An excerpt from Yankee Doctor in the Bible Belt: A Memoir.
There are patients you can help. You can see them through a crisis, give them a magic medicine that makes everything better. There are others where there is little you can do. Their distress is beyond cure. The following story is about one person I could help.
Tony Bowman is a man in his early 50s. I see him often in the clinic, mostly for follow-up for type 2 diabetes. He often tells me about his romantic entanglements and asks for Viagra.
Tony had a heart attack two years before. After bypass surgery, he got an infection of the surgical wound. It turned out to be an MRSA infection, which required a monthlong round of powerful antibiotics. He had gotten better, with no evidence of a lingering MRSA infection.
This time when I see him in the clinic, he is obviously in pain: clutching the right side of his abdomen, pale, and running a high fever. The pain started two weeks ago and has come and gone. He has already been to the ER twice. Standard tests for gallbladder disease were negative. He had been sent home on pain meds and an oral antibiotic.
I remembered another patient with type 2 diabetes I had seen some years previous. He had the same RUQ pain and fever. He too was twice sent home from the ER. On the third visit, the surgeon on call—his name was Dr. Mo—scheduled him for the OR. He did an exploratory surgery and discovered a gallbladder that was swollen and rupturing. The surgical staff responded quickly and stabilized the patient. He stayed in the hospital for a month, with strong IV antibiotics.
With this previous patient in mind, I sent Tony back to the ER and called the ER doctor. The imaging tests were again negative. They were about to send Tony home again. The young doctor on the other end of the phone agreed to have the surgeon on call take a look at the patient. Tony went to surgery later that evening. He was found to have a swollen, rupturing gallbladder and a raging MRSA infection.
This case illustrates the advantage of experience and trusting your instincts when a patient’s presentation scares you. Tony was given an antibiotic strong enough to kill MRSA. After a course of treatment, he was sent home again. He continued to see me in the clinic with further stories of his romantic entanglements.
On a separate, largely unrelated note, I remember a young woman I worked with in the ER. She was pretty and quite young, no more than 23. She was funny. One time she said, “I think Dr. Mo is awfully handsome. He can do surgery on me anytime he wants to.” I think this was sexual innuendo. She did not need any surgery.
Janet Tamaren is a family physician.
