MD, MAPP
University o Toronto Associate Pro essor and Assistant Dean or Scholarship and
Toronto, Ontario, Canada [148] Discovery
Director
G. Caleb Alexander, MD, MS GME Clinical Learning Environment Innovation
Associate Pro essor o Epidemiology and Medicine Pritzker School o Medicine
Bloomberg School o Public Health University o Chicago
Johns Hopkins University Chicago, Illinois [13]
Baltimore, Maryland [e3]
Cameron Ashbaugh, MD
Anne E. Allan, MD Assistant Pro essor
Miraca Li e Sciences Harvard Medical School
Irving, Texas [146] Division o In ectious Diseases
Ashwin Ananthakrishnan, MD Boston, Massachusetts [196]
Attending Physician
Massachusetts General Hospital Saima Aslam, MD, MS
Instructor in Medicine, Harvard Medical School Assistant Pro essor
Boston, Massachusetts [183] Director
Solid Organ Transplant In ectious Diseases service
Division o In ectious Diseases
University o Cali ornia, San Diego
San Diego, Cali ornia [188]
xiii
Mark J. Ault, MD Robert B. Baron, MD, MS
Pro essor o Medicine Pro essor o Medicine
University o Cali ornia Associate Dean or Graduate and Continuing Medical Education
Los Angeles School o Medicine Vice Chie , Division o General Internal Medicine
Department o Medicine University o Cali ornia
Cedars-Sinai Medical Center San Francisco School o Medicine
Los Angeles, Cali ornia [125] San Francisco, Cali ornia [36]
Patrick Avila, MD, MPhil, MPH Tom Baudendistel, MD, FACP

Internal Medicine Resident Physician Internal Medicine Residency Program Director
Brigham and Women’s Hospital Kaiser Permanente
C
Boston, Massachusetts [160] Oakland, Cali ornia [39]
O
N
Vasilis C. Babaliaros, MD Mihaela H. Bazalakova, MD, PhD
T
Pro essor o Medicine and Surgery Assistant Pro essor
R
I
B
Co-Director Department o Neurology
U
Emory Structural Heart and Valve Center Center or Sleep Medicine and Sleep Research
T
O
Emory University Hospital University o Wisconsin-Madison
R
Atlanta, Georgia [131] Madison, Wisconsin [96]
S
Lindsey R. Baden, MD Joshua A. Beckman, MD, MSc
Associate Pro essor Section o Vascular Medicine
Harvard Medical School Cardiovascular Division
In ectious Diseases Division Vanderbilt University Medical Center
Brigham and Women’s Hospital and Dana-Farber Cancer Institute Nashville, Tennessee [255]
Boston, Massachusetts [204]
Nicole M. Bedi, RD, CNSC
Meridale V. Baggett, MD Birmingham, Michigan [58]
Harvard Medical School Laurence Beer, MD, SFHM
Inpatient Clinician Educator Service Emory University School o Medicine
Department o Medicine Atlanta, Georgia [8]
Massachusetts General Hospital Michael Belkin, MD
Boston, Massachusetts [78] Division o Vascular Surgery
James L. Bailey, MD Brigham and Women’s Hospital
Pro essor Boston, Massachusetts [256]
Emory University School o Medicine Elie F. Berbari, MD
Atlanta, Georgia [241] Pro essor o Medicine
Stephen J. Balevic, MD Mayo Clinic College o Medicine
Adult and Pediatric Rheumatology Fellow Rochester, Minnesota [194]
Duke University Medical Center Colm Bergin, MD, FRCPI, FRCP, FIDSA
Durham, North Carolina [248] Clinical Pro essor o Medicine
Peter A. Banks, MD Trinity College Dublin
Pro essor o Medicine Consultant Physician in In ectious Diseases
Harvard Medical School Associate Director
Director o the Center or Pancreatic Disease Wellcome-Health Research Board Clinical Research Facility
Division o Gastroenterology, Hepatology and Endoscopy St. James’s Hospital
Department o Medicine Dublin, Ireland [195]
Brigham and Women’s Hospital Aaron L. Berkowitz, MD, PhD
Boston, Massachusetts [157] Department o Neurology
Aditya Bardia, MD, MPH Brigham and Women’s Hospital
Assistant Pro essor Harvard Medical School
Harvard Medical School Boston, Massachusetts [98]
Attending Physician Rachelle E. Bernacki, MD, MS
Massachusetts General Hospital Cancer Center Assistant Pro essor o Medicine
Boston, Massachusetts [177, 183] Harvard Medical School
Maria F. Barile, MD Director o Quality Initiatives
Clinical Instructor in Radiology Palliative Care
Harvard Medical School Dana-Farber Cancer Institute
Thoracic Radiologist, Brigham and Women’s Hospital
Brigham and Women’s Hospital Ariadne Labs
Boston, Massachusetts [114, 115] Boston, Massachusetts [105, 214]
xiv
Robert A. Bessler, MD Ghada Bourjeily, MD
CEO Associate Pro essor o Medicine
Sound Physicians The Warren Alpert Medical School o Brown University
Tacoma, Washington [23, 25] The Miriam Hospital
Pulmonary, Critical Care, Obstetric Medicine
John P. Bilezikian, MD Department o Medicine
Dorothy L. and Daniel H. Silberberg Pro essor o Medicine Providence, Rhode Island [220]
Pro essor o Pharmacology
Columbia University Medical College John M. Braver, MD
Chie , Division o Endocrinology Assistant Pro essor
Director Harvard Medical School
C
Metabolic Bone Diseases Program Director
O
Columbia University Medical Center Gastrointestinal Radiology
N
New York, New York [240] Brigham and Women’s Hospital
T
R
Boston, Massachusetts [116, 117]
I
Courtney Bilodeau, MD, FACP
B
U
Assistant Pro essor Ursula C. Brewster, MD
T
O
The Warren Alpert Medical School o Brown University Associate Pro essor o Medicine
R
Department o Obstetric Medicine, Women’s Medicine Section o Nephrology
S
Collaborative Yale University School o Medicine
Miriam Hospital New Haven, Connecticut [245]
Providence, Rhode Island [222]
Joseph Brito, MD
Kenneth D. Bishop, MD, PhD Division o Urology
Assistant Pro essor o Medicine The Warren Alpert Medical School o Brown University
Division o Hematology/Oncology Providence, Rhode Island [180]
Rhode Island Hospital
The Warren Alpert Medical School o Brown University Jared R. Brosch, MD, MS
Providence, Rhode Island [176] Assistant Pro essor o Neurology
Indiana University School o Medicine
Ioannis A. Bliziotis, MD, PhD, MSc Indianapolis, Indiana [192]
Internal Medicine and In ectious Diseases Specialist
Senior Researcher Katherine L. Brown, MD, MPH
Al a Institute o Biomedical Sciences Suncoast Dermatology
Athens, Greece [184] Orlando, Florida [148]
Arline D. Bohannon, MD Tod A. Brown, MD

Associate Pro essor o Internal Medicine Assistant Pro essor
Virginia Commonwealth University Anesthesia and Perioperative Medicine
Richmond, Virginia [103] Medical University o South Carolina
Charleston, South Carolina [62]
Peter A. Boling, MD
Pro essor o Internal Medicine Avery L. Buchholz, MD, MPH
Virginia Commonwealth University Health System Department o Neurosurgery
Richmond, Virginia [103] Medical University o South Carolina
Marcy B. Bolster, MD
Associate Pro essor Tina Budnitz, MPH, MHM
Harvard Medical School Senior Advisor
Director Society Hospital Medicine
Rheumatology Fellowship Training Program Philadelphia, Pennsylvania [e4]
Massachusetts General Hospital Robert Burakof , MD, MPH
Boston, Massachusetts [248, 249] Associate Pro essor o Medicine
Diego F. Bonilla Arcos, MD Division o Gastroenterology, Hepatology, and Endoscopy
Pulmonary Critical Care Brigham and Women’s Hospital
Boston University Harvard Medical School
Pulmonary Center Boston, Massachusetts [155]
Boston Medical Center T. Karl Byrne, MD, FACS
Boston, Massachusetts [237] Pro essor o Surgery
Joanna M. Bonsall, MD, PhD Director
Assistant Pro essor o Medicine Bariatric Surgery Program
Division o Hospital Medicine Medical University o South Carolina
Emory University School o Medicine Charleston, South Carolina [63]
Atlanta, Georgia [12]
xv
Amanda Caissie, MD, PhD, FRCPC Olga S. Chajewski, MD
Department o Radiation Oncology Department o Pathology and Laboratory Medicine
Dalhousie University Medical University o South Carolina
Saint John Regional Hospital Charleston, South Carolina [57]
Saint John, New Brunswick, Canada [215]
Walter W. Chan, MD, MPH
Evelyn Cantillo, MD, MPH Assistant Pro essor o Medicine
Clinical Instructor o Obstetrics and Gynecology Division o Gastroenterology, Hepatology, and Endoscopy
Program in Women’s Oncology Harvard Medical School
Women &In ants’Hospital o Rhode Island Brigham and Women’s Hospital
The Warren Alpert Medical School o Brown University Boston, Massachusetts [155]
C
O
Arjun S. Chanmugam, MD, MBA
N
Stephanie M. Cantu, MD Associate Pro essor o Emergency Medicine
T
Department o Medicine Johns Hopkins University School o Medicine
R
I
B
Brigham and Women’s Hospital Baltimore, Maryland [79]
U
T
Helen Chen, MD
O
Mitchell S. Cappell, MD, PhD Assistant Pro essor o Medicine
R
S
Pro essor o Medicine Harvard Medical School
Oakland University William Beaumont School o Medicine Division o Gerontology
Chie , Division o Gastroenterology and Hepatology Beth Israel Deaconess Medical Center
Department o Medicine Chie Medical O cer
William Beaumont Hospital Hebrew SeniorLi e
Royal Oak, Michigan [163] Boston, Massachusetts [73]
Alexander R. Carbo, MD, FACP, SFHM Kenneth K. Chen, MD, FRACP

Assistant Pro essor o Medicine Assistant Pro essor o Medicine and OB/GYN
Harvard Medical School Division o Obstetric and Consultative Medicine
Hospitalist The Warren Alpert Medical School o Brown University
Beth Israel Deaconess Medical Center Providence, Rhode Island [221]
Steven T. Chen, MD, MPH
Teresa L. Carman, MD Instructor in Dermatology
Assistant Pro essor o Medicine Harvard Medical School
Case Western Reserve University School o Medicine Massachusetts General Hospital
Director Boston, Massachusetts [145]
Vascular Medicine
University Hospitals Case Medical Center Xi Chen, MD, PhD
Cleveland, Ohio [86] Neurology Department
Atrius Health
Patrick J. Cawley, MD, MHM Boston, Massachusetts [96]
CEO
MUSC Health Nishay Chitkara, MD
Vice President or Health A airs Assistant Pro essor o Medicine
Medical University o South Carolina NYU Langone Medical Center/Bellevue Hospital
Charleston, South Carolina [1] Department o Medicine
Division o Pulmonary
Laura K. Certain, MD, PhD Critical Care and Sleep Medicine
Instructor in Medicine New York, New York [143]
Division o In ectious Diseases Louisa W. Chiu, MD
Massachusetts General Hospital Assistant Pro essor o Surgery
Boston, Massachusetts [193] Michael E. DeBakey Department o Surgery
Baylor College o Medicine
Matthew E. Certain, MD Houston, Texas [55]
Interventional and Peripheral Cardiologist
Southeast Georgia Health Systems Elbert B. Chun, MD
Brunswick, Georgia [130] Assistant Pro essor
Division o Hospital Medicine
Sukit Chaiyachati, MD Department o Internal Medicine
Assistant Pro essor o Medicine Emory University School o Medicine
Division o Hospital Medicine Emory University Hospital
Emory University School o Medicine Atlanta, Georgia [132]
xvi
Roger P. Clark, DO Frank E. Corrigan, III, MD
Assistant Pro essor o Medicine Cardiology Fellow
Division o Geographic Medicine and In ectious Diseases Emory University School o Medicine
Tu ts Medical Center Atlanta, Georgia [101]
Consultant, In ectious Diseases
Brigham and Women’s Faulkner Hospital Dominique L. Cosco, MD, FACP
Boston, Massachusetts [199] Assistant Pro essor o Medicine
Associate Program Director
John O. Clarke, MD Grady Memorial Hospital
Associate Pro essor o Medicine J. Willis Hurst Internal Medicine Residency Program
Division o Gastroenterology &Hepatology Emory University School o Medicine
C
Johns Hopkins University Atlanta, Georgia [230]
O
Baltimore, Maryland [97]
N
Douglas B. Coursin, MD, FCCP
T
Stephen D. Clements, Jr., MD Pro essor o Anesthesiology and Medicine
R
I
B
Pro essor o Medicine (Cardiology) University o Wisconsin School o Medicine and Public Health
U
R. Harold Harrison Chair in Cardiology Madison, Wisconsin [153]
T
O
Division o Cardiology
Lisa Criscione -Schreiber, MD, MEd
R
Department o Medicine
S
Emory University School o Medicine Associate Pro essor o Medicine
Atlanta, Georgia [130] Rheumatology Training Program Director
Duke University Medical Center
Steven L. Cohn, MD, FACP, SFHM Duke University School o Medicine
Pro essor o Clinical Medicine Durham, North Carolina [248, 249]
University o Miami Miller School o Medicine
Medical Director Yvette M. Cua, MD
UHealth Preoperative Assessment Center Associate Pro essor o Medicine
Director Department o Medicine
Medical Consultation Services Associate Vice Chair or Clinical A airs
University o Miami Hospital and Jackson Memorial Hospital Department o Medicine
Miami, Florida [49, 50] University o Louisville
Louisville, Kentucky [28-30, 32]
Lauren Colbert, MD
Fellow Randall Czajkowski, MS, RRA, RT(R)(CT)
Radiation Oncology Lead Clinical CT Technologist
MD Anderson Cancer Center Brigham and Women’s Hospital
Houston, Texas [182] Boston, Massachusetts [119]
Alexandra Columbus, MD Sonye K. Danof , MD, PhD

