Ten years ago, a woman who had previously received an artificial heart valve at the University of Virginia's Medical Center saw her local physician in a West Virginia town. Although unknown to anyone at that time, later experience would show this type of valve to be vulnerable to material fatigue and abrupt malfunction. The West Virginia doctor did not like the sound of her valve and called to request an appointment for her the following Monday at the medical center. On Friday night, the weather forecasters predicted a weekend blizzard. Although this physician saw enough patients daily to create a mental blur of pathology at the end of the day, that night he recalled this woman's plan and telephoned her to suggest that she leave early to avoid the snow. She agreed to do so. As she approached the hospital in a blizzard that Sunday, her valve completely failed. She required emergency valve replacement surgery within the hour to prevent death. The operation was successful, and she returned home well in ten days. What possessed the West Virginia doctor to think in such detail about this patient that he called her at home to suggest a change in her travel plans because of a weather forecast?

A few years ago an elderly professor appeared to be dying of pneumonia in a setting of incurable malignancy and other irreversible problems. Experiencing bone pain in recent months, he had supplemented his codeine with excess vodka for pain relief and had fallen and broken a cancerous bone. Physicians less familiar with his background had inserted a breathing tube, attached him to a respirator, and started antibiotics. My inclination was to remove these supportive measures and allow death to come with compassion and a minimum of discomfort. The problem was gently presented to his wife with a gloomy prediction. She said, however, that her husband had an enormous will to live and would want "everything" done. And so we did everything. Indeed, the man did recover from this episode, and he lived, sometimes even enjoyed, another ten months at home before he succumbed to more of the same.