Research Article| Volume 27, ISSUE 11, P1290, November 2021

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“I've Had a Good Run”

    Reprint requests: Mark Dunlap, MD, The MetroHealth System, Department of Cardiology, 2500 MetroHealth Dr, Cleveland, OH 44109.
    Division of Cardiology, MetroHealth Campus of Case Western Reserve University, Cleveland, Ohio
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      Patients with heart failure (HF) who we take care of over many years don't exactly become "friends," but mutual bonds do form that transcend the strict doctor/patient relationship. They become more than simply "patients." We get to know family members, likes and dislikes, anecdotes from their lives, sometimes political stances, and more. And although they generally know a lot less about us than we do about them, they still often find out about major life events like births of kids and grandkids, marriages, and more, as well as random facts we might share. So when their HF takes a turn for the worse, it is very different than when we meet a patient for the first time who may be in dire straits or even dying, when it is somehow more purely clinical, and we as clinicians are a bit more detached. In patients we have know a long time, subtle differences also become easier to detect, including when things seem to be starting to go downhill and approaching later stages of disease. We may see it coming before saying anything to them, trying to gauge how to best time it so that things like end-of-life discussions occur at just the right time: not too early, not too late, sort of like Goldilocks.
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