Resident Associate Pro essor o Medicine
General Surgery Department o Medicine
Brigham and Women’s Hospital Division o Pulmonary and Critical Care Medicine
Boston, Massachusetts [45] Johns Hopkins University School o Medicine
Jose F. Condado, MD, MS
Cardiology Research Fellow Jatin K. Dave, MD, MPH
Structural Heart and Valve Center Part-Time Instructor, Harvard Medical School
Division o Cardiology Division o Aging, Brigham and Women’s Hospital
Emory University School o Medicine Boston, Massachusetts
Atlanta, Georgia [131] Medical Director
Geriatrics and Senior Care Options
Nicholas J. Connors, MD Tu ts Health Plan
Assistant Pro essor o Medicine Watertown, Massachusetts [68, 73]
Division o Emergency Medicine David B. De Lurgio, MD
Section o Medical Toxicology Pro essor
Charleston, South Carolina [100] Clinical Cardiac Electrophysiology
Emory Saint Joseph’s Hospital
Darin J. Correll, MD Atlanta, Georgia [136]
Assistant Pro essor o Anesthesia
Harvard Medical School Steven B. Deitelzweig, MD, MMM, SFHM, FACP
Director Ochsner Health System
Postoperative Pain Management Service Medical Director o Regional Business Development
Department o Anesthesiology, Perioperative, and Pain Medicine System Chairman, Hospital Medicine
Chair, Acute Pain Committee Associate Pro essor o Medicine-Ochsner Clinical School [24]
xvii
Paul F. Dellaripa, MD Daniel D. Dressler, MD, MSc, SFHM, FACP
Associate Pro essor Pro essor o Medicine
Harvard Medical School Director
Division o Rheumatology Internal Medicine Teaching Services
Brigham and Women’s Hospital Emory University Hospital
Boston, Massachusetts [246] Associate Program Director
J. Willis Hurst Internal Medicine Residency Program
E. Patchen Dellinger, MD Co-Director
Pro essor and Vice Chair Semmelweis Society
Department o Surgery Emory University School o Medicine
University o Washington Atlanta, Georgia [101]
C
Seattle, Washington [55]
O
Jacob M. Drew, MD
N
Harry A. Demos, MD Assistant Pro essor
T
Associate Pro essor
R
Department o Orthopedics
I
B
Department o Orthopedics Medical University o South Carolina
U
T
O
R
Catherine E. DuBeau, MD
S
Rebecca Dezube, MD Pro essor o Medicine
Postdoctoral Fellow Family Medicine and Community Health, and Obstetrics and
Johns Hopkins University Gynecology
Pulmonary and Critical Care Medicine Clinical Chie o Geriatrics
Baltimore, Maryland [95] University o Massachusetts Medical School
Lorenzo Di Francesco, MD, FACP, FHM Worcester, Massachusetts [71]
Pro essor o Medicine Jenni er Duf , MD
Division o General Medicine &Geriatrics Assistant Pro essor o Medicine
Program Director Division o Hematology and Oncology
J. Willis Hurst Internal Medicine Residency Program Department o Medicine
Assistant Chie o Medicine, Grady Memorial Hospital University o Florida College o Medicine
Emory University School o Medicine Hematology and Oncology Section
Atlanta, Georgia [93] NF/SG Veterans A airs Medical Center
Shira Doron, MD, FIDSA Gainesville, Florida [175]
Antimicrobial Steward Liam Durcan, MD, FRCPC
Associate Hospital Epidemiologist Assistant Pro essor
Division o Geographic Medicine and In ectious Diseases Department o Neurology and Neurosurgery
Tu ts Medical Center McGill University
Boston, Massachusetts [191] Consultant Neurologist
Michael Dougan, MD, PhD McGill University Health Centre
Gastroenterology Fellow Montreal, Quebec, Canada [207]
Massachusetts General Hospital Kent Russell Edwards, Jr., MD
Boston, Massachusetts [183] Urology Research Assistant
James D. Douketis, MD, FRCP(C), FACP, FCCP University o South Carolina School o Medicine
Pro essor o Medicine Columbia, South Carolina [67]
McMaster University Mikhael F. El-Chami, MD, FACC, FHRS
Hospitalist Service Associate Pro essor o Medicine
St. Joseph’s Healthcare Hamilton Division o Cardiology-Section o Electrophysiology
Hamilton, Ontario, Canada [56, 252] Emory University
Aeron A. D. Doyle, MD, CM, FRCPC Atlanta, Georgia [134]
Assistant Pro essor o Anesthesiology Elwaleed A. Elhassan, MD, FACP, FASN
University o British Columbia Assistant Pro essor o Medicine
Department o Anesthesiology, Perioperative Medicine, and Pain Division o Nephrology and Hypertension
Management Wayne State University School o Medicine
Providence Health Care Detroit, Michigan [242]
Vancouver, British Columbia, Canada [47]
William J. Elliott, MD, PhD
Tracy J. Doyle, MD, MPH Chair
Instructor in Medicine Department o Biomedical Sciences
Harvard Medical School Chie , Division o Pharmacology
Pulmonary and Critical Care Medicine Pro essor o Preventative Medicine, Internal Medicine, Pharmacology
Brigham and Women’s Hospital Paci c Northwest University o Health Sciences
Boston, Massachusetts [85] Yakima, Washington [244]
xviii
John M. Embil, MD, FRCPC, FACP James C. Fang, MD, FACC, FAHA
Pro essor o Internal Medicine and Medical Microbiology Chie
University o Manitoba Cardiovascular Division
Director Pro essor o Medicine
In ection Prevention and Control Unit, Health Sciences Centre John and June B. Hartman Presidential Endowed Chair
Winnipeg, Manitoba, Canada [147, 202] Executive Director
Cardiovascular Service Line
Scott F. Enderby, DO, MMM, SFHM, FACP University o Utah Health Sciences Center
CEO/Medical Director Salt Lake City, Utah [129]
Bay Area Hospitalist Associates, Inc.
San Francisco, Cali ornia [25] John Fanikos, RPh, MBA
C
Department o Pharmacy Services
O
Jeannine Z. Engel, MD Brigham and Women’s Hospital
N
Associate Pro essor o Medicine Boston, Massachusetts [254]
T
Internal Medicine, Huntsman Cancer Hospital
R
I
Harrison W. Farber, MD
B
Physician Advisor, Billing Compliance
U
Compliance Services Pro essor o Medicine
T
O
University o Utah Health Sciences Boston University School o Medicine
R
Salt Lake City, Utah [31] Director
S
Pulmonary Hypertension Center
Joseph C. English, III, MD Boston Medical Center
Pro essor o Dermatology Boston, Massachusetts [237]
University o Pittsburgh Department o Dermatology
Pittsburgh, Pennsylvania [144] Claire E. Farel, MD, MPH
Clinical Assistant Pro essor o Medicine
Mary Eno, MD, MPH University o North Carolina School o Medicine
Regional Chie o Addiction Medicine Medical Director
Southern Cali ornia Permanente Medical Group UNC In ectious Diseases Clinic
Los Angeles, Cali ornia [251] UNC Institute or Global Health and In ectious Diseases
Andrew S. Epstein, MD Chapel Hill, North Carolina [203]
Assistant Attending Dimitrios Farmakiotis, MD
Memorial Sloan Kettering Cancer Center Assistant Pro essor o Medicine
Gastrointestinal Oncology Service New York University School o Medicine
New York, New York [182] Division o In ectious Diseases and Immunology, NYU Langone
Evert A. Eriksson, MD, FACS, FCCP Medical Center
Associate Pro essor o Surgery New York, New York [201]
Department o Surgery Jeanne M. Farnan, MD, MHPE
Medical University o South Carolina Associate Pro essor
Charleston, South Carolina [46] Section o Hospital Medicine
Samir M. Fakhry, MD, FACS Assistant Dean, Curricular Development and Evaluation
Charles F. Crews Pro essor o Surgery Pritzker School o Medicine
Chie , Division o General Surgery University o Chicago
Department o Surgery Chicago, Illinois [13]
Medical University o South Carolina Grace Farris, MD
Charleston, South Carolina [46] Beth Israel Deaconess Medical Center
Matthew E. Falagas, MD, MSc, DSc Boston, Massachusetts [168]
Adjunct Associate Pro essor o Medicine Kevin Felner, MD
Tu ts University School o Medicine Associate Pro essor
Boston, Massachusetts Division o Pulmonary and Critical Care
Director New York University School o Medicine
Al a Institute o Biomedical Sciences Harbor VA Medical Center
Director New York, New York [141]
Department o Internal Medicine and In ectious Diseases
Iaso General Hospital Andrew Z. Fenves, MD, FACP, FASN
Athens, Greece [184] Associate Pro essor o Medicine
Kenneth R. Falchuk, MD Clinician Educator Service
Associate Clinical Pro essor o Medicine Massachusetts General Hospital
Co-Director
Inf ammatory Bowel Disease Center
Department o Medicine, Division o Gastroenterology
Beth Israel Deaconess Medical Center
xix
Joseph D. Feuerstein, MD Michael Gardam, MD, MSc, FRCPC
Assistant Pro essor o Medicine Associate Pro essor o Medicine
Harvard Medical School University o Toronto
Attending in Gastroenterology Director
Center or Inf ammatory Bowel Disease In ection Prevention and Control
Beth Israel Deaconess Medical Center University Health Network
Boston, Massachusetts [164] Medical Director
Tuberculosis Clinic
Joseph J. Fins, MD, MACP Toronto Western Hospital
The E. William Davis, Jr., MD Pro essor o Medical Ethics and Toronto, Ontario, Canada [200]
C
Weill Cornell Medical College Brian T. Garibaldi, MD
O
Director Assistant Pro essor o Medicine
N
Medical Ethics and Attending Physician Johns Hopkins University School o Medicine
T
R
New York Presbyterian Hospital-Weill Cornell Medical Center Department o Medicine
I
B
New York, New York [33] Division o Pulmonary and Critical Care Medicine
U
T
O
Leslie A. Flores, MHA, SFHM
R
Nelson Flores Hospital Medicine Consultants Steven Garlow, MD, PhD
S
La Quinta, Cali ornia [26] Associate Pro essor
Chie o Psychiatry
John A. Flynn, MD, MBA, MEd, FACP, FACR Emory University Hospital
Medical Director Atlanta, Georgia [223]
Spondyloarthritis Program
Associate Dean and Executive Director Germán E. Giese, MD
Clinical Practice Association Assistant Pro essor o Medicine
Vice President, O ce o Johns Hopkins Physicians University o Miami Miller School o Medicine
Johns Hopkins University Attending, Division o Hospital Medicine
Baltimore, Maryland [76] University o Miami Hospital
Miami, Florida [37]
Ryan M. Ford, MD
Assistant Pro essor o Medicine Richard S. Gitomer, MD, MBA, FACP
Director o Viral Hepatitis Assistant Pro essor
Emory Transplant Center Emory University School o Medicine
Transplant Hepatologist President and Chie Quality O cer
Emory University Hospital Emory Healthcare Network
Atlanta, Georgia [159] Atlanta, Georgia [18]
Vance G. Fowler Jr., MD, MHS Jef rey J. Glasheen, MD, SFHM
Division o In ectious Diseases Chie Quality O cer
Duke University Medical Center University o Colorado Hospital
Durham, North Carolina [189] Associate Dean or Clinical A airs, Quality and Sa ety Education
Director
Gil Freitas, MD Institute or Healthcare Quality, Sa ety and E ciency
Division o Trauma, Burn, and Surgical Critical Care Pro essor
Harvard Medical School Division o General Internal Medicine
Fellow, Metabolic Support Service University o Colorado School o Medicine
Brigham and Women’s Hospital Aurora, Colorado [59]
Dragan Golijanin, MD
Joseph M. Furman, MD, PhD Associate Pro essor o Surgery
Pro essor Director
Departments o Otolaryngology Genitourinary Oncology
Neurology, Bioengineering and Physical Therapy The Warren Alpert Medical School o Brown University
University o Pittsburgh School o Medicine Providence, Rhode Island [180]
Director
Divisions o Balance Disorders Lucas Golub, MD
Pittsburgh, Pennsylvania [84] Emory University School o Medicine
Julia M. Gallagher, MD
Medical Director Steven M. Gorbatkin, MD, PhD
MGH Home Based Palliative Care Program Associate Pro essor
Division o Palliative Care Emory University School o Medicine
Massachusetts General Hospital Nephrologist, Atlanta VA Medical Center
Boston, Massachusetts [74] Decatur, Georgia [241]
xx
Norman D. Grace, MD Caroline N. Harada, MD
Lecturer on Medicine Associate Pro essor o Medicine
Harvard Medical School Assistant Dean or Community-Engaged Scholarship
Pro essor o Medicine University o Alabama School o Medicine
Tu ts University School o Medicine Division o Gerontology, Geriatrics, and Palliative Care
Sta Physician Birmingham, Alabama [166]
Division o Gastroenterology, Hepatology, and Endoscopy
Department o Medicine Nikroo Hashemi, MD, MPH
Brigham and Women’s Hospital Instructor o Medicine
Boston, Massachusetts [53, 160] Harvard Medical School
C
Yonatan H. Grad, MD, PhD Division o Gastroenterology and Hepatology
O
Assistant Pro essor Boston, Massachusetts [109]
N
Harvard T. H. Chan School o Public Health
T
Joaquim M. Havens, MD
R
Division o In ectious Diseases
I
B
Brigham and Women’s Hospital Assistant Pro essor o Surgery
U
T
O
Division o Trauma, Burn, and Surgical Critical Care
R
Charles S. Greenberg, MD Brigham and Women’s Hospital
S
Department o Medicine Boston, Massachusetts [45]
Division o Hematology/Oncology
Medical University o South Carolina Meghan Hayes, MD, FACP
Charleston, South Carolina [54] Department o Internal Medicine
Sutter Medical Group
Stephen B. Greenberg, MD, MACP Clinical Instructor
Distinguished Service Pro essor, Herman Brown Teaching University o Cali ornia
Pro essor Davis Medical Center
Baylor College o Medicine Sacramento, Cali ornia [218, 220]
Vice Chie o Sta , Chie o Medicine
Ben Taub Hospital Catherine P. M. Hayward, MD, PhD, FRCPC
Houston, Texas [198] Pro essor
Pathology and Molecular Medicine/Medicine McMaster University
Norton J. Greenberger, MD, MACP Head, Coagulation
Clinical Pro essor o Medicine Hamilton Regional Laboratory Medicine Program
Harvard Medical School West Hamilton, Ontario, Canada [172]
Senior Physician
Brigham and Women’s Hospital Galen V. Henderson, MD
Boston, Massachusetts [75] Director
Neurocritical Care and Neuroscience Intensive Care Unit
Anne F. Gross, MD Brigham and Women’s Hospital
Assistant Pro essor o Psychiatry Assistant Pro essor, Harvard Medical School
Associate Residency Training Director Boston, Massachusetts [209]
Oregon Health &Science University
Portland, Oregon [229] Kathie L. Hermayer, MD, MS, FACE, FACP
Angela S. Guarda, MD Medical Director or Diabetes Management Services at MUSC
Associate Pro essor o Psychiatry and Behavioral Sciences Division o Endocrinology, Diabetes, and Medical Genetics
Johns Hopkins School o Medicine Medical University o South Carolina
Director Chair, Diabetes Task Force
Eating Disorders Program Ralph H. Johnson Veteran’s A airs Medical Center
The Johns Hopkins Hospital Charleston, South Carolina [52]
Heather Herrington, MD
Navin R. Gupta, MD Associate Pro essor o Medicine
Department o Medicine Division o Gerontology, Geriatrics, and Palliative Care
Renal Division University o Alabama at Birmingham
Brigham and Women’s Hospital Birmingham, Alabama [166]
Stacy Higgins, MD, FACP
Sarah P. Hammond, MD Associate Pro essor o Medicine
Assistant Pro essor o Medicine Division o General Medicine and Geriatrics
Harvard Medical School Emory University School o Medicine
Division o In ectious Diseases Atlanta, Georgia [12]
xxi
Keiki Hinami, MD, MS Jef C. Huf man, MD
Collaborative Research Unit Associate Pro essor o Psychiatry
Cook County Health &Hospitals System Harvard Medical School
Chicago, Illinois [41] Medical Director
Inpatient Psychiatry
Ashley B. Hink, MD, MPH Massachusetts General Hospital
General Surgery Resident Boston, Massachusetts [229]
Department o General Surgery John T. Huggins, MD
Charleston, South Carolina [63] Associate Pro essor o Medicine
Division o Pulmonary and Critical Care
Kerstin Hogg, MD, MBChB, MSc
C
O
Assistant Pro essor Charleston, South Carolina [236]
N
T
McMaster University Daniel P. Hunt, MD
R
I
B
East Hamilton, Ontario, Canada [253] Pro essor o Medicine
U
Director
T
Fernando Holguin, MD, MPH
O
Emory Division o Hospital Medicine
Associate Pro essor o Medicine and Pediatrics
R
S
Asthma Institute Emory University School o Medicine
Division o Pulmonary Atlanta, Georgia [78]
Allergy and Critical Care Medicine
University o Pittsburgh William R. Hunt, MD
Pittsburgh, Pennsylvania [231] Assistant Pro essor o Medicine
Division o Pulmonary, Allergy, Critical Care, and Sleep Medicine
Anthony N. Hollenberg, MD Department o Medicine
Pro essor o Medicine Emory-Children’s Center or Cystic Fibrosis
Harvard Medical School McKelvey Lung Transplant Center
Chie , Division o Endocrinology, Diabetes, and Metabolism Emory University School o Medicine
Beth Israel Deaconess Medical Center Atlanta, Georgia [234]
Aubrey Ingraham, MD
Elizabeth H. Holt, MD, PhD Department o Internal Medicine
Associate Pro essor Kaiser Permanente
Yale School o Medicine Oakland, Cali ornia [39]
Yale Endocrinology
Yale Endocrine Oncology Program Bertrand L. Jaber, MD, MS
New Haven, Connecticut [240] Associate Pro essor o Medicine
Tu ts University School o Medicine
Michael H. Hoskins, MD Vice Chair or Clinical A airs
Assistant Pro essor Department o Medicine
Clinical Cardiac Electrophysiology Caritas St. Elizabeth’s Medical Center
Emory University Hospital Boston, Massachusetts [243]
Atlanta, Georgia [133, 136]
Claire S. Jacobs, MD, PhD
Susy Hota, MD, MSc, FRCPC Department o Neurology
Assistant Pro essor o Medicine Brigham and Women’s Hospital
University o Toronto Boston, Massachusetts [211]
Hospital Epidemiologist and In ectious Diseases Specialist
University Health Network Francine L. Jacobson, MD, MPH
Toronto, Ontario, Canada [200] Thoracic Radiologist at Brigham and Women’s Hospital
Assistant Pro essor
Liangge Hsu, MD Department o Radiology
Assistant Pro essor o Radiology Harvard Medical School
Division o Neuroradiology Boston, Massachusetts [107, 112-119]
Harvard Medical School Shilpa H. Jain, MD
Boston, Massachusetts [118] Clinical Assistant Pro essor (A liated)
Division o Endocrinology, Gerontology, and Metabolism
Margo S. Hudson, MD Stan ord University School o Medicine
Assistant Pro essor o Medicine Veterans A airs Palo Alto Health Care System
Harvard Medical School Palo Alto, Cali ornia [154]
Diabetes Management Service
xxii
Kunal Jajoo, MD Laurence Katznelson, MD
Assistant Pro essor Associate Dean o Graduate Medical Education
Harvard Medical School Pro essor o Neurosurgery and Medicine (Endocrinology and
Associate Physician Metabolism)
Brigham and Women’s Hospital Medical Director
Boston, Massachusetts [158] Pituitary Center
Stan ord University School o Medicine
Edward C. Jauch, MD, MS Stan ord, Cali ornia [154]
Pro essor
Director Clive Kearon, MB, MRCPI, FRCPC, PhD
Division o Emergency Medicine Jack Hirsh Pro essorship in Thromboembolism
C
Pro essor, Department o Neurosciences Department o Medicine
O
Vice Chair, Research, Department o Medicine McMaster University
N
Pro essor, Department o Bioengineering (Adjunct) Juravinski Hospital
T
R
Clemson University Hamilton, Ontario, Canada [253]
I
B
U
Robert T. Keenan, MD, MPH
T
O
R
Brent Jewett, MD Director
S
Clinical Instructor o Surgery Duke Gout and Crystal Arthropathy Clinic
Department o Surgery Duke University School o Medicine
Medical University o South Carolina Durham, North Carolina [247]
Corey D. Kershaw, MD
Danielle Jones, MD, FACP Associate Pro essor o Medicine
Associate Pro essor o Medicine Division o Pulmonary &Critical Care Medicine
Division o General Medicine and Geriatrics University o Texas Southwestern Medical Center
Emory University School o Medicine Medical Director, MICU
Atlanta, Georgia [93] William P. Clements Jr. University Hospital
Dallas, Texas [142]
J. Ryan Jordan, MD
Cardiovascular Disease and Clinical Cardiac Electrophysiology Adeel M. Khan, MD, MPH
South Denver Cardiology Associates, PC Taussig Cancer Institute
Littleton, Colorado [135] Cleveland Clinic Foundation
Cleveland, Ohio [181]
S. Andrew Josephson, MD
Vice President Claude Killu, MD
Neurohospitalist Society Intensive Care
Carmen Castro-Franceschi and Gladyne K. Mitchell Distinguished Los Angeles Medical Center
Neurohospitalist Pro essorship Los Angeles, Cali ornia [125]
Vice Chairman, Parnassus Programs Director, Neurohospitalist
Program Emmanuel S. King, MD, FHM, FACP
Department o Neurology Associate Pro essor o Clinical Medicine
University o Cali ornia, San Francisco Perelman School o Medicine
San Francisco, Cali ornia [104] University o Pennsylvania
Director o Clinical Operations
Brian W. Kaebnick, MD Section o Hospital Medicine
Structural Cardiology Fellow Division o General Internal Medicine
Department o Cardiology Hospital o the University o Pennsylvania
Emory University Hospital Philadelphia, Pennsylvania [21]
Joyce E. King, MD
Stephen P. Kalhorn, MD Assistant Pro essor
Assistant Pro essor Neurosurgery Georgetown University School o Medicine
Medical University o South Carolina Washington, DC
Charleston, South Carolina [64] Clinical Instructor
University o Maryland Medical School
Jameela Kari, MD Director Inpatient Medicine
Pediatric Nephrology Unit Family Medicine Residency
Department o Pediatrics Medstar Franklin Square Medical Center
King Abdulaziz University Baltimore, Maryland [228]
Jeddah, Kingdom o Saudi Arabia [239]
Emad Kishi, MD
Assistant Pro essor o Surgery
Division o Abdominal Transplant
Department o Surgery
xxiii
Joshua P. Klein, MD, PhD Mark S. Lachs, MD, MPH
Associate Pro essor o Neurology and Radiology Irene and Roy Psaty Distinguished Pro essor o Medicine
Harvard Medical School Co-Chie o Geriatrics and Palliative Medicine
Chie , Division o Hospital Neurology Weill Cornell Medicine
Department o Neurology Director o Geriatrics
Brigham and Women’s Hospital New York Presbyterian Health System
Boston, Massachusetts [106] New York, New York [167]
Michael Klompas, MD, MPH Victoria D. Lackey, MD

