On the afternoon of Tuesday, June 30, 1969, I picked up my ‘‘whites’’ and presented myself to Osler 3, one of the internal medicine house staff services at the Johns Hopkins Hospital. My internship formally began later that day (12 midnight, July 1). That afternoon I read through some of the ‘‘off-service notes’’ written by the interns who were themselves about to become ‘‘JARs (junior assistant resident).’’ As I recall, one of them may even have served as a source of continuity for the Osler 3 service team, which included 2 JARs, 3 interns, and 3 students. By tradition our attending physician would go on rounds with the team 3 times a week, hearing about our patients as we ‘‘flipped the cards’’ in the doctor’s office or did walking rounds. I stored my black bag (a gift from Eli Lilly) and the Barnes Manual (the Washington University handbook of inpatient medicine) on the shelf above the desk in Osler 3 (next to several vials of Ritalin someone had left behind), introduced myself to Amy (the Osler 3 charge nurse), and went home to my row house apartment 1 block behind Hopkins Hospital in the neighborhood where my new wife and I would live for the next several years while I completed training. I returned to Osler 3 at midnight, and made rounds on my patients. Some time in the middle of the night I was urgently called to the emergency department to pick up my first admission. He was a man in his mid-50s who was described to me over the telephone as febrile, hypotensive, stuporous, with possible ‘‘polymicrobial sepsis,’’ and Di Guglielmo syndrome, type 2. On the way down to the emergency department I looked at the Barnes Manual to see if I could find any mention of this syndrome but found none. In the emergency department I was told by the admitting resident that it was ‘‘some kind of myelodysplastic condition.’’ Having no real clue what this meant, I met my patient, who was semistuporous with a low blood pressure, on the gurney. He had various purpuric lesions, no nuchal rigidity, and came with a thick chart that told me he had been taking prednisone. The admitting resident said they had ‘‘Gram stained’’ his blood smear and thought there might be both gram-positive and gram-negative organisms on the slide. His Wright stain blood smear showed immature-looking white cells. I do not recall his complete blood count. I remember that we did our own laboratory work in the rudimentary facility that each Osler floor hosted at the end of the entrance hallway. Honestly frightened by how sick this patient was, I admitted him to a bed just across the hall from the nursing station (the priority arrangement that served as an intensive care unit [ICU] in those days). Calling my resident, who was at home, we developed a plan for a lumbar puncture (atraumatic and clear), chest x-ray, urinalysis, blood cultures, stress-level steroids, pushing normal saline, and broad antibiotic coverage for sepsis. In those days we used a regimen short-handed as ‘‘KKK’’ (an acronym I never fully understood because it referred to kanamycin, Keflex, and colistin: KKC?). The patient somehow survived the night. The patient was seen by the attending physician the next morning, who elaborated on the differential diagnosis of polymicrobial sepsis (a phenomenon I recall as one associated with visceral abscesses that erode into an intravascular space). I remember being interested in the differential diagnosis, although I was confused by how it might apply to this particular case. There was also a discussion of how exogenous steroids were metabolized, in what form they were active, and the advantages/disadvantages of methylprednisolone. The attending physician asked about the blood cultures, which I knew were ‘‘cooking but negative.’’ I wondered whether I had somehow mismanaged the patient. Not much was said about Di Guglielmo syndrome, type 2. The patient died several weeks later, partially of renal failure. Years later I believe it was suggested that the KKK Tazo S. Inui, MD, is a first-year surgery resident at the University of California, San Diego; Thomas S. Inui, ScM, MD, is President and Chief Executive Officer of the Regenstrief Institute for Health Care, the Sam Regenstrief Professor of Health Services Research, and Associate Dean for Health Care Research at Indiana University School of Medicine.