all initial tests were ruling out an MI, the severity of his symptoms
warranted a hospital admission. As the hours progressed, his arm pain
worsened, and by 2:00 A.M., the medical team was getting nervous. The
aged patient was developing blisters and “ecchymoses” (bruises) on his
left arm. Instead of an MI, they are now considering some ominous issue
with his musculoskeletal system.
I am a know-nothing surgical intern, just months removed from medical
school graduation, but I agree to come evaluate the patient as a first-line
responder for my surgical team. I sit up in bed, take a deep breath, and
slide on my day-worn, slightly smelly socks. After fumbling for my shoes,
my thoughts become more organized, and I’m already starting to generate
a “differential diagnosis,” the list of possible causes behind this man’s
presentation. While trying not to wake my bunkmate and fellow intern, I
slip out of the night call room and jog up the echoic stairway to the
medical floor.
Briskly walking down the darkened hallway, I arrived in the Medical
Unit, which is a beehive of activity. Nurses and aides are darting around,
and are oddly relieved to see me. Typically, floor nurses in an academic
medical center rightfully have disdain for interns. They arrive every July
with their new MD degree, but are as helpless as a newly licensed motorist
trying to drive a stick-shift, uphill, for the first time. But these were
medical nurses, adept at caring for cardiac patients, but greenhorns
themselves when dealing with an odd musculoskeletal patient who would
normally be a couple floors down on the orthopedic floor.
A young nurse points to the corner bed, where a seventy-eight-year-old
gentleman restlessly lies in his hospital bed, his left arm propped up on
pillows. Rapidly, I can see the bruises that the nurse was telling me about,
and I can also see that his forearm is swollen. I ask, “Mr. Louis, does your
arm hurt?”
This aged man is truly sick, and can only mumble a feeble, “yes.”
Growing concerned, I approach his bedside, and focus on his arm. There
are dark, splotchy patches of bruises the color of grape jelly. I lean over
the bed, inspecting the inside aspect of his elbow. There are several raised
burgundy-colored blisters above his elbow, and I am starting to feel out of
my league. What am I looking at?
I reach for his wrist to lift his arm, and instantly feel the crackle of air
under the forearm skin that feels like squeezing a bag full of wet Rice
marcin
(Marcin)
#1