Associate Pro essor Duke University School o Medicine
Department o Population Medicine Division o Rheumatology and Immunology
C
Harvard Medical School Duke University Medical Center
O
Division o In ectious Diseases Durham, North Carolina [249]
N
T
Joshua R. Lakin, MD
R
I
B
U
Christopher Knudson, MD Dana-Farber Cancer Institute
T
O
Instructor o Medicine Boston, Massachusetts [105]
R
S
Emory University School o Medicine Albert Q. Lam, MD
Atlanta, Georgia [90] Associate Physician
Division o Renal Medicine
Serena Koenig, MD, MPH Brigham and Women’s Hospital
Assistant Pro essor Harvard Medical School
Division o Global Health Equity
Division o In ectious Diseases Lindy H. Landzaat, DO, FAAHPM
Brigham and Women’s Hospital Assistant Pro essor
Boston, Massachusetts [205] Division o Palliative Medicine
University o Kansas Medical Center
Sophia Koo, MD Kansas City, Kansas [217]
Harvard Medical School Vijay H. Lapsia, MD, MBBS
Division o In ectious Diseases Assistant Pro essor o Medicine
Brigham and Women’s Hospital Mount Sinai School o Medicine
Boston, Massachusetts [201] New York, New York [238]
Makeida B. Koyi, MD Lucia Larson, MD, FACP

Deputy Director o Adult Inpatient Consultation Service Associate Pro essor o Medicine
Clinical Instructor Director
Community Psychiatry Program Division o Obstetric Medicine
Department o Psychiatry and Behavioral Sciences Women’s Medicine Collaborative
Johns Hopkins Bayview Medical Center The Alpert Medical School o Brown University
Baltimore, Maryland [81] Providence, Rhode Island [218]
Svetlana Krasnokutsky, MD, MS Jodi Layton, MD

Assistant Pro essor o Medicine Assistant Pro essor o Medicine
Co-Director The Warren Alpert Medical School o Brown University
NYU Crystal Diseases Study Group Hematology and Oncology
New York University School o Medicine Rhode Island Hospital Comprehensive Cancer Center
New York, New York [247] Providence, Rhode Island [180]
Harold Kudler, MD Brian Leber, MDCM, FRCPC

Adjunct Associate Pro essor Pro essor o Medicine
Department o Psychiatry and Behavioral Sciences McMaster University
Duke University Medical Center Attending Physician
Durham, North Carolina [224] Hamilton Health Sciences/Juravinski Hospital and Cancer Centre
Hamilton, Ontario, Canada [170]
Carlos E. Kummer eldt, MD
Sta Pulmonologist Noah Lechtzin, MD, MHS, FCCP
TJ Samson Community Hospital Assistant Pro essor
Glasgow, Kentucky [236] Director
Johns Hopkins Adult Cystic Fibrosis Program
Pulmonary Director
Johns Hopkins Amyotrophic Lateral Sclerosis Clinic
Pulmonary and Critical Care Medicine
Johns Hopkins University
xxiv
Ji Yeon Lee, MD David J. Likosky, MD, SFHM, FAHA, FACP
Pulmonary/Critical Care Fellow President
Emory University School o Medicine Neurohospitalist Society
Division o Pulmonary, Allergy, Critical Care &Sleep Medicine Medical Director
Atlanta, Georgia [235] EvergreenHealth Neuroscience Institute
Clinical Assistant Pro essor
Linda A. Lee, MD University o Washington
Clinical Director EvergreenHealth
Division o Gastroenterology and Hepatology Kirkland, Washington [104]
Johns Hopkins University School o Medicine
Director o Endoscopy Ming Y. Lim, MB BChir
C
Johns Hopkins Hospital Department o Medicine
O
Director Division o Hematology/Oncology
N
Johns Hopkins Integrative Medicine &Digestive Center Medical University o South Carolina
T
R
Lutherville, Maryland [80] Charleston, South Carolina [54]
I
B
U
Linda S. Lee, MD Walter Limehouse, MD, MA, FACEP
T
O
Assistant Pro essor o Medicine Associate Pro essor o Emergency Medicine
R
Harvard Medical School Medical University o South Carolina
S
Director Charleston, South Carolina [33]
Endoscopic Education and Women’s Health in GI
Co-Director Lori-Ann Linkins, MD, MSc (Clin Epi), FRCPC
Pancreas Center Associate Pro essor
Brigham and Women’s Hospital Department o Medicine
Boston, Massachusetts [161] Division o Hematology &Thromboembolism
McMaster University
Blair J. N. Leonard, MD, PhD, FRCP Juravinski Thromboembolism Service
Senior Hematology Fellow MF1 Director/MF1 Hematology Subunit Planner
McMaster University Michael G. DeGroote School o Medicine
Hamilton, Ontario, Canada [170] Thrombosis &Atherosclerosis Research Institute
William I. Levin, MD
Associate Pro essor o Medicine Ra ael H. Llinas, MD
Division o General Internal Medicine Associate Pro essor o Medicine
University o Pittsburgh School o Medicine Associate Pro essor o Neurology
Pittsburgh, Pennsylvania [60] Chairman o Neurology
Johns Hopkins Bayview Medical Center
Katherine Lewis, MD, MSCR Baltimore, Maryland [89]
Assistant Pro essor o Medicine and Pediatrics
The Medical University o South Carolina Hermioni N. Lokko, MD, MPP
Charleston, South Carolina [52] Clinical Fellow o Psychiatry
Cindy Lien, MD Administrative Chie Resident
Assistant Pro essor o Medicine Massachusetts General Hospital
Palliative Care Physician
Internal Medicine Hospitalist Lenny López, MD, MPH, MDiv
Beth Israel Deaconess Medical Center Associate Pro essor o Medicine
Boston, Massachusetts [216] Chie o Hospital Medicine
San Francisco VA Medical Center
Elaine Chiewlin Liew, MD, FRCA University o Cali ornia
Assistant Pro essor o Anesthesiology San Francisco, Cali ornia [3]
Department o Anesthesiology and Perioperative Medicine
David Ge en School o Medicine David J. Lucier, Jr., MD, MBA, MPH
University o Cali ornia, Los Angeles (UCLA) Instructor o Medicine
Ronald Reagan UCLA Medical Center Harvard Medical School
Los Angeles, Cali ornia [153] Director o Quality and Patient Sa ety
Hospital Medicine Group
Assistant in Medicine
Division o General Internal Medicine
Massachusetts General Hospital
xxv
Courtney H. Lyder, ND, ScD(Hon), FAAN Merry Jenni er Markham, MD
Pro essor o Nursing, Geriatric Medicine, and Public Health Associate Pro essor o Medicine
Dean Emeritus Division o Hematology and Oncology
School o Nursing Department o Medicine
University o Cali ornia University o Florida College o Medicine
Los Angeles, Cali ornia [72] Gainesville, Florida [175]
William L. Lyons, MD Alayne D. Markland, DO, MSc

Pro essor Associate Pro essor o Medicine
Division o Geriatrics and Gerontology Division o Gerontology, Geriatrics, and Palliative Care
Department o Internal Medicine University o Alabama at Birmingham
C
University o Nebraska Medical Center Birmingham, Alabama [71]
O
Omaha, Nebraska [165]
N
Greg S. Martin, MD, MSc, FACP, FCCP, FCCM
T
Elizabeth H. Mack, MD, MS Pro essor and Associate Division Director or Critical Care
R
I
B
Pediatric Critical Care Division o Pulmonary, Allergy, and Critical Care
U
Medical University o South Carolina Emory University School o Medicine
T
O
Charleston, South Carolina [19] Director o Research
R
Emory Critical Care Center
S
James H. Maguire, MD, MPH Section Chie , Grady Memorial Hospital
Pro essor o Medicine Atlanta, Georgia [142]
Senior Physician R. Kirk Mathews, MBA
Division o In ectious Diseases Partner, Schmidt
Brigham and Women’s Hospital Mathews LLC
Boston, Massachusetts [205] Providing Executive Search and Leadership
Development Services [24]
Rahul Maheshwari, MD
Gastroenterology Fellow Melissa Mattison, MD, SFHM, FACP
Division o Digestive Diseases Assistant Pro essor o Medicine
Emory University School o Medicine Harvard Medical School
Atlanta, Georgia [159] Chie , Hospital Medicine Unit
Scott Manaker, MD, PhD Boston, Massachusetts [168]
Associate Pro essor o Medicine, Pulmonary, Allergy, and Critical
Care Division Saverio M. Maviglia, MD, MSc
Vice Chair or Regulatory A airs Assistant Pro essor o Medicine
Department o Medicine Harvard Medical School
Perelman School o Medicine, University o Pennsylvania Hospitalist Service
Philadelphia, Pennsylvania [27] Brigham and Women’s Hospital
E rén Manjarrez, MD, SFHM
Chie , Division o Hospital Medicine Laura K. Max, BA
Associate Pro essor o Clinical Medicine Clinical Research Assistant
Miller School o Medicine Johns Hopkins School o Medicine
University o Miami Anesthesiology and Critical Care Medicine
Miami, Florida [37] Johns Hopkins Hospital
Kimberly D. Manning, MD, FACP, FAAP
Associate Pro essor o Medicine Matthew W. McCarthy, MD
Director Assistant Pro essor o Medicine
Distinction in Teaching and Leadership Weill Cornell Medicine
J. Willis Hurst Internal Medicine Residency Program Assistant Attending Physician
Department o Medicine NewYork-Presbyterian Hospital
Division o General Medicine and Geriatrics New York, New York [33]
Atlanta, Georgia [5] Michael McDaniel, MD, FSCAI
Michael Manogue, MD Emory University School o Medicine
Fellow in Cardiovascular Disease Director
Emory University School o Medicine Cardiac Catheterization Lab
Atlanta, Georgia [133, 135] Grady Health Systems
Gary Margolias, MD
Assistant Pro essor o Anesthesiology
xxvi
Timothy B. McDonald, MD, JD Karina Meijer, MD, PhD
Pro essor, Anesthesiology and Pediatrics Division o Haemostasis and Thrombosis
Chie Sa ety and Risk O cer or Health A airs Department o Haematology
University o Illinois University Medical Centre Groningen
Chicago, Illinois [20] Groningen, The Netherlands [173]
Andrew McFarlane, MLT, ART, FCSMLS(D) David Meltzer, MD, PhD

Technical Specialist Fanny L. Pritzker Pro essor o Medicine
Molecular Hematology and Red Cell Disorders Economics and Public Policy Chie
Lecturer McMaster University Section o Hospital Medicine
Department o Medicine Director, Center or Health and The Social Science
C
McMaster University Medical Centre The University o Chicago
O
Hamilton, Ontario, Canada [169] Chicago, Illinois [e2]
N
T
John W. McGillicuddy, MD, FACS Peter A. Merkel, MD, MPH
R
I
B
Associate Pro essor o Surgery Chie , Division o Rheumatology
U
Medical University o South Carolina Pro essor o Medicine and Epidemiology
T
O
Charleston, South Carolina [66] University o Pennsylvania
R
Philadelphia, Pennsylvania [257]
S
Gerard Michael McGorisk, MD, FACC, MRCPI
Assistant Pro essor o Medicine Joseph J. Miaskiewicz, Jr., MD, FCCP, SFHM
Emory University Assistant Clinical Pro essor
Atlanta, Georgia [132] Tu ts Medical School
Chie o Utilization Review and Clinical Documentation
Sylvia C. McKean, MD, SFHM, FACP Hospitalist
Deputy Editor or Editorial Projects, UpToDate North Shore Medical Center
Boston, Massachusetts [107, 112, 116, 123, 124, e4] Salem, Massachusetts [110, 122]
Graham T. McMahon, MD, MMSc Chad S. Miller, MD, FACP, FHM
Adjunct Pro essor Associate Pro essor
Northwestern University Division Director
Feinberg School o Medicine General Internal Medicine
President and Chie Executive O cer Saint Louis University School o Medicine
Accreditation Council or Continuing Medical Education St. Louis, Missouri [92, 94]
Chicago, Illinois [150]
Tracey A. Milligan, MD, MS, FAAN
Julia McNabb-Baltar, MD Assistant Pro essor o Medicine
Instructor o Medicine Harvard Medical School
Harvard Medical School Vice Chair or Education
Center or Pancreatic Disease Department o Neurology
Division o Gastroenterology, Hepatology, and Endoscopy Brigham and Women’s Hospital
Department o Medicine Boston, Massachusetts [211]
Boston, Massachusetts [157] Elinor Mody, MD
Division o Rheumatology
Thomas E. McNalley, MD Brigham and Women’s Hospital
Associate Pro essor Boston, Massachusetts [127]
University o Washington School o Medicine
Department o Rehabilitation Medicine Daniel L. Molloy, Jr., MD
Seattle Children’s Hospital Division o Cardiology
University o Washington Medical Center Emory University
Seattle, Washington [69] Atlanta, Georgia [130]
Jakob I. McSparron, MD Paul A. Monach, MD, PhD

