My stomach sunk. The results of the biopsy were back and it was not good. I had met Ms. Jones eight days ago when she was admitted for a pneumonia that antibiotics couldn’t seem to shake. Once hospitalized, we’d brought out the big guns and she had been clinically improving on that well-loved duo of vanc and zosyn. (Med students take note: vanc/zosyn is almost always an acceptable answer when pimped about which antibiotics to start – they may be overkill, but you’re unlikely to be wrong.) Despite her improvement, things had not been adding up – we kept putting 2 and 2 together and getting 6. A young woman in her late 30s, she had no good reason to have this month-long pneumonia and her chest x-ray looked, in a word, terrible. Even I as an intern could see that what had been a right middle lobe infection when she first presented a month ago was now also in her upper lobes and – oddly – her left lung was looking increasingly cloudy.