Choose Your Own Adventure! Medical Mystery Edition

The other day, while Jacqui was studying, I decided to quiz her via text message. I sent her a message of some symptoms to see if she could come up with a diagnosis. I was just making it up as I go along; it quickly turned into a bit of a “choose your own adventure” story. At the end though, it’s a love story:

JCH- Let’s say they have glassy eyes and a bloody noose just started. There was no trauma.

JMW-Could be just a bloody nose, could be something in the brain. It all depends. I’d like some more history. 

JCH- The patient has a sore throat, a bloody nose, glassy eyes, no trauma, knee pain, shortness of breath and dizziness.

JMW-Kid, it could be a bazillion things, even as simple as dehydration or allergies.

JCH- Come on House! What do you do? Uhoo! You’ve just noticed yellowing of the patients eyes! A new symptom!

JMW- Yellowing of the eyes suggests possible liver failure and/or hemolytic anemia. 

JCH-Which combined with our other symptoms could be caused by, what?

JMW-It could be malaria. Any cyclic fevers? Or it could be a rheumatic fever. Any nodules on the skin, or possible new heart murmur?

JCH- Fever is 99.7F and nothing more. However the nurse looks dirty and you suspect that she hasn’t washed her hands since she clocked in at 10AM.

JMW-Ew, grime nurse, but the symptoms don’t sound related to her griminess, especially if they started before hand. Does the patient have any nausea, vomiting, diarrhea, or constipation?

JCH- Your patient tells you that they haven’t shit in a week, and you now notice blood in the bathroom. After questioning the patent they admit that they threw up a bloody mess in there three times since being admitted to the hospital 48hrs ago. They were too afraid to tell anyone. 

JMW- It sounds like Ebola. Any recent travel, or drug use? Is there anyone sick at home? How old is the patient? Do we have prior medical history?

JCH- The patient is a20 year old white male with no drug use who recently returned from a trip to Florida two weeks ago. They had no prior health problems and nobody is sick at home.

JCH- The fever has spiked to 102.8F

JMW-This sounds infectious and the patient is septic. Let’s do a cbc, cmp, stool culture, blood culture, and abdominal imaging. 

JCH- “What are we looking for, I don’t want any unneeded tests!” says your attending. 

JMW-We are looking for a source of infection, either in the blood or GI track. We should rule out obstruction, hemorrhage from a mass or tumor, and assess hydration status. 

JCH-The patient is now bleeding from the nose and ears. He complains of a headache. A brain bleed and swelling is to be suspected.

JMW-We need a CT scan stat to find the bleed and edema. We may need emergent craniotomy depending.

JCH- Good, good. Way to prioritize. You’ve drilled to relieve the pressure, and have started the patient on broad spectrum antibiotics. 

JCH-You leave for the night as the patent stabilizes and their fever begins to fall under 100F, but the next day four patients on the same floor, who had no contact with Patient Zero, begin to show similar symptoms in the same way and timeline. What do you do?

JMW-Contagion! I would put the patients in isolation ASAP and clear the floor. From there we start antibiotic therapy and rehydration. Some big dogs at the hospital should also be notified. 

JCH-Patient Zero, while trying to give a stool sample (it his is 11^th day without pooping) vomits blood and attacks the dirty nurse while she waits for him to poop into a clear plastic Ziploc bag. He begins scratching, biting, and punching. Security shows up, but not before the nurse is severely disfigured. The patient is tranquilized, and 24 hours later, the nurses temperature beings to rise. 

JCH- By the third day of your shift, you are denied access to the hospital. Thirty seven patients have spiked fevers, vomiting, et cetera and have become violent. You begin to wonder if you’ve been exposed and if the dirty nurse is even still alive. You hear gunshots coming from inside the hospital and you make your way to the subway. You arrive home to your boyfriend, who has been longing for your return. You tell him what happened. What do you do next?

JMW-Zombie apocalypse? I’m out. 

JCH-You have chosen to leave, but your boyfriend, for work, stays. You take shelter in the suburbs of Philadelphia, and within a week Manhattan Island is quarantined and the Tapanzee and Bear Mountain bridges upstate have been shutdown. Route I-95 and all public transportation have also been closed. Police and military roadblocks pepper the landscape. A month later, you buy your first gun, pack a bag and start driving out west. You haven’t heard from your boyfriend in four days and fear that he is dead. 

JMW-Bummer, He shouldn’t have stayed…I guess I’m headed west. Maybe I’ll find a caravan of survivors to group up with. 

JCH- Thankfully the virus is contained and never leaves the north eastern United States despite claiming the lives of tens of millions of people. Your boyfriend got on one of the last planes to fly out of Westchester Airport. The plan was to fly to Philadelphia, but as they took off rumors swirled of the infection reaching the city of brotherly love. The pilot, in an act of desperation, and in complete disregard for FAA and federal regulations, flies the plane and successfully lands in a quite airstrip in Newfoundland, Canada. From there your boyfriend books passage on a plane for Europe and joins a gypsy clan that lives 40 miles outside of Paris, where he falls in love with an accordion player 18 years his senior. 

You will run into your boyfriend almost six years later, in the same streets where you first met, after his former French lover dies of Tuberculosis. You both try to rekindle your lost love but neither of you is the same person you once were, and aside from mailing cheeses corporate holiday cards to each other, you will almost never speak. The only thing that will upset you about this is that you are not really upset at all about it.