Instructor in Medicine Chie , Rheumatology Section
Harvard Medical School VA Boston Healthcare System
Division o Pulmonary, Critical Care, and Sleep Medicine Associate Pro essor
Beth Israel Deaconess Medical Center Section o Rheumatology
Boston, Massachusetts [85] Boston University School o Medicine
Niharika D. Mehta, MD
Assistant Pro essor o Medicine Carmen Monzon, MD
The Warren Alpert Medical School o Brown University Clinical Assistant Pro essor o Psychiatry and Human Behavior
Director o Ambulatory services The Warren Alpert Medical School o Brown University
Division o Obstetric and Consultative Medicine Women’s Behavioral Medicine, Women’s Medicine Collaborative
Women and In ants Hospital o Rhode Island Miriam Hospital
Providence, Rhode Island [221] Providence, Rhode Island [221]
xxvii
Luis Fernando Mora, MD Jenni er S. Myers, MD, FACP, FHM
The Arrhythmia Center o South Florida Associate Pro essor o Clinical Medicine
Delray Beach, Florida [134] Department o Medicine
Division o General Internal Medicine
CoLette Morgan, MD, FHM, CCDS, CDIP Section o Hospital Medicine
Assistant Pro essor Perelman School o Medicine
Division o Hospital Medicine University o Pennsylvania
Department o Medicine Philadelphia, Pennsylvania [21]
Atlanta, Georgia [32] Satish N. Nadig, MD, PhD, FACS
Assistant Pro essor
Christopher Moriates, MD
C
Surgery, Microbiology, and Immunology
O
Assistant Clinical Pro essor Medical University o South Carolina
N
Division o Hospital Medicine Transplant Surgery
T
University o Cali ornia at San Francisco
R
I
B
Director o Caring Wisely Program
U
UCSF Center or Healthcare Value Amulya Nagarur, MD
T
O
San Francisco, Cali ornia Instructor in Medicine
R
Director o Implementation Initiatives Harvard Medical School
S
Costs o Care, Inc. Hospital Medicine Group
Boston, Massachusetts [2] Massachusetts General Hospital
Ala Moshiri, MD, PhD
Assistant Pro essor o Ophthalmology Peter Najjar, MD
Eye Center Resident
University o Cali ornia, Davis Department o Surgery
Sacramento, Cali ornia [83] Brigham and Women’s Hospital
John E. Moss, MD Boston, Massachusetts [44]
Department o Critical Care Medicine Dale M. Needham, MD, PhD, FCPA
Mayo Clinic Florida Pro essor
Jacksonville, Florida [137] Division o Pulmonary &Critical Care Medicine
Department o Physical Medicine &Rehabilitation
Srinivasan Mukundan, MD, PhD School o Medicine, Johns Hopkins University
Associate Pro essor o Radiology Baltimore, Maryland [81]
Boston, Massachusetts [113] John Nelson, MD, MHM
Overlake Medical Center
L. Silvia Munoz-Price, MD, PhD Nelson Flores Hospital Medicine Consultants
Associate Pro essor o Clinical Medicine Bellevue, Washington [24]
Institute or Health and Society
Medical College o Wisconsin Karin J. Neu eld, MD, MPH
Enterprise Epidemiologist Clinical Director o Psychiatry
Froedtert Health System Johns Hopkins Bayview Medical Center
Milwaukee, Wisconsin [185] Associate Pro essor
Johns Hopkins University School o Medicine
Mandakolathur R. Murali, MD Department o Psychiatry and Behavioral Sciences
Director o Clinical Immunology Laboratory Baltimore, Maryland [81]
Harvard Medical School Tobenna Nwizu, MD
Boston, Massachusetts [230] Taussig Cancer Institute
Cleveland Clinic Foundation
Ernest Murray, MD Cleveland, Ohio [181]
Hospital Medicine Section
General Internal Medicine and Geriatrics Christopher D. Ochoa, MD
Medical University o South Carolina Fellow
Charleston, South Carolina [250] Pulmonary and Critical Care Medicine
Daniel M. Musher, MD Atlanta, Georgia [232]
Distinguished Service Pro essor o Medicine
Pro essor o Molecular Virology and Microbiology Victor M. Orellana, MD
Chie Emeritus, In ectious Disease Section Department o Medicine
Michael E. DeBakey VA Medical Center Rhode Island Hospital
Houston, Texas [186] Providence, Rhode Island [174]
xxviii
Karin Ouchida, MD Nicholas J. Pastis, MD
Assistant Pro essor o Medicine Assistant Pro essor o Medicine
Weill Cornell Medical College Division o Pulmonary and Critical Care
New York Presbyterian Hospital Medical University o South Carolina
New York, New York [167] Charleston, South Carolina [236]
Thomas A. Owens, MD Vihas Patel, MD

Vice President or Medical A airs Instructor
Chie Medical O cer Department o Surgery
Duke University Health System Director
Associate Pro essor o Medicine and Pediatrics Metabolic Support Service
C
Duke University School o Medicine Brigham and Women’s Hospital
O
Durham, North Carolina [189] Division o Trauma, Burn, and Surgical Critical Care
N
T
David A. Oxman, MD, FACP
R
I
B
U
Sidney Kimmel Medical College Timothy J. Patton, DO
T
O
Medical Intensive Care Unit Assistant Pro essor o Dermatology
R
Thomas Je erson University Hospital University o Pittsburgh
S
Philadelphia, Pennsylvania [206] Pittsburgh, Pennsylvania [144]
Menaka Pai, MD, MSc, FRCPC Jill M. Paulson, MD

Associate Pro essor Assistant Pro essor o Endocrinology
Department o Medicine George Washington University School o Medicine.
Associate Member, Department o Pathology and Molecular George Washington Medical Faculty Associates
Medicine Washington, DC [152]
McMaster University
Trans usion Medicine Quality Lead and Consultant Laboratory Allan B. Peetz, MD
Hematologist Instructor
Hamilton Regional Laboratory Medicine Program Department o Surgery
Hamilton, Ontario, Canada [56, 252] Brigham and Women’s Hospital
Division o Trauma, Burn, and Surgical Critical Care
Sumanta K. Pal, MD Harvard Medical School
Assistant Pro essor and Co-Director Boston, Massachusetts [42-45]
Kidney Cancer Program
Department o Medical Oncology &Experimental Therapeutics Vincent D. Pellegrini, Jr., MD
City o Hope Comprehensive Cancer Center John A. Siegling Pro essor and Chair
Duarte, Cali ornia [179] Department o Orthopedics
Robert M. Palmer, MD Charleston, South Carolina [65]
Director
Glennan Center or Geriatrics and Gerontology Jason Persof , MD, SFHM
Eastern Virginia Medical School University o Colorado School o Medicine
Nor olk, Virginia [87] Hospital Medicine Group
Aurora, Colorado [137]
Anand K. Pandurangi, MD, MBBS, DABPN
Pro essor o Psychiatry and Adjunct Pro essor o Radiology Brent G. Petty, MD
Vice Chair, Department o Psychiatry and Chair, Division o The Johns Hopkins Hospital
Inpatient Psychiatry Baltimore, Maryland [9]
Virginia Commonwealth University (VCU) Kurt P ei er, MD, FACP, FHM
Medical Director Pro essor o Medicine
Inpatient Psychiatry General Internal Medicine
VCU Health System Medical College o Wisconsin
Richmond, Virginia [225] Milwaukee, Wisconsin [51]
Jonathan B. Parr, MD, MPH Tania J. Phillips, MD
University o North Carolina School o Medicine Pro essor o Dermatology
Division o In ectious Disease Boston University School o Medicine
Chapel Hill, North Carolina [203] Boston, Massachusetts [148]
Jenni er C. Passini, MD Edward F. Pilkington, III, MD
Clinical Assistant Pro essor Instructor o Medicine
Hospital Medicine Hospitalist Service
University o Wisconsin Department o Medicine Brigham and Women’s Hospital
Madison, Wisconsin [153] Boston, Massachusetts [189]
xxix
Michael H. Pillinger, MD Amir A. Qamar, MD
Pro essor o Medicine and Biochemistry and Molecular Assistant Pro essor o Medicine
Pharmacology Tu ts University School o Medicine
Co-Director Boston, Massachusetts Senior Sta Hepatologist
NYU Crystal Diseases Study Group Lahey Hospital and Medical Center
New York University School o Medicine Burlington, Massachusetts [53]
Rheumatology Section Chie
VA New York Harbor Health Care System, New York Campus Susan Y. Quan, MD [97]
New York, New York [247] Clinical Assistant Pro essor (A liated)
Stan ord University School o Medicine
J. Richard Pittman, Jr., MD, FACP Division o Gastroenterology and Hepatology
C
Assistant Pro essor o Medicine Veterans A airs Palo Alto Healthcare System
O
Division o General Medicine and Geriatrics Palo Alto, Cali ornia
N
T
Timothy R. Quinn, MD, CM
R
I
B
Atlanta, Georgia [11, 101] Medical Director o Dermatopathology
U
Dermpath Diagnostics New England
T
O
Carol Pohlig, RN, BSN, CPC Marlborough, Massachusetts [146]
R
Senior Coding and Education Specialist
S
O ce o Clinical Documentation Talat H. Raja, MD
Department o Medicine Instructor
Hospital o the University o Pennsylvania Hospital Medicine
Philadelphia, Pennsylvania [27] Division o General Internal Medicine and Geriatrics
Timothy J. Poterucha, MD Charleston, South Carolina [82]
Resident Physician and Clinical Fellow
Harvard Medical School Graham W. Redgrave, MD
Department o Medicine Assistant Pro essor o Psychiatry and Behavioral Sciences
Brigham and Women’s Hospital Director or Residency Education
Boston, Massachusetts [108] Johns Hopkins School o Medicine
Assistant Director
Raymond O. Powrie, MD, FRCP, FACP Eating Disorders Program
Pro essor o Obstetrics, Gynecology, and Medicine The Johns Hopkins Hospital
Alpert School o Medicine o Brown University Baltimore, Maryland [226]
Chie Medical Quality O cer
Care New England John J. Reilly, Jr., MD
SVP or Population Health Vice Chancellor or Health A airs
Chie o Medicine Dean or School o Medicine
Women &In ants Hospital o Rhode Island University o Colorado School o Medicine
Providence, Rhode Island [219] Aurora, Colorado [60]
Michaella Maloney Prasad, MD Kerry Reynolds, MD

Assistant Pro essor o Urology and Pediatrics Instructor in Medicine
Medical University o South Carolina Harvard Medical School
Charleston, South Carolina [67] Attending Physician
Massachusetts General Hospital Cancer Center
Alicia Privette, MD Boston, Massachusetts [177, 183]
Assistant Pro essor o Surgery
Medical University o South Carolina Joseph Rhatigan, MD
Department o Surgery Associate Pro essor o Medicine
Charleston, South Carolina [46] Harvard Medical School
Division o Global Health Equity
Alberto Puig, MD, PhD, FACP Brigham and Women’s Hospital
Associate Pro essor o Medicine Boston, Massachusetts [e1]
Director Jessica Rimsans, PharmD, BCPS
Clinician Educator Service Senior Clinical Pharmacist
Massachusetts General Hospital Hemostatic and Antithrombotic Stewardship Pharmacist
Boston, Massachusetts [38] Brigham and Women’s Hospital
Rana C. Pullatt, MD, MS, MRCS, FACS, FASMBS
Diplomate in Obesity Medicine Tina Rizack, MD, MPH
Associate Pro essor o Surgery Assistant Pro essor o Medicine and Obstetrics and Gynecology
Director Robotic Surgery The Warren Alpert Medical School o Brown University
Director Bariatric Surgery VISN-7 Hematology/Oncology
Medical University o South Carolina Program in Women’s Oncology
Charleston, South Carolina [63] Women &In ants Hospital
xxx
Malcolm K. Robinson, MD Bradley T. Rosen, MD, MBA, FHM
Assistant Pro essor o Surgery Medical Director
Harvard Medical School ISP Hospitalist Service
Director Medical Director
Nutrition Support Service Supportive Care Medicine (Palliative Care)
Brigham and Women’s Hospital Director
Boston, Massachusetts [58] Care Transitions and Complex Medical Management
Associate Pro essor, Cedars-Sinai Medical Center
Katina Robison, MD Associate Pro essor, UCLA School o Medicine
Assistant Pro essor o Obstetrics and Gynecology Cedars-Sinai Health System
Program in Women’s Oncology Los Angeles, Cali ornia [120]
C
Department o Obstetrics and Gynecology, Women &
O
In ants’Hospital o Rhode Island Karen Rosene -Montella, MD, FACP
N
The Warren Alpert Medical School o Brown University Senior Vice President
T
R
Providence, Rhode Island [178] Vice Chair o Medicine or Quality/Outcomes
I
B
Division Chie Obstetric Medicine
U
Thomas P. Rocco, MD
T
Pro essor o Medicine and Obstetrics and Gynecology
O
Associate Pro essor o Medicine The Warren Alpert Medical School at Brown University
R
S
Providence, Rhode Island [219, 221, 222]
Clare Rock, MD, MS, MRCPI Assistant Pro essor o Medicine
Department o Medicine Harvard Medical School
Division o In ectious Diseases Hospitalist Service
Johns Hopkins University Brigham and Women’s Hospital
Baltimore, Maryland [195] Boston, Massachusetts [197, 201, 212]
Sarahi Rodríguez-Pérez, MD Stephen R. Rotman, MD
Director o Clinical Operations Gastroenterology Fellow
Assistant Pro essor o Clinical Medicine Brigham and Women’s Hospital
Miller School o Medicine Boston, Massachusetts [156]
University o Miami Hospital Joseph Rudolph, MD
Miami, Florida [37] Department o Neurology
Cleveland Clinic
Vinayak S. Rohan, MD Cleveland, Ohio [210]
Department o Surgery
Medical University o South Carolina Matthew L. Russell, MD, MSc
Charleston, South Carolina [66] Medical Director
Rehabilitation Service Units
Karen L. Roos, MD Hebrew Rehabilitation Center
John and Nancy Nelson Pro essor o Neurology Hebrew Senior Li e
Pro essor o Neurological Surgery Boston, Massachusetts [73]
Indiana University School o Medicine
Indianapolis, Indiana [192] Daniel F. Ruthven, MD
Clinical Associate o Psychiatry and Behavioral Sciences
Alexander E. Ropper, MD Johns Hopkins University School o Medicine
Assistant Pro essor Baltimore, Maryland [226]
Department o Neurosurgery
Baylor College o Medicine Arturo P. Saavedra, MD, PhD
Houston, Texas [208] Assistant Pro essor
Allan H. Ropper, MD, FRCP Medical Director
Pro essor o Neurology Medical Dermatology
Harvard Medical School Massachusetts General Hospital
Executive Vice Chair o Neurology Boston, Massachusetts [145]
Boston, Massachusetts [208, 212] Michel J. Sabbagh, MD
Assistant Pro essor
Anesthesia and Perioperative Medicine
Cheryl A. Sadow, MD
Assistant Pro essor o Radiology
Division o Abdominal Imaging and Intervention
xxxi
Bisan A. Salhi, MD, MA Jef rey L. Schnipper, MD, MPH, FHM
Assistant Pro essor o Emergency Medicine Associate Pro essor o Medicine
Emory University Harvard Medical School
Department o Emergency Medicine Director o Clinical Research, Hospitalist Service
Atlanta, Georgia [121] Brigham and Women’s Hospital
Boston, Massachusetts [40, 151]
John R. Saltzman, MD, FACP, FACG, FASGE, AGAF
Associate Pro essor o Medicine Robert W. Schrier, MD, MACP
Harvard Medical School Pro essor Emeritus o Medicine
Director o Endoscopy University o Colorado School o Medicine
Brigham and Women’s Hospital Division o Renal Diseases and Hypertension
C
Boston, Massachusetts [156, 162] University o Colorado Hospital
O
Aurora, Colorado [242]
N
Kenneth Sands, MD, MPH
T
Associate Pro essor o Medicine Allison R. Schulman, MD
R
I
B
Harvard Medical School Gastroenterology Fellow
U
Senior Vice President, Health Care Quality Brigham and Women’s Hospital
T
O
Beth Israel Deaconess Medical Center Boston, Massachusetts [158]
R
S
David A. Schulman, MD, MPH, FCCP
Milda Saunders, MD, MPH Associate Pro essor o Medicine
Assistant Pro essor Division o Pulmonary, Allergy Critical Care, and Sleep Medicine
Section o Hospital Medicine and MacLean Center or Clinical Emory University School o Medicine
Medical Ethics Atlanta, Georgia [235]
University o Chicago Sam Schulman, MD, PhD
Chicago, Illinois [e3] Thrombosis Service, McMaster Clinic
Hamilton Health Sciences-General Hospital
Marianne E. Savastano, MS, CCC-SLP Hamilton, Ontario, Canada [173]
Speech/Language Pathology Practice Leader
Stroke and Spinal Cord Injury Programs Richard M. Schwartzstein, MD
Spaulding Rehabilitation Hospital Gordon Pro essor o Medicine and Medical Education
Boston, Massachusetts [70] Harvard Medical School
Associate Chie , Division o Pulmonary, Critical Care, and
Paul E. Sax, MD Sleep Medicine
Pro essor o Medicine Beth Israel Deaconess Medical Center
Division o In ectious Diseases Julian L. Sei ter, MD
Boston, Massachusetts [203] Harvard Medical School
Senior Nephrologist and the James Haidas Family Master Clinician
Adam C. Schaf er, MD Brigham and Women’s Hospital
Instructor in Medicine Boston, Massachusetts [61]
Hospital Medicine Unit Samir K. Shah, MD
Brigham and Women’s Hospital Division o Vascular Surgery
Boston, Massachusetts [35, 111] Brigham and Women’s Hospital
Chie Quality O cer and Hospitalist Daniel S. Shapiro, MD
Associate Pro essor o Medicine Pro essor o Internal Medicine
Medical University o South Carolina University o Nevada School o Medicine
Charleston, South Carolina [82, 190] Reno, Nevada [e5]
Lynn Schlanger, MD Ann M. Sheehy, MD, MS

