Shades

Sometimes, melodrama is necessary. At these times, dialogue sounds like a bad made-for-TV movie, like something you've heard before while watching actors play a role: hackneyed, yes, and cliché-filled, certainly.

From “This isn't a minor problem, sir, this is life or death. Without treatment, you will die.” (Did I really say that?)

Mr. B. was a 62-year-old African American, with a history of hypertension and diabetes. According to the triage note, he presented to the emergency department because his feet hurt, and he thought he was having an attack of gout. We physicians are sometimes an unsuspecting lot. We pick up charts with rather benign complaints, only to fall into a vortex of trouble. As it turned out, Mr. B.'s legs were rather edematous, and gout did not seem to be the culprit.

“How long have your legs been this swollen?” I asked.

“Pretty long now. Dr. S. said they're getting worse,” Mr. B. said.

Dr. S.? He was a nephrologist.

“Why do you see Dr. S.?” I asked.

“He told me I need the dialysis, but I don't want it,” Mr. B. said.

When I first met Mr. B., he seemed affable …