Stories From a Night On-Call or How I Spent My Youth Saying Goodbye Mr. T.Y. had difficult problems. He was a 60 something pipe fitter who was suffering from metabolic disease. Metabolic disease is a term that doctors use to lump together health problems that are related to problems with glucose and fat metabolism and often lead to heart attacks, stroke and kidney diseases. Mr. T.Y. was overweight, had high blood pressure, diabetes, kidney disease, and he had some smoking-related lung disease. I had met him several times over my first two years of my internal medicine residency. Usually we met late at night in the emergency room. He would come in, finding it hard to breathe, leaning forward on his swollen knees huffing and puffing saying “Doc, I just can’t catch my breath, my feet have swollen up and I feel like crap”. Our usual routine was to do some tests, and start him on some diuretics; often he was suffering from heart failure related to underlying heart disea