Associate Pro essor Associate Pro essor and Division Head, Hospital Medicine
Emory University School o Medicine Department o Medicine
Atlanta, Georgia [241] University o Wisconsin
Madison, Wisconsin [153]
Robert K. Schneider, MD, FACP
Associate Pro essor Eugenie Shieh, MD
Departments o Psychiatry, Internal Medicine, and Family Medicine Clinical Fellow
Virginia Commonwealth University Johns Hopkins Medicine
Director o Mental Health and Primary Care Integration Division o Gastroenterology
McGuire VA Medical Center Baltimore, Maryland [80]
Richmond, Virginia [227]
xxxii
Deborah M. Siegal, MD, MSc, FRCPC Scot T. Smith, MD
Division o Hematology and Thromboembolism Chie Medical O cer
Department o Medicine Sound Physicians
McMaster University Denver, Colorado [25]
Diana L. Snow, MA, CCS, CPC, CHC
Eric M. Siegal, MD, SFHM Director o Revenue Integrity &Quality
Clinical Associate Pro essor o Medicine (Adjunct) University o Utah Healthcare
University o Wisconsin School o Medicine and Public Health University o Utah School o Medicine
Medical Director Salt Lake City, Utah [31]
Aurora Critical Care Service
David R. Snydman, MD, FACP, FIDSA
C
Aurora St Luke’s Medical Center
O
Milwaukee, Wisconsin [138] Pro essor
N
Tu ts University School o Medicine
T
Mark Siegler, MD Chie , Division o Geographic Medicine and In ectious Diseases
R
I
B
Lindy Bergman Distinguished Service Pro essor Hospital Epidemiologist
U
Pro essor, Departments o Medicine and Surgery Tu ts Medical Center
T
O
Director Boston, Massachusetts [191]
R
MacLean Center or Clinical Medical Ethics
S
University o Chicago Medical Center Society o Hospital Medicine Key Characteristics
Chicago, Illinois [e3] Workgroup [24]
Members o the Society o Hospital Medicine Key Characteristics
Ross D. Silverman, JD, MPH Workgroup are Patrick Cawley, MD, Steven Deitelzweig, MD, Leslie
Pro essor o Health Policy and Management Flores, MHA, Joseph Miller, MS, John Nelson, MD, Scott Rissmiller,
Indiana University Richard M. Fairbanks School o Public Health MD, Laurence Wellikson, MD, and Winthrop Whitcomb, MD
Pro essor o Public Health and Law
Indiana University Robert H. McKinney School o Law Aaron Sodickson, MD, PhD
Indianapolis, Indiana [34] Associate Pro essor o Radiology
Christian T. Sinclair, MD, FAAHPM Section Chie o Emergency Radiology
Assistant Pro essor Medical Director o CT
Division o Palliative Medicine Brigham and Women’s Hospital
University o Kansas Medical Center Boston, Massachusetts [113]
Kansas City, Kansas [217]
Lauge Sokol-Hessner, MD
Ajay K. Singh, MBBS, MBA, FRCP Instructor in Medicine
Renal Division Harvard Medical School
Brigham and Women’s Hospital Associate Director o Inpatient Quality
Boston, Massachusetts [239] Attending Hospitalist
Beth Israel Deaconess Medical Center
Anika T. Singh Boston, Massachusetts [16]
Renal Division
Brigham and Women’s Hospital Margarita Sotelo, MD
Boston, Massachusetts [239] Associate Clinical Pro essor
Divisions o Geriatrics and Hospital Medicine
Mousumi Sircar, MD San Francisco General Hospital
Geriatrics Fellow
San Francisco, Cali ornia [165]
Department o Gerontology Geof rey L. Southmayd, MD
Beth Israel Deaconess Medical Center Instructor o Medicine
Boston, Massachusetts [73] Emory University School o Medicine
Chie Medical Resident, Emory University Hospital
Gerald W. Smetana, MD, FACP J. Willis Hurst Internal Medicine Residency Program
Division o General Medicine and Primary Care Nathan Spell, MD
Beth Israel Deaconess Medical Center Associate Pro essor o Medicine
Boston, Massachusetts [51] Emory University School o Medicine
Chie Quality O cer
Dustin T. Smith, MD Emory University Hospital
Atlanta, Georgia [8, 10]
Kelly Cunningham Sponsler, MD, SFHM
Robert L. Smith, MD Assistant Pro essor o Medicine
Associate Pro essor
Section o Hospital Medicine
Division o Pulmonary and Critical Care
Vanderbilt University Medical Center
New York University School o Medicine
Nashville, Tennessee [14]
Harbor VA Medical Center
New York, New York [141]
xxxiii
Jerry E. Squires, MD, PhD Ashley Stuckey, MD
Department o Pathology and Laboratory Medicine Assistant Pro essor o Obstetrics and Gynecology
Medical University o South Carolina Program in Women’s Oncology
Charleston, South Carolina [57] The Warren Alpert Medical School o Brown University
Department o Obstetrics and Gynecology
Christopher J. Standaert, MD Women &In ants’Hospital o Rhode Island
Clinical Associate Pro essor Providence, Rhode Island [178]
Rehabilitation Medicine, Neurological Surgery, and Orthopedics
and Sports Medicine Prem S. Subramanian, MD, PhD
University o Washington School o Medicine Pro essor o Ophthalmology, Neurology, and Neurosurgery
University o Washington Medicine Sports and Spine Physicians Vice Chair or Academic A airs, Department o Ophthalmology
C
Clinic University o Colorado School o Medicine
O
Harborview Medical Center Aurora, Colorado [83]
N
Seattle, Washington [69]
T
Ram M. Subramanian, MD
R
I
Gerald W. Staton, MD
B
Associate Pro essor o Medicine and Surgery
U
Pro essor o Medicine Hepatology and Critical Care
T
O
Division o Pulmonary and Emory University School o Medicine
R
Critical Care Medicine Atlanta, Georgia [159]
S
Emory University School o Medicine Katelyn W. Sylvester, PharmD, BCPS, CACP
Atlanta, Georgia [232] Pharmacy Manager
Clinical Pharmacy Specialist
Arlene Stecenko, MD Brigham and Women’s Hospital
Associate Pro essor o Pediatrics and Medicine Boston, Massachusetts [254]
Chie , Division o Pulmonary, Allergy and Immunology,
Cystic Fibrosis and Sleep Jef rey A. Tabas, MD
Department o Pediatrics Pro essor o Emergency Medicine
Director Director o Outcomes and Innovations
Emory-Children’s Center or Cystic Fibrosis O ce o Continuing Medical Education
Associate Director University o Cali ornia
Emory-Children’s Center or Cystic Fibrosis and Airways San Francisco School o Medicine
Disease Research San Francisco, Cali ornia [36]
Emory University School o Medicine Jenni er K. Tan, MD
Atlanta, Georgia [234] Associate Physician
Daniel I. Steinberg, MD Northstar Dermatology
Mount Sinai Beth Israel Fort Worth, Texas [149]
New York, New York [7] Todd A. Taylor, MD
Michael Sterling, MD Assistant Pro essor o Emergency Medicine
Assistant Pro essor o Medicine Emory University
Division o Pulmonary, Allergy and Critical Care Medicine Atlanta, Georgia [121]
Emory University School o Medicine Tracy J. Tipton, MD
Atlanta, Georgia [139] Urology Resident
Theodore A. Stern, MD Medical University o South Carolina
Ned H. Cassem Pro essor o Psychiatry in the eld o Charleston, South Carolina [67]
Psychosomatic Medicine/Consultation Catherine Dawson Tobin, MD
Harvard Medical School Assistant Pro essor
Chie , Avery D. Weisman Psychiatry Consultation Service Anesthesia and Perioperative Medicine
Massachusetts General Hospital Medical University o South Carolina
Director Charleston, South Carolina [62]
O ce or Clinical Careers
Massachusetts General Hospital Derrick J. Todd, MD, PhD
Boston, Massachusetts [229] Instructor in Medicine
Melissa B. Stevens, MD Division o Rheumatology
Assistant Pro essor o Medicine Brigham and Women’s Hospital
Division o Hospital Medicine Boston, Massachusetts [246]
Atlanta, Georgia David Tong, MD, MPH
Atlanta VA Medical Center Assistant Pro essor o Hospital Medicine
Decatur, Georgia [12] Department o Medicine
xxxiv
Anne C. Travis, MD, MSc Madeleine Verhovsek, MD, FRCPC
Department o Medicine Assistant Pro essor
Division o Gastroenterology, Hepatology and Endoscopy Division o Hematology and Thromboembolism
Brigham and Women’s Hospital McMaster University
Boston, Massachusetts [162] Consultant Laboratory Hematologist, Red Cell Disorders Laboratory,
Hamilton Regional
Glenn J. Treisman, MD, PhD Laboratory Medicine Program
Eugene Meyer, III Pro essor o Psychiatry and Medicine Hamilton, Ontario, Canada [77, 169]
Departments o Psychiatry and Behavioral Sciences and
Internal Medicine Donald C. Vinh, MD, FRCPC, FACP
Johns Hopkins University School o Medicine Assistant Pro essor
C
Baltimore, Maryland [228] Faculty o Medicine
O
McGill University
N
Elly Trepman, MD Division o In ectious Diseases, Department o Medicine
T
Department o Medical Microbiology
R
McGill University Health Centre
I
B
University o Manitoba Montreal, Quebec, Canada [202]
U
Winnipeg, Manitoba, Canada [147]
T
O
Kittane S. Vishnupriya, MBBS
Geof rey Tsaras, MB, ChB, MPH
R
S
Clinical Assistant Pro essor o Medicine Johns Hopkins University School o Medicine
University o Illinois College o Medicine at Rock ord Baltimore, Maryland [79]
Rock ord, Illinois [194]
Ruth Ann Vleugels, MD, MPH
Jef rey Turner, MD Associate Pro essor o Medicine
Assistant Pro essor o Medicine Harvard Medical School
Section o Nephrology Director
Yale University School o Medicine Autoimmune Skin Disease Program
New Haven, Connecticut [245] Department o Dermatology
Amit Uppal, MD Brigham and Women’s Hospital
Assistant Program Director Boston, Massachusetts [149]
Director o MICU Megan Ann Waldrop, MD
Bellevue Hospital Pediatric Neurology Fellow
Division o Pulmonary, Critical Care, and Sleep Medicine University o Cali ornia, Irvine
New York University Medical Center Children’s Hospital o Orange County
New York, New York [140] Orange, Cali ornia [213]
W. Alexander Vandergri t, III, MD Ruth H. Walker, MB, ChB, PhD
Associate Pro essor Neurosurgery Departments o Neurology
Medical University o South Carolina James J. Peters Veterans A airs Medical Center, Bronx, NY
Charleston, South Carolina [64] Mount Sinai School o Medicine
Joseph Varon, MD, FACP, FCCP, FCCM, FRSM New York, New York [210]
Chie o Critical Care Services Leon Walthall, MD
University General Hospital Hospital Medicine Section
Pro essor General Internal Medicine and Geriatrics
Department o Acute and Continuing Care Medical University o South Carolina
University o Texas Health Science Center at Houston Charleston, South Carolina [250]
Clinical Pro essor o Medicine
University o Texas Medical Branch at Galveston David A. Walton, MD, MPH
Pro essor o Medicine and Surgery UDEM, UNE, UABC, UAT, Division o Global Health
Anahuac, UACH, USON, UPAEP – Mexico [91] Brigham and Women’s Hospital
Boston, Massachusetts [e1]
Alvaro Velasquez, MD
Assistant Pro essor o Medicine John Scott Walton, MD
Division o Critical Care and Respiratory Medicine Associate Pro essor
Emory University School o Medicine Anesthesia and Perioperative Medicine
Atlanta, Georgia [90] Medical University o South Carolina
Nicole F. Velez, MD
Westmoreland Dermatology Associates
University o Pittsburgh Medical Center East
Pittsburgh, Pennsylvania [145]
xxxv
Annabel Kim Wang, MD Tosha B. Wetterneck, MD, MS
Associate Pro essor (Neurology) Department o Medicine
University o Cali ornia, Irvine School o Medicine and Public Health
Orange, Cali ornia Center or Quality and Productivity Improvement
Sta Neurologist University o Wisconsin Madison
VA Long Beach Healthcare System Madison, Wisconsin [41]
Long Beach, Cali ornia [213]
Omar Wever-Pinzon, MD
Sally Wang, MD Assistant Pro essor o Medicine
Instructor University o Utah School o Medicine
Harvard Medical School Department o Medicine, Cardiology Division,
C
Hospitalist Heart Failure Section
O
Brigham and Women’s Hospital University o Utah Health Science Center
N
Boston, Massachusetts [126] Salt Lake City, Utah [129]
T
R
I
Martha C. Ward, MD Christopher M. Whinney, MD, FACP, FHM
B
U
Assistant Pro essor Clinical Assistant Pro essor o Medicine
T
O
Department o Psychiatry and Behavioral Sciences Cleveland Clinic Lerner College o Medicine
R
Department o Medicine Chairman, Department o Hospital Medicine
S
Society Advisor, Osler Society Cleveland Clinic
Assistant Course Director Cleveland, Ohio [4]
Essentials o Patient Care Course
Emory University School o Medicine I. David Wiener, MD
Atlanta, Georgia [223] Pro essor o Medicine and Physiology and Functional Genomics
University o Florida College o Medicine
Theodore E. Warkentin, MD, FRCP(C), FACP, FRCP(Edin) Chie , Nephrology and Hypertension Section
Pro essor Gainesville VA Medical Center
Department o Pathology and Molecular Medicine and Department Gainesville, Florida [238]
o Medicine Michael G. DeGroote School o Medicine
McMaster University Jef rey G. Wiese, MD, FACP, FSM, SFHM
Trans usion Medicine, Hamilton Regional Laboratory Medicine Pro essor o Medicine
Program Tulane University
Service o Clinical Hematology, Associate Chairman, Department o Medicine
Hamilton General Hospital Senior Associate Dean or Graduate Medical Education
Hamilton, Ontario, Canada [171] Director
Tulane Internal Medicine Program
Kathryn Webert, MD, MSc, FRCPC Tulane University Health Sciences Center
Associate Pro essor New Orleans, Louisiana [92, 94]
Department o Pathology and Molecular Medicine
McMaster University B. Robinson Williams, III, MD
Medical Director, Utilization Assistant Pro essor o Medicine
Canadian Blood Services Program Director
Hamilton, Ontario, Canada [172] Cardiovascular Disease Fellowship
Steven Weinberger, MD, FACP Atlanta, Georgia [135]
Executive Vice President and CEO
American College o Physicians Neil H. Winawer, MD, SFHM
Adjunct Pro essor o Medicine Pro essor o Medicine
University o Pennsylvania Emory University School o Medicine
Philadelphia, Pennsylvania Director
Senior Lecturer on Medicine Hospital Medicine Unit
Harvard Medical School Grady Memorial Hospital
Boston, Massachusetts [6] Atlanta, Georgia [230]
Saul N. Weingart, MD, PhD Eric S. Winer, MD

