The patient described and interviewed below faces a crossroads in medical care. Consider the patient's history and the patient's perspective, expressed in his/her own words. Then review the questions posed and imagine you are caring for this patient. How would you approach this crossroads? Using evidence from the literature and your own experience, respond by using the link to the right. Responses will be selected for posting online based on their timeliness and quality including use of the available evidence, weighing the issues, and addressing the patient's concerns. The discussion of this Clinical Crossroads case, authored by Dr James P. Rathmell, will be published in the May 7, 2008, issue of JAMA; responses must be received by April 30, 2008, to be considered for online posting.