A 66-year-old man, a known intravenous heroin user for 45 years, presented to Baylor University Medical Center (BUMC) in May 2001 with a painful left upper arm after falling off a crate. A fractured left humerus was diagnosed, the arm was placed in a sling, and the patient was sent home. Upon reviewing the radiograph the following day, the attending radiologist noticed abnormal lung findings and called the patient, who reported a 1-to 2-month history of dyspnea on exertion. Several months earlier the patient was found to have an ejection fraction of 30% by echocardiogram, as well as severe chronic pulmonary obstructive disease. A partial gastrectomy had been performed many years previously, and a bypass operation had been done in one leg. He had no known allergies. The only medicine he