Chie Medical O cer and Senior VP Medical A airs Division o Hematology/Oncology
Tu ts Medical Center Rhode Island Hospital
Pro essor o Medicine Providence, Rhode Island [174]
Tu ts University School o Medicine Kristin R. Wise, MD, FHM
Boston, Massachusetts [15] Assistant Pro essor o Medicine
Stacy Westerman, MD, MPH Hospital Medicine Section, General Internal Medicine and Geriatrics
Fellow, Cardiovascular Disease Medical University o South Carolina
Department o Medicine, Division o Cardiology Charleston, South Carolina [250]
xxxvi
Karl D. Wittnebel, MD, MPH Brian K. Yorkgitis, DO
Medical Director Assistant Pro essor
Pre-Operative Pain Program Department o Surgery
Department o Medicine University o Florida College o Medicine-Jacksonville
Cedars-Sinai Medical Center Jacksonville, Florida [43]
Hospitalist
Division o General Internal Medicine Bishoy Zakhary, MD
Cedars-Sinai Medical Center Pulmonary and Critical Care Fellow
Los Angeles, Cali ornia [120] Department o Pulmonary, Critical Care, and Sleep Medicine
New York University Medical Center
Brian D. Wol e, MD New York, New York [140]
C
O
Hospital Medicine Section Shanta M. Zimmer, MD
N
University o Colorado Denver Associate Pro essor o Medicine
T
University o Pittsburgh
R
University o Colorado Hospital
I
B
Aurora, Colorado [59] Director
U
Internal Medicine Residency Training Program
T
O
Kenneth E. Wood, DO, FCCP University o Pittsburgh Medical Center
R
Chie Medical O cer Pittsburgh, Pennsylvania [88]
S
Geisinger Medical Center
Director Camilla Zimmermann, MD, PhD, FRCPC
Center or Systems Re-engineering in Healthcare, Geisinger Head, Palliative Care Program
Health System University Health Network
Clinical Pro essor o Medicine Director o Research
Temple University School o Medicine Lederman Palliative Care Centre
Geisinger Medical Center Princess Margaret Hospital
Danville, Pennsylvania [153] Associate Pro essor o Medicine
University o Toronto
Rollin Wright, MD Toronto, Ontario, Canada [215]
Division o Geriatric Medicine and Gerontology
University o Pittsburgh
Pittsburgh, Pennsylvania [87]
Irene M. Yeh, MD, MPH

