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3. Blackhall LJ, Ziogas A, Azen SP. Low survival rate after cardiopul- monary resuscitation in a country hospital. Arch Intern Med. 1992; 152:2045- 58.

4. Cummins RO, Chamberlain DA, Abramson NS, et al. Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style. Ann Emerg Med. 1991;20:861-74.

5. Eisenberg MS, Cummins RO, Damon S, Larsen MP, Hearne TR. Survival rates from out-of-hospital cardiac arrest: recommendations for uniform definitions and data to report. Ann Emerg Med. 1990; 19:1249-59.

6. Eisenberg MS, Cummins RO, Larsen MP. Numerators, denominators, and survival rates: reporting survival from out-of-hospital cardiac arrest. Am J Emerg Med. 1991;9:544-6.

7. Valenzuela TD, Spaite DW, Meislin HW, Clark LL, Wright AL, Ewy GA. Case and survival definitions in out-of-hospital cardiac arrest, effect on survival rate calculation. JAMA. 1992;267;272-4.

8. Jastremski MS. In-hospital cardiac arrest. Ann Emerg Med. 1993;22: 113-7.

9. American Heart Association. Textbook of Advanced Cardiac Life Support, 2nd ed. Dallas, TX: American Heart Association, 1990.

REFLECTIONS

The Benefits of Being Wrong

I SAW JENNY this weekend . Despi te her total lack of hair (h idden by a scarf), she looked good, and well. She" ate and she didn ' t cough, bo th visible signs of a remarkable improvement . She walked wi thou t shor tness of breath. Her smile was s o m e h o w more comple te .

My react ion to Jenny 's improvemen t is a paradox. I feel some guilt and shame but I 'm ex t remely grateful to still have her around.

Jenny got breast cancer a few years ago. She had surgery and chemothe rapy and radiation. During that t ime we were all hopeful. Because w e lived far apart t hen and I wasn' t wi tness to the cyclical hor rors of her chemothe r - apy, I den ied her illness. After all, on the occasions w h e n I saw her, she looked well.

One year ago, though, Tom, her husband, broke the news of a recurrence . It was then that I accep ted her illness and it became real. More c h e m o t h e r a p y and radiation en- sued. We lived closer now, for one thing, and this t ime the trips to the doctor , the pain, and the vomit ing w e r e less deniable.

Just a few mon ths ago came more bad news- - -new metastases to her lungs, severe shor tness of brea th and oxygen. When my wife told me, wi th tears, I w e n t into my doc tor mode. Maintaining my composure , I said that we needed to prepare for the worst . Jenny was dying. We wouldn ' t have her for m u c h longer. The prognosis was grim. We bo th spoke of h o w hard this must be for her two teenage children.

There was talk of m o r e chemothe rapy and a bone marrow transplant. Jenny had lots of doubts, w h i c h she expressed to my wife. I think she was leaning toward not doing any more. I d idn ' t talk to Jenny direct ly about my feelings because I was afraid I'd inf luence her. I spoke, to my wife alone, about h o w comfor t care might be her bes t option, about h o w I wasn ' t sure more chemothe rapy or the transplant was w o r t h it.

But, as luck would have it, she deve loped acute cardiac

t amponade and was rushed into a pericardial tap and win- dow. I think this very real brush wi th death mot ivated some instinct and Jenny reluctant ly unde r took ano ther round of chemotherapy . W h e n I nex t saw her, I was dev- astated by her appearance. She was shor t of breath, in pain, housebound , using oxygen, and, you could tell, just tol- erat ing her situation. This was not the old Jenny w h o was a phi losopher , a teacher, a mother , always smiling, rarely anxious, a comfor t to be around. There was no comfor t now. There w e r e s leepless nights, lots of pills, chron ic nausea, no appetite, Hickman catheters , and lots of shots. My pessimism was validated. I was almost smug wi th in my sorrow. After all, I had p red ic t ed this.

And then they came this weekend . A long trip wi th no oxygen and she b rough t apple pies she had made. She ate wi th us and talked. I saw the love she and Tom shared. I w a t c h e d her laugh wi th bo th her ch i ldren and mine. Her ches t x-ray and various scans have cleared. Her w o u n d s are healing.

In short, the old Jenny is back. And this is the source of my guilt. As a physician, I 'd once again b e e n lulled into morb id complacency by statistics. I don ' t know h o w Jenny feels, but wha teve r c h e m o t h e r a p y had to give, those hours this w e e k e n d w e r e w o r t h it, at least for me. She looked good enough to live. I hadn ' t p r ed i c t ed this. There in lies the paradox. Jenny ' s i m p r o v e m e n t has fo rced me to accep t that I was wrong. If it had b e e n up to me, Jenny wou ld have b e e n bur ied by now.

Even though I still k n o w the odds are against her, this w e e k e n d was a miracle for me. If she had died in a car w r e c k on the way home, my last me mo r i e s w o u l d be pleas- ant ones. Thank God Jenny 's alive. Thank God I wasn ' t he r doctor .

KEITH WRENN, MD Emergency Medicine Residency, Vanderbilt Univers#y Medical Center, Nashville, Tennessee