In 2022, Erica Eyres, a vigorous fifty-six-year-old aerobics instructor who had struggled to breathe, was given “absolutely devastating” news: She might need a lung transplant. She had never smoked, ran cross-country track in high school, and was a personal trainer for years, but, by 2024, a transplant assessment was arranged. (1) “I decided that I will make that decision,” she said, “only if it’s the last resort, and I’m on my deathbed.” A few months before her consultation, however, Eyres, then fifty-eight, made an appointment with a new primary care doctor for routine prescription refills. She was about to be introduced, literally and figuratively, to a new kind of medicine. It would change everything. Dr. James Miller, a former surgeon, liked to get to know his patients, so he asked Eyres for her history. She told him of her diagnosis, thirty years prior, with a serious but manageable case of scleroderma. In 2020, however, this auto-immune disorder, which can affect skin and organs...
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