Division o Adult Palliative Care
Dana-Farber Cancer Institute
xxxvii
SECTION REVIEWERS
Joanna M. Bonsall, MD, PhD Don S. Dizon, MD, FACP
Assistant Pro essor o Medicine Associate Pro essor o Medicine
Division o Hospital Medicine Harvard Medical School
Emory University School o Medicine Clinical Co-Director, Gynecologic Oncology
S
E
Atlanta, Georgia Director
C
Part I, Section 3 The Oncology Sexual Health Clinic
T
I
Massachusetts General Hospital Cancer Center
O
Yvette M. Cua, MD
N
Associate Pro essor o Medicine Part VI, Section 7
R
E
V
Associate Vice Chair or Clinical A airs Francine L. Jacobson, MD, MPH
I
E
Department o Medicine Thoracic Radiologist at Brigham and Women’s Hospital
W
University o Louisville Assistant Pro essor
E
R
Louisville, Kentucky Department o Radiology
S
Part I, Section 6 Harvard Medical School
Jatin K. Dave, MD, MPH Part V, Section 2
Part-Time Instructor
Harvard Medical School Tina Rizack, MD, MPH
Division o Aging, Brigham and Women’s Hospital Assistant Pro essor o Medicine and Obstetrics and Gynecology
Boston, Massachusetts The Warren Alpert Medical School o Brown University
Medical Director Hematology/Oncology
Geriatrics and Senior Care Options Program in Women’s Oncology
Tu ts Health Plan Women &In ants Hospital
Watertown, Massachusetts Providence, Rhode Island
Part III Part VI, Section 7
Steven B. Deitelzweig, MD, MMM, SFHM, FACP Karen Rosene -Montella, MD, FACP
Ochsner Health System Senior Vice President
Medical Director o Regional Business Development Women’s Services and Clinical Integration, Li espan
System Chairman, Hospital Medicine Vice Chair o Medicine or Quality/Outcomes
Associate Pro essor o Medicine-Ochsner Clinical School Division Chie Obstetric Medicine
Part I, Section 5 Pro essor o Medicine and Obstetrics and Gynecology
The Warren Alpert Medical School at Brown University
Providence, Rhode Island
Part VI, Section 12
Dustin T. Smith, MD
Atlanta, Georgia
Part I, Section 2
xxxix
FOREWORD
I well remember reading the landmark article by Wachter and important topics in both clinical and nonclinical areas, ranging rom
Goldman entitled “The emerging role o ‘hospitalists’ in the value-based medicine to transplant surgery consultation. The sec-
American health care system,” published in the New England Journal tion on billing, coding, and clinical documentation has been greatly
of Medicine in 1996.1 In this article, the authors recognized the need expanded, as has coverage o a wide host o malignancies. Because
F
or “a new breed o physicians … specialists in inpatient medicine” o the importance o the recovery period and transitions to a variety
O
R
and coined the term “hospitalist” to re er to this new type o physi- o settings a ter hospital discharge, a welcome new section on reha-
E
cian specialist. Since then, the specialty o hospital medicine has bilitation and skilled nursing care has also been added.
W
become an increasingly popular and success ul career pathway, The editors and authors are to be congratulated on again having
O
R
and has expanded beyond its roots in internal medicine to other made a major contribution to the care o hospitalized patients and
D
disciplines, such as pediatrics, amily practice, and obstetrics. The to those physicians, whether or not they ormally identi y them-
Society o Hospital Medicine estimated there were approximately selves as hospitalists, who care or these patients. Given the breadth
44,000 hospitalists in the United States in 2014, and predicted that and the depth o this text, there are ew questions that clinicians
number will continue to grow.2 will not be able to answer or guidance that they will not be able to
When hospital medicine started, the expertise o hospitalists was obtain about how to provide the best care or the wide spectrum o
ocused on the clinical issues surrounding care o the hospitalized their hospitalized patients.
patient. More recently, there has been increasing emphasis on the Steven E. Weinberger, MD, MACP, FRCP
hospitalist’s role in designing and improving the systems o care Executive Vice President and Chie Executive O cer
in the hospital. These added responsibilities have necessitated an American College o Physicians
expansion o the hospitalist’s skills set beyond just a clinical knowl- Adjunct Pro essor o Medicine
edge base to an understanding o such topics as teamwork, transi- Perelman School o Medicine at the University o Pennsylvania
tions o care, quality metrics and improvement, and patient sa ety, Senior Lecturer on Medicine
among many others. A consequence o this proli eration o speci c Harvard Medical School
competencies has been the creation o an optional pathway or
internal medicine hospitalists to maintain their certi cation with the
American Board o Internal Medicine, o cially re erred to as Focused
Practice in Hospital Medicine. REFERENCES
In the rst edition o Principles and Practice of Hospital Medicine,
1. Wachter RM, Goldman L. The emerging role o “hospitalists” in
McKean and her co-editors took on the herculean task o assem-
the American health care system. N Engl J Med. 1996;335:514-517.
bling an outstanding group o contributing authors and putting
together a superb, comprehensive textbook o hospital medicine 2. Bureau o Labor Statistics. http://www.bls.gov/careeroutlook/
that was published in 2012. In this second edition, the editors 2015/youre-a-what/hospitalist.htm . Accessed April 12, 2016.
have not only updated content but have also added a number o
xli
PREFACE
Since its initial publication in 2012, Principles and Practice of Hospital concentrates on what the consulting hospitalist needs to know
Medicine has become established as a leading resource or the when consulting on patients undergoing bariatric surgery, neuro-
specialty o hospital medicine. More than 200 renowned generalists surgery, orthopedic surgery, transplant surgery and urologic proce-
and specialists contributed to make this book comprehensive and dures. All chapters ocus on problems commonly encountered in
P
authoritative, but as practical as possible. Clinical chapters presented the hospital setting, such as assessment and management o the
R
E
questions that commonly arise in the course o practice and empha- diabetic patient, risk assessment and risk reduction or patients with
F
A
sized core concepts with well-illustrated subject matter, radiology, end-stage liver disease, and preoperative assessment o patients
C
clinical images and quick-view decision trees. The scope o content with hematologic disorders.
E
de ned most o the eld o hospital medicine as it existed in 2012, Part III: Rehabilitation and Skilled Nursing Care. This new part,
and the ormat o the text itsel was enhanced both with an online written primarily by experts in rehabilitation medicine, provides
edition available through the widely used AccessMedicine.com, and key in ormation that hospitalists need to consider as they work to
an app version or use on iPad. ensure sa e transitions rom the inpatient setting to extended care
Since the publication o the rst edition, the eld o hospital acilities. Individual chapters address rehabilitation options, physi-
medicine has continued to evolve into areas beyond evidence- cal and occupation therapy, common issues such as bowel and
based general medical care into the practice o co-management bladder incontinence, dysphagia, pressure ulcers, care o surgical
o surgical and medical subspecialties, rehabilitation medicine, and wounds and pressure ulcers. The chapter on patient sa ety and quality
palliative care. Driven by quality improvement e orts, as well as improvement emphasizes core concepts embraced by hospitalists—
reimbursement models such as bundled payments, the last ew the multidisciplinary approach, prevention o complications, and
years have seen an increased emphasis on coordination o care patient-centered communication in the transition o patients to
between acute care hospitals and other settings, including skilled and rom the post-acute setting. The chapter on hospice ocuses on
nursing acilities, rehabilitation acilities, and long-term acute care common issues that clinicians need to address as they shi t toward
acilities. The rapid growth o the eld has been accompanied by an palliative care and consider the best setting or their patients.
emerging cadre o outstanding clinicians and leaders, both at the Part IV: Approach to the Patient at the Bedside. These chap-
local, national, and international level, and this book is the product ters provide detailed guidance or the initial inpatient evaluation,
o their collective e orts. diagnostic testing, and management o patients with common
The second edition o Principles and Practice of Hospital Medicine presenting complaints that may be encountered at the time o
provides tools to address the unique set o challenges hospitalists admission or in the middle o the night. Each disorder is addressed
ace in a healthcare system that ought to be sa er and more e ec- rom the perspective o hospital care, which in many cases di ers
tive. It comprehensively covers topics not included in any other signi cantly rom initial outpatient care or the same complaint.
print or online textbook. For example, this edition has new sections Even experienced clinicians will nd value in reviewing an initial,
and chapters on the value and values o hospital medicine; practi- sometimes algorithmic, approach to common problems such as
cal, specialty in ormation relating to what consulting hospitalists anemia, alls, delirium, dizziness and vertigo, insomnia, numbness,
need to know as they co-manage patients rom other services; key and weakness (how to localize the problem). Many o the chapters
in ormation in rehabilitation and skilled nursing care pertinent to re er to subsequent chapters in Part VI, which covers the diagnosis
patient sa ety and quality; expanded content on the approach to and management o speci c diagnoses.
the patient at the bedside and clinical conditions in the inpatient Part V: Diagnostic Testing and Procedures. E ciency o care,
setting. Using the basic ormat o the rst edition, all content has reduced cost, especially length o stay, coupled with high quality
been updated to incorporate new medical knowledge relevant to begins with clinical problem solving at the time o admission. This
the practice o hospital medicine. part explains how to interpret common admission tests, such as liver
The second edition has six major parts, covering issues o impor- biochemical tests or arterial blood gas reports, and how to avoid
tance to hospitalists everywhere: waste ul, unnecessary medical tests and treatments. The radiology
Part I: The Specialty of Hospital Medicine and Systems of Care. section reviews indications o radiology studies typically ordered in
The authors o this section represent some o the most knowledge- the hospital setting, a general approach to interpretation, patient
able and orward-thinking people in the areas o value based medi- sa ety issues in imaging and procedures per ormed by interven-
cine, critical decision making at the point o care, transitions o care, tional radiologists. A comprehensive textbook in hospital medicine
patient sa ety and quality improvement, practice management, would not be complete without a section on procedures. The
ethics and pro essional development. This part emphasizes the mul- procedures’ section provides some standardization o procedure
tidisciplinary approach, teamwork, prevention o hospital-acquired per ormance, highlights indications, initial assessment, prevention
complications, and patient-centered communication to ensure sa e o complications, and interpretation o results with links to video
and e cient care transitions and hando s. online resources that provide additional instruction, not possible
Part II: Medical Consultation. This part explains the traditional in a text ormat. This section includes the core set o procedures
role o the medical consultant and updates preoperative cardiac most likely to be per ormed or supervised by hospitalists and
and pulmonary risk assessment and risk reduction. Chapters that acknowledges local and regional variations in the role o hospitalists
ref ect the evolving role o hospitalists in co-management o surgi- per orming or supervising these procedures.
cal patients include general principles o surgery and anesthesia, Part VI: Clinical Conditions in the Inpatient Setting. Updated
perioperative pain management, and management o common clinical content across the breadth o hospital medicine includes major
complications in noncardiac surgery. The surgical specialties section disciplines in internal medicine such as cardiology, gastroenterology,
xliii
and in ectious diseases as well as sections with special relevance to hospital medicine has evolved and the skills required o hospitalists
hospital medicine, such as geriatrics, palliative care, psychiatry, toxi- so that they can provide exceptional patient care and clinical care
cology, and addiction. In response to the evolving role o hospitalists leadership. We thank the American College o Physicians or its col-
on oncology inpatient services, the section covering hematology laborative publishing arrangement with McGraw-Hill that included
and oncology has been substantially expanded. input into the editors, contributors, and overall scope or this new
Electronic chapters (available on AccessMedicine.com) cover edition. Through its engagement in this book, the college advances
hospital medicine aspects o global health and hospital medicine, it mission to enhance the quality and e ectiveness o health care.
the core competencies o hospital medicine, the economics o
health care, principles o medical ethics, and bioterrorism. Sylvia C. McKean, MD, FACP, SFHM
In summary, the second edition o Principles and Practice of
Hospital Medicine takes into account how the eld and practice o
P
R
E
F
A
C
E
xliv
Another random document with
no related content on Scribd:
where everyone had become alive to the fact that all was over for us.
Where was my husband? What had become of them all? This
thought nearly drove me mad with anxiety. I could not imagine what
their fate had been, but I knew the anguish of mind my husband
would endure when the sound of those terrible guns would tell him
that we were being attacked again, as he knew we were almost
powerless to make any resistance, through lack of ammunition.
We knew that our one chance lay in retreating, as that move had
been meditated by Colonel Skene early in the evening, before the
truce had taken place; so after an hour had gone by the doctor
began moving the wounded out of the cellar, as an immediate retreat
had been decided upon.
We were still without any definite tidings of the position of Mr.
Quinton and my husband, and the other officers who had
accompanied them, and our anxiety on their behalf increased every
hour.
It took a long time to get all the wounded on to the grass outside.
Mr. Brackenbury was moved first. Poor lad! he begged so hard to be
left in peace where he was, and the moving caused him terrible
agony. One by one all the poor fellows were helped out, until only a
few remained. I gave my arm to one of these, and we were going out
through the cellar door, when we were met by four Kahars, carrying
someone back into the hospital. The moonlight shone down upon
them as they came, and lit up the white face of him they carried, and
I saw that it was Mr. Brackenbury. The movement had killed him, and
he had died on the grass outside a few seconds after leaving the
cellar. Better thus than if he had lived a few hours longer to bear the
pain and torture of our terrible march; but it made one’s heart ache to
leave that young lad lying there dead, alone in the darkened cellar. I
went back there just before we left the place, and covered him up
gently with a sheet that was lying on the ground, and I almost envied
him, wrapped in the calm slumber of death, which had taken all pain
and suffering away.
I had no hope that we should ever succeed in making our escape,
and it seemed almost useless even to make the attempt. All was
ready, however, by this time for our departure, and I went out too,
hoping that the Manipuris would soon set fire to the house, which
would prevent any indignities being heaped upon the dead by their
victorious enemies.
Outside the noise was deafening. Shells burst around us at every
turn, and kept striking the trees and knocking off great branches. All
idea of going up into the house had to be abandoned, so I could not
get a hat or cloak or anything for the journey before us, and had to
start as I was. Just before lunch-time I had taken off the close-fitting
winter gown which I had put on in the morning, and instead had
arrayed myself in a blue serge skirt and white silk blouse, which
gave me more freedom for my work in the hospital. I could not have
chosen better as far as a walking costume went, and should have
been all right if only I had been able to collect a few outdoor
garments—hat, cloak, and boots, for instance. As things happened, I
was wearing on my feet thin patent leather slippers, which were
never meant for out-of-door use, and my stockings were the ordinary
flimsy kind that women generally wear. My dress had got soiled
already in the hospital, and was not improved by the march
afterwards; but I managed to get it washed when we eventually
reached British territory, and have it by me to this day. It will be
preserved as an interesting relic.
CHAPTER XVI.
Escape of the servants—Mr. Gurdon comes for me—Away from shelter and one’s
life in one’s hands—Over the hedge and across the river—Lie in the ditch for
shelter from shot—Fired on at Burri Bazaar.
The bustle and confusion outside were great. The Sepoys were
being mustered into marching order, but around them on all sides
people were rushing about, knocking each other over in their
eagerness to make good their escape. These were chiefly servants,
Bunnias,[17] and the many followers who accumulate wherever a
regiment goes.
I stood for some time watching them tearing away, until a sudden
fear took hold of me that I had been forgotten and left behind. I was
meditating going myself, but on second thoughts I remembered I had
promised the officers to remain where I was, and they had said they
would come for me; and just at that moment one of them came and
told me that we were to make a move.
Out in the open, away from the shelter of the house, with one’s life
in one’s hands, as it were, my senses nearly left me. The noise was
awful, for besides the bursting of the shells, the firing was heavier
than it had been before. I had not gone six yards from the house
when a shell exploded almost at my feet, knocking off some
branches of a big tree close by, and wounding me very slightly in the
arm. I jumped behind the tree, in the vain hope that its broad trunk
might save me from further injury, and there I remained for some
seconds. The scurrying of those going towards the river awoke me to
my senses again, and off I went, too, forgetting to look for my
companion, from whom I had managed to get separated.
It was no easy matter to get on to the Cachar road from the back
of the Residency, as there were many obstacles in the way. The
inner garden was separated from the outer compound by a tall
hedge, composed of thorns and sharp twigs. I had superintended the
erection of this hedge myself. We had kept a great many cows, and
they were always making their way into the flower-garden and
destroying the rose-bushes. Nothing seemed to keep them out until
we made this thorn hedge, and that, as I remarked to my husband
when I took him to see it first, ‘was calculated to keep an army of
men out if it came to the point.’
Fortunately, by the time I arrived at this hedge it had become
much broken down, the result of the energy of those who had
already gone through it. I found a convenient hole, and got through
with comparatively little damage to my raiment; but my hands
received a good many scratches, and my poor stockings were
dreadfully torn. However, on I went, perfectly insensible as to who
were travelling with me. The next obstacle was a mud wall, low
enough on our side, but with a six-foot drop on the other. I found
myself sitting on the top of this, wondering how I was going to make
the descent of the other side, when someone gave me a gentle
push, as a sort of warning that I was stopping the traffic, and I slid
gracefully down on the other side into the arms of a friendly Bunnia,
who also helped me down the river bank, which was very slippery
and muddy. I fell two or three times, doing considerable damage to
my already dirty dress; but I got to the water’s edge at last, and
made a valiant effort to cross the river.
Fortunately for us, it was March, and not April or May; for had
these events taken place later in the year, I do not know how we
should have crossed that river. But as it was the end of the cold
weather, and the rains had not commenced, the stream was low and
easily waded. I did not know how deep it was, for we had never
crossed it riding, as we generally did Manipuri rivers. We had often
thought of doing so, but the banks were so steep and slippery that
my husband said it would do the horses no good to clamber down
them, and then we might find the river too deep to ford.
So with this delightful uncertainty about things, I made my first
plunge, and stepped into the water, which was dreadfully cold. I had
got into the middle of the stream, when I was overtaken by the
doctor, who seemed rather astonished at finding me there alone.
However, I explained to him that I had been too frightened to remain
at the house when I saw so many people running away, and had
managed fairly well up to that time, but I did not like the river.
He was certainly a good Samaritan on this occasion, for he carried
me the rest of the way through the water, and was just about to land
me high and dry on the bank, when his foot slipped in the mud, and
down we went. We soon picked ourselves up, however, and
scrambled out, and then I found that the heel had come off my shoe
in the water. I was covered with mud and shivering with cold, for my
skirts were dripping with water and very heavy. But there was no
time to be lost, and I climbed up the bank and crossed the road, on
the other side of which was a deep ditch, into which I retreated and
lay down, for firing was going on, and I did not know from which side
it came, whether from our men, who had all caught me up by this
time, or the Manipuris. Whenever I heard shots afterwards I used to
be alarmed, for I never could tell when our men were firing, and
always feared the worst, unless I was actually in the midst of the
Sepoys, and could see them shooting with my own eyes.
We waited in the ditch some time, until all the Sepoys had crossed
the river, and then we started off again to find the way to Cachar. We
went some way in the opposite direction at first, and had to come
back again; but at length we turned down on to the right road, and
commenced the march in real earnest. It was a moonlight night,
which enabled us to see quite plainly. Had it been dark, our
difficulties would have been increased tenfold. We could not march
fast, for the wounded had to be brought along with us, and the
number of Kahars carrying them was limited. What they must have
endured no one can imagine, being jolted along for so many hours
together without any food or rest. I knew every inch of the road we
were travelling, as I had ridden down and up it so often in my
journeys to and from Cachar, and I was able to give the others the
benefit of my knowledge.
We marched along in silence for some miles. At a place called
Burri Bazaar we were fired on, but we were not followed from the
palace, as we had fully expected. Whether they did not know we had
escaped, or whether they thought discretion the better part of valour,
and preferred remaining behind the shelter of their stone walls, to
following after us with hostile intent, I cannot say. But it was fortunate
for us that they gave us the start, and let us get some distance away
before they attempted to pursue us.
CHAPTER XVII.
Burning of the Residency and of all our effects—Difficulties of retreat—No food,
wet clothes, burning sun—Pursued—Exhaustive march—Kindness of a Naza
boy—Fired on—Sleep after a march of twenty miles—Have to march again—
Captured—A Manipuri with rice—Enemy lurks around us—Come upon a
stockade—Are attacked—Goorkhas in sight.
It was about two in the morning that we left the Residency, and we
marched steadily on until daybreak. We had not gone four miles
away from the station, when I turned to look back, and found the
whole sky for miles round lit with a red glow, whilst from among the
trees surrounding our house flames were leaping up. Those only
who have feelings of affection for the places where they live, and
which they call home, can picture what that burning house meant for
me.
All we possessed was there—all our wedding presents, and
everything that goes towards making a place homelike and
comfortable; and these were being destroyed under my very eyes,
while I, like Lot’s wife of old, had to turn my face in an opposite
direction, utterly powerless to avert the terrible destruction which was
overtaking all I valued.
I thought of my husband, who I believed to be a prisoner in the
palace, surrounded by enemies, witnessing the demolition of the
house, and not knowing where I was, or what had become of me. He
would see the flames, and hear those terrible guns booming out at
every second, and he would know that I was either flying for my life
or dead, but no more. And yet I thought he was better off than we
were. All hoped that Mr. Quinton and his party would be quite safe,
even though they were prisoners, safer than we were; and I myself,
knowing the Jubraj so well, thought that he would be clever enough
to see his own advantage in keeping them as hostages, even if he
were not influenced by feelings of friendship for my husband. And
with this reflection I had to quiet my own misgivings. But it was hard
to march on in silence without giving way, and it was only by
resolving not to look back at all that I managed to restrain my
feelings.
I was glad when the dawn came. Every misfortune seems so
much harder to bear at night, and there is something in the daylight
which gives us strength. If we are ill, we always seem worse during
the night; if in sorrow, it is harder to bear in the dark when we are
awake and the world is sleeping. And so with myself at this time. The
daylight seemed to lessen the horror of the whole situation, and
when the pink flush of the dawn came, it mingled with the red glow
caused by our burning home, until all was merged into the full light of
the rising sun. Then we halted, and had a consultation as to what
route we were to pursue. If we went straight on for another six or
seven miles, we knew we should have to pass a large Thana
strongly garrisoned. On the other hand, if we forsook the main road
and took to the hills, we stood the chance of losing our way
altogether.
Our great hope was to meet with Captain Cowley and his
detachment of two hundred men, who, we knew, were marching up
from Cachar. They had commenced their journey to Manipur some
days before the rebellion had taken place, and did not know anything
of the sort was likely to occur. We knew they were due at a place
called Leimatak, some thirty miles from the capital, on the 25th, so
that if they had kept to their dates, they could not be more than
twenty miles away from us at that moment.
It was the early morning of the 25th when we found ourselves
debating over the road, twelve miles away from Manipur. It was
decided at length to cut across the fields, and make our way over the
hills, hoping to strike the Cachar road again at a higher point, and
avoid the Bishenpur Thana.
So we started off again. I was then very exhausted. We had had
no food, and the water we met with was very dirty. My feet were cut
and sore from the rough walking I had already had, and my clothes
still damp and heavy. By this time the sun was fairly high in the
heavens, and beat down upon my uncovered head, threatening me
with a bad headache at the least, and possibly sunstroke. It was
quite evident that some sort of head-gear must be provided, so after
trying a turban, which I found insufferably hot and heavy, one of the
officers gave me his helmet, and wore the pugaree himself. Our way
lay for some distance across Dhan-fields.[18] Owing to the heavy
dew which had fallen during the night, these were very wet and
soppy, and we were glad when we reached the first hill and began
the ascent.
We had been unmolested for some hours now, but the boom of
the guns and the crack of the bullets hitting the walls of the house
had left such an impression on me that I fancied firing was still going
on, and could scarcely believe the others when they told me nothing
of the kind was taking place, for the noise in my ears was dreadful.
The first hill was very steep, but only a foretaste of what was to
come later on. It was covered with short straggling green grass,
interspersed with the rough stubble of last year, which had originally
been several feet high, but had been burned, according to the
custom in those parts. Here and there a long tough end that had
escaped the fire hit one in the face, covering one with smuts, and
leaving a black mark where it had touched one, so that after a very
short time we all looked more or less like sweeps.
The hill we were climbing had a small plateau about three-quarters
of the way up, and we steered for this, intending to have a really long
halt, and hoping to find water. It was a shady little spot, and when we
did reach it, we were all glad to lie down and rest after our terrible
exertions. We had a wide view of the plain and the road by which we
had travelled, so knew we should be able to note at once if the
enemy were pursuing us, and could afford to give ourselves a little
breathing space. Water had been found, as we expected, quite near,
and as it was much cleaner than what we had discovered in the
fields below, everyone drank a good deal, and the Sepoys filled up
their bottles with it.
I do not know how long we remained here, as I went to sleep
almost at once on our arrival; but when I woke up at last, the others
were moving on up the hill, and I had to go too with them. Some
distance behind we noted a crowd of natives following us. It was
difficult to distinguish whether they were Manipuris or Nagas, but as
they were armed with spears and Daôs,[19] we concluded they must
be the latter. Manipuris would have had rifles.
They never came very close to us, for fear of being shot
themselves; but we could see them the whole time dancing behind
us, shouting and waving spears about. Once or twice they were fully
within range, and we could have shot some of them; but it was
hardly worth while, and our ammunition was none too plentiful. A
terrible fate would have overtaken any straggler who might have
fallen behind without the means to defend himself. His head would
have been captured as a glorious trophy, carved off while he was
alive, for these tribes never trouble about killing their victim first
before taking his scalp unless he offers great resistance.
We had reached by this time an elevation of about 4,000 feet
above sea-level, and knew that more than 2,000 feet at least still
awaited us to be climbed before the top of the ridge could be
reached. The Leimatak hill, towards which point we were travelling,
was 6,700 feet high, and was the topmost peak of the first range of
hills lying between us and Cachar.
We clambered on steadily, but very slowly. I was so tired that I
could hardly put one foot in front of the other, and felt much more
inclined to lie down in the jungle and go to sleep, than to march on.
We were very hungry, but I think I suffered less in that respect than
the men did; for though I should have eaten probably as heartily as
the rest had we possessed food, as there was none to be got, I
never thought much about it. Sleep seemed much more desirable.
It was two o’clock on the morning of the 25th that we left the
Residency, and it was now between three and four in the afternoon.
Every fresh hill seemed worse than its predecessor, and at last we
began ascending one which appeared almost impossible to climb. Its
sides were very steep and rocky, and there was only the merest
apology for a path to direct us in any way. It was a case of using
hands and knees to perform the ascent, and it seemed as though we
should never reach the summit. When, after wearily toiling on for
some hours, we did arrive at the top, I felt that I could not move
another step.
We did halt for a short time here, and while we waited an incident
occurred which touched me very much. A young Naga, who had
been a Sais[20] in our service for several months at one time, found
his way to our camp at the risk of losing his life had he been
discovered by the enemy, and presented me with three eggs,
expressing at the same time his sorrow at not being able to do more
for me. He stayed till sunset with us, and then crept back under
cover of the darkness to his village. I was much touched at this
simple act of kindness, and I have often remembered it since, and
wished it were in my power to do something for the brave lad. But
unfortunately I have forgotten his name, and that of the village to
which he belonged.
Three eggs are not many among eight hungry people, not to
speak of the Sepoys; but no one would share them with me, in spite
of my begging them to do so. I could not manage a raw egg, though I
made several valiant efforts to swallow one. Eventually they all came
to a bad end, for the two remaining ones were put into somebody’s
pocket for safety, and were smashed later on, so no one benefited
much by the little Naga boy’s well-meant offering.
While we were halting on the top of this hill, one of the officers
took a few men with him and went on to take stock of the
surrounding country, as our exact whereabouts seemed uncertain.
He came to a Manipuri Thana before he had proceeded far, and had
a parley with the native officer in command there, who called to him,
telling him he had something to say. So the party went up to within
speaking distance, and the Manipuri called out that he had orders to
‘pass the Memsahib and Sepoys,’ but that all the officers must return
to Manipur.
However, as soon as he was told that our party intended
proceeding undivided, he ordered his men to fire on us, which they
immediately did, and we had to begin marching again down the hill
and up the other side of the ravine. The firing continued on both
sides the whole time, and it was only when we eventually reached
the summit of the opposite hill to that upon which we had halted, and
disappeared over the crest, that it ceased.
The sun had set, and night was beginning to close in and put an
end to the longest day I have ever known. It seemed months almost
since our departure from the Residency, and yet it was but twenty-
four hours.
How I envied my husband and the others, who, as I then thought,
were at any rate in comparative safety, able to eat and sleep, even
though they were prisoners! Not that anxiety on my husband’s
account did not trouble me. I longed to know how he was being
treated, and whether they would tell him of my escape, and spare
him the torture of not knowing my fate, for I knew how he would fret
over it if he did not know.
It seemed so terrible to be obliged to march away leaving them all
behind, and at times I longed to hurry back and see for myself what
was happening, while, again, I would have given anything to have
reached Cachar, and been able to send up help to those in captivity.
We thought that Mr. Melville had been made prisoner and brought
back to Manipur, as a rumour to that effect had reached us on the
24th, and in that case we supposed he would be with the Chief and
his party, a prisoner in the palace.
Perhaps the utter weariness of body and mind which threatened to
overcome me at this time prevented my brooding too much on the
possible fate of those we had been forced to leave in the hands of
their enemies, and it may have been well that it was so.
All that terrible night we tramped on, I with bare feet, as my thin
shoes had given out long since. At length, about one o’clock in the
morning, we halted in a small grove of trees, lying in a hollow
between two hills. We had marched more than twenty miles, and rest
was absolutely essential. Here we lay down and slept. The officers
gave me their great-coats and bore the intense cold themselves, and
I slept as I have seldom slept in a comfortable bed at home, never
waking once until someone aroused me about half-past three in the
morning, and told me the weary tale again—we were to move on.
The first glimmer of dawn was appearing as we commenced
marching again—hungry, tired, and dispirited. No one knew the way,
and we only had rough paths here and there to guide us through the
jungle; but the actual walking was not so difficult, as we were
travelling along the top of a ridge of hills, and had no very steep
ascent or descent.
Every now and then we were able to see the Leimatak peak, still
some distance off, which I had recognised and pointed out to the
others, and I knew that the road to Cachar passed right through a
small grove of trees on its summit, so we made it our landmark.
The chances of meeting Captain Cowley’s party seemed growing
less every hour. Had he been obliged to turn back? we wondered.
Would he have gone on towards Manipur, and have passed the
place where we hoped to strike the road? We knew nothing.
We were all utterly weary, and dispirited from want of food and
rest. It was now the morning of the 26th, and we had none of us
tasted food since the 24th. I was so tired that I wished I were dead
more than once, and everything seemed quite hopeless, when we
came upon the road suddenly.
I think from this moment fate favoured us. We had entertained so
little hope of finding the road at all, that it seemed a piece of good
fortune when we came upon it suddenly, even though we had all our
work still before us and were without food.
The next thing that happened cheered our drooping spirits not a
little. We came round a corner and found three Manipuri Sepoys
sitting by the roadside, with their arms and accoutrements by them,
cooking their morning meal. They were taken by surprise at our
sudden advent, and two of them fled, leaving the third a prisoner in
our hands. He was not so active as the rest, and the Ghoorkas were
too quick for him. They tied him up with straps and anything they
could find, and the poor creature evidently thought that his last hour
had come. He fell on his knees when he saw me, calling me ‘Ranee,
Ranee,’ and imploring of me to save him. So I spoke to him as well
as I could in Manipuri, telling him not to be frightened; that we did not
intend to hurt him.
Meanwhile, the rice they had cooked came in most acceptably,
and perhaps, had a disinterested onlooker been present, he might
have been very much amused at the eager way we all rushed at it to
devour it. How good it seemed, even though there were scarcely two
mouthfuls for each one. What there was was received most
gratefully, and I felt very selfish at discovering that, in their
thoughtfulness for me, the officers had managed to save a small
basketful, which no one would touch, and which they insisted on
keeping for me. After the rice was disposed of, we questioned the
Manipuri we had captured to find out whether he knew anything of
Captain Cowley’s movements. He told us that he knew the Sahib
had arrived at Leimatak on the 25th, and that he had not yet passed
along the road towards Manipur. So we were cheered at the tidings,
for we knew now that, with any luck, we must meet with the
detachment before very long, and could not be more than eight miles
away from Captain Cowley at that moment.
The Manipuri went on to say that there were a number of the
enemy lying in wait for us about half a mile further on, and he
advised us to take to the jungle again, offering to show us a path that
would lead us into Captain Cowley’s camp. The idea of more fighting
struck terror into my heart, and had I been in command I should
have been foolish enough to take the man’s advice; but fortunately
the others decided without hesitation to go on, and said they did not
believe the prisoner was speaking the truth.
We had scarcely gone half a mile when we came suddenly upon a
stockade, and as soon as we appeared round the turn in the road
which disclosed it to our view, we were fired on from the hillside
above us. I threw myself down for protection against the sloping side
of the road, but was not allowed to remain there, as the stockade
was about to be rushed, and I had to get over it too, as best I could.
Fortunately it had been constructed to prevent Captain Cowley’s
party from getting past that point in the road, and was in
consequence easier for us to clamber over, as we had come from
the opposite direction; but I knew that it was useless for me to
attempt climbing over it, as my dress would be certain to catch on
the sharp ends of the bamboos with which the stockade was
constructed, and there I should be suspended, an excellent mark for
any stray bullet. So I made a rush to the other side of the road,
where I lost my footing and fell, rolling down the Khud. But luckily it
was not as steep as it might have been, and I managed to scramble
up and get round the stockade, helped very considerably by my
former friend the Bunnia, before mentioned, who stretched out his
leg from a secure position, and I clambered up by it and lay down
completely exhausted and panting from my exertions down the
hillside.
Meanwhile firing was going on overhead, which was returned by
our men, who killed one or two of the enemy. But the latter were so
well screened by the trees around them that it was difficult to get a
shot at them at all. I do not know how matters might have ended, but
suddenly someone called out that there were more men coming up
the hill. No one knew who they were, for they were a long way off,
and could only be seen every now and then as they appeared in and
out of the trees. Sepoys they were we knew, but were they friends or
enemies?
I felt too exhausted to get up and look at them, as all the others
were doing, until there was an exclamation from someone that the
new arrivals were Ghoorkas. I had felt certain that they would turn
out to be Manipuris, who would put an end to us in a very short time.
But when opinion became divided as to their identity, the longing for
life which we all possess so strongly surged up into my brain, driving
me nearly crazy with excitement, and hope, that takes so much
killing, rose again within me.
Still we were doubtful. We could see as they came nearer that
they wore Kharkee, but the uniform worn by the Jubraj’s men was
almost identical with that of the Ghoorkas. We sounded our bugle,
and it was answered by the advancing party; but then we
remembered the Manipuri bugle call was the same as that of the
43rd Ghoorka Rifles, to which regiment Captain Cowley belonged.
We got out our only pocket-handkerchief, tied it to a stick, and waved
it about, but we could not see whether that signal was returned or
not. The time which had elapsed since they were first sighted
seemed hours; it was in reality only a few minutes.
Gradually they advanced nearer, running up the hill as fast as they
could, and then the majority cried out that they were the Ghoorkas
from Cachar. I shut my eyes, for I could not bear the strain of
watching them while their identity was uncertain. But at last a Sahib
was descried amongst them, and all doubt was over; they were the
Ghoorkas, and we were saved. I remember someone asking me if I
would make one last effort and run down the hill to meet them, as
the firing was still going on, and a stray bullet might even then find its
billet; and I remember getting up, with a mist in my eyes and a
surging in my head, and running as I have never run before or since
down the hill, helped along by two of the officers.
I remember putting my foot on a stone which rolled away from
under it, and gave my ankle a wrench which sprained it, and turned
me sick and giddy with pain; and I remember meeting Captain
Cowley, and seeing his men rushing past me up the hill, and then I
remember nothing more for some time. I did not faint, but I believe I
sat down on the side of the road and sobbed, for the strain had been
more than I could bear after all the horrors of the previous two days,
and tears were a relief.
CHAPTER XVIII.
Saved—Captain Cowley pursues the enemy, and we fall on our feet—Have to
wear Sepoys’ boots—Halt at Leimatak—Transitions of climate—Manipuri
attack—Tables turned on them—Shortness of food—The Nagas—Cross the
Jhiri and regain the British frontier.
We were saved! That was the one thought in my mind when I was
able to recover my senses sufficiently to be able to think at all.
Saved from the terrors of starvation, and from the hands of our
enemies; and in my heart I thanked God for having given me the
strength which had enabled me to bear all the misery and weariness
of the last few days. We human beings are so given to forgetfulness,
and fail so often to remember that we owe thanks to Providence for
preserving us when man’s help is of no avail. We are ready enough
to thank our fellow-men for what they do for us, but we forget the
rest. This time I can honestly say that I thanked God from the bottom
of my heart.
As I sat there by the side of the road, bereft of everything I
possessed in the world save only the clothes I wore, I did not think of
what I had lost, but only of the life that was still mine. This world is
very good and pleasant to live in. Home and friends are very dear to
one at all times. But all these are never so precious as when we see
them slipping from our grasp, and feel that even our breath, and the
lifeblood coursing through our veins, are to be taken from us; then
alone do we fully rouse ourselves to action, while we struggle and
fight for the life that is so dear.
It was some time before I recovered my senses sufficiently to be
able to join with the rest in giving the rescuing party a detailed
account of our miraculous escape. Some of Captain Cowley’s men
were still pursuing the now-retreating foe, and we could hear shots
being fired from the brow of the hill above us. We remained where
we were for some time, and our rescuers produced biscuits and
potted meat and soda-water. They had whisky with them too, so we
really felt we had fallen on our feet. I was too exhausted to eat much,
and did not feel at all hungry; but I was glad enough to drink a peg,
[21] and felt very much better for it. My ankle was very painful, so the
doctor, who was among the newcomers, bound it up for me, and I
went to sleep by the roadside for a short time.
I have said we were saved, but that does not mean that we were
entirely out of danger of being fired upon by the Manipuris. They had
not spared Captain Cowley’s party, though they had allowed him to
march up to within twenty miles of us without making themselves
unpleasant. But the night before he met us he had marched as usual
into a new camping-ground, wholly ignorant of what had occurred in
Manipur, and to his great surprise had been fired on. Shortly
afterwards fugitives from our party arrived, and told him that we were
wandering about in the jungle with every chance of coming to grief
before very long, unless rescued. This news was startling, to say the
least of it, and caused him to hurry on to our help. When, some miles
away, he heard shots being fired from the top of the hill, he
concluded that we were not far off, and before long caught sight of
the stockade and arrived in the nick of time with men, food, and
ammunition to our aid.
The rest of our march was a different thing to what the
commencement had been, though discomforts were still many and
great. Food was none too plentiful for the Sepoys, though we did not
fare badly, and after two days of starvation one is not particular. The
43rd had got a supply of beer, whisky, and cocoa, which were all
most acceptable commodities, and I was able to get other luxuries
from one of the party, viz., a brush, a sponge, a grand pair of woollen
stockings, and some Sepoys’ boots, which each measured about a
foot and a half in length and were broad in proportion. However,
beggars can’t be choosers, and as my ankle was very much swollen
the commodious boots did not come amiss.
After we had rested some hours we pushed on down the hill to
Leimatak, which place was reached before sunset. I was carried in a
dooly, as my ankle was too painful to allow of my walking.
When we arrived at the camp we found a string of elephants and
mules, which had been travelling up with the detachment, and which
had been left behind by Captain Cowley when he discovered the
state of affairs we were in, and had to hurry on to our help. It seemed
difficult to realize that we were still in a hostile country, surrounded
by enemies, for the camp looked just the same as it had done in
more peaceful regions.
I had travelled down from Shillong, in the winter of 1890, with the
43rd Ghoorka Rifles, and was consequently quite accustomed to the
bustle and movement accompanying a regiment on the march.
We halted at Leimatak for four or five hours, and had a very
respectable dinner, to which we did full justice. Afterwards I lay down
and went to sleep again, until it was time to move on.
From this time our march was very monotonous. We got up at
three every morning and marched until sunset. We had a meal of
army rations and cocoa in the morning, and another meal of army
rations and beer in the evening, after which we all went to sleep as
we were, and never woke until the bugle sounded the reveille.
We were always dead-tired. The hills were very steep, and as we
got nearer Cachar the heat was intense during the day, and the cold
piercing at night. We could only move very slowly, and with caution,
for we never knew when we might be attacked. Pickets were posted
all around us on the hills at night, for the purpose of keeping a look-
out against the enemy.
We were fired at several times during the march, but the Manipuris
did not like the look of a large party, and kept a respectful distance,
sometimes firing at us from such a long way off that we did not take
the trouble to reply to it. And yet I was more nervous and unstrung at
this time than I had been when the danger was really imminent, and
bullets coming fast. A stray shot used to make my heart beat with
terror, and at last I got so nervous that whenever a shot was fired my
companions used to say it was only a bamboo burning in the jungle
behind us.
We set fire to nearly all the Thanas on the road, which we found
for the most part deserted and empty. At one place called Khowpum,
the Manipuris had only left the Thana a few minutes before our
arrival. They were lying in wait for us though, on the top of a small
ridge, hoping to catch us as we came round the turn of the road. But
they were caught themselves, as the Ghoorkas made a small detour
and appeared on the top of the ridge instead of below it, and opened
fire upon them, causing them to retreat hastily, after a very slight
show of resistance.
We then marched into the Thana, and found a quantity of rice in
baskets, which had evidently just arrived from the Maharajah’s
Godowns[22] for the monthly rations. We could not take the whole
amount with us, but the Sepoys were allowed to carry as much as
they could, and it was a lucky find. It was often very difficult to
procure food for the men, and they had more than once to go without
dinner when they got in at night, though as a rule they had half-
rations. We had managed to get a supply of rice from one of the
Naga villages situated near the road.
The Nagas were for the most part friendly disposed towards us,
but here and there they gathered together near their villages, which
they had deserted for the meanwhile, and had a stray shot at us as
we passed along. We never burned these villages, thinking they
might be useful to the troops when they should return.
I walked most of the way, except the first march after meeting
Captain Cowley. He had a pony which he lent me, but the hills were
very steep at the best of times for riding, and on this occasion I had
to balance myself as best I could on a man’s saddle, with the off
stirrup crossed over the pony’s neck to make some sort of pommel.
Riding thus downhill was an impossibility, and I never made the
attempt.
My ankle pained me very much at times, but for the most part it
seemed to have no feeling in it at all, and was swollen into an
unsightly mass.
We came across one or two poor old Manipuri women on the road
as we neared the frontier. They had been peaceably travelling up to

