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The Vietnam war turned Ned from a tough-as-nails fighter into a worried soul as fragile as porcelain. He survived his tour of duty physically intact, but with his emotional resilience worn away like an old roof, allowing disabling fear to deluge over something as routine as a blood pressure check.

As I prepare to enter Ned's exam room, I scan over my last progress note, along with test results.The red alert flag catches my eye: PSA 5.6, with the upper limit of normal 4.0. It is unlikely that this indicates a dangerous prostate cancer, but I cannot be sure, and following up on this will require a conversation that is likely to send Ned's anxiety reeling. I feel like I am suddenly up on two wheels on a steep curve in my day, unsure how to right myself. Clicking orders for routine labs can become almost a reflex, and here lies the danger. We did not share this decision, as we should have.

I knock on the door and enter Ned's room, considering how I will present this to him, having led him into a zone of uncertaintly. I am glad to see that his wife, always a pillar of support, is sitting beside him. We will both really need her help today.

Jeffrey Millstein
Woodbury Heights, New Jersey