Principles and Practice of Hospital Medicine 2Nd Edition Edition Sylvia C Mckean All Chapter

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Principles and Practice of Hospital Medicine 2Nd Edition Edition Sylvia C Mckean All Chapter

Uploaded by

Copyright:

Available Formats

Principles and Practice of Hospital

Medicine 2nd Edition Edition Sylvia C.

John J. Ross, MD, CM, FIDSA

Daniel D. Dressler, MD, MSc, SFHM, FACP

Danielle B. Scheurer, MD, MSCR, SFHM

This book was set in Myriad pro by Cenveo Publisher Services.

RR Donnelley was printer and binder.

Library o Congress Cataloging-in-Publication Data

PART I: THE SPECIALTY OF HOSPITAL

23 Building, Growing and Managing a

SECTION 1 Surgery PART III: REHABILITATION AND SKILLED

Perioperative Risk Assessment and

51 Perioperative Pulmonary Risk Assessment and 77 Evaluation of Anemia ............................... 533

Prevention, Assessment, and 84 Dizziness and Vertigo ............................... 587

106 Weakness: How to Localize the Problem . . . . . . . . . . . . . . 763

137 Inpatient Cardiac Arrest and Cardiopulmonary

SECTION 2 Radiology 144 Flushing and Urticaria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1105

122 Arterial Blood Gas and Placement of A-line . . . . . . . . . . . . 901

John J. Ross, MD, CM, FIDSA

Daniel D. Dressler, MD, MSc, SFHM, FACP

Danielle B. Scheurer, MD, MSCR, SFHM

Samer Abdel-Aziz, MD Daniel A. Anaya, MD

Patrick Avila, MD, MPhil, MPH Tom Baudendistel, MD, FACP

Arline D. Bohannon, MD Tod A. Brown, MD

Alexander R. Carbo, MD, FACP, SFHM Kenneth K. Chen, MD, FRACP

Alexandra Columbus, MD Sonye K. Danof , MD, PhD

Michael Klompas, MD, MPH Victoria D. Lackey, MD

Makeida B. Koyi, MD Lucia Larson, MD, FACP

Svetlana Krasnokutsky, MD, MS Jodi Layton, MD

Harold Kudler, MD Brian Leber, MDCM, FRCPC

William L. Lyons, MD Alayne D. Markland, DO, MSc

Andrew McFarlane, MLT, ART, FCSMLS(D) David Meltzer, MD, PhD

Jakob I. McSparron, MD Paul A. Monach, MD, PhD

Thomas A. Owens, MD Vihas Patel, MD

Menaka Pai, MD, MSc, FRCPC Jill M. Paulson, MD

Michaella Maloney Prasad, MD Kerry Reynolds, MD

Lynn Schlanger, MD Ann M. Sheehy, MD, MS

Saul N. Weingart, MD, PhD Eric S. Winer, MD

Irene M. Yeh, MD, MPH

You might also like