Ritual

Learning From Experience, Pt. 5

[there was a knock outside the door]

Me: Come in.

[Dr Kors enters the exam room. It is now Tuesday morning. He puts my charting on the counter and rolls his stool in front me, sitting down to face me as I am seated comfortably in a chair. He has been my physician since 2010.]

Kors: I am sorry to have see you under these circumstances, Ronnie [the nurse who took my history and assessed my vitals] shared with me how challenging the last fews days have been for you. So, what do you think is going on?

“Well, initially I thought it was a 24-hour-thing, but it has persisted now for 3 days. Every morning I feel better with the fever at about 99-100 degrees, but by mid-day it is at 102 and every evening spikes over 103. I am shaking violently, getting little sleep and have night sweats. So, to answer your question, on Sunday I started to have concerns about leukemia – [I pause for laughter] and I appreciate you not smiling or laughing while you are in the room…you know that I know better. Besides, yesterday morning I developed a pretty significant cough that has progressively worsened. So, you would think that would dispel any notions of leukemia – but, then again, it is me.”

Any panic attacks?

“No, sir. An elevated heart rate, but that has been present since the fever started and that could be related as much to my immune response as anxiety. I did take a klonopin 2 hours before this visit, but have otherwise kept things under control. So, it is in the back of my mind – and I know better – but I know that the most reasonable thing to expect is that this is just a bitch of a virus. But how long can something go on this intensely?”

Five days or more.

“Ugh, I guess I have been lucky never to have anything like this before.”

Yes, you have been. Are you having any difficulty breathing? Any additional respiratory symptoms aside from the cough?

“No, just the cough and it all seems like it is in my upper throat.”

Any congestion?

“No, sir.”

And you told Ronnie that your fever responds well to ibuprofen?

“Indeed, 2 tabs every 4-6 keeps me comfortable…until the evenings decide to kick my ass.”

Okay, it sounds like you are probably spot on by thinking that it is viral, but let’s go through the exam.

[Dr Kors commences his exam….and later concludes it]

So…here is what I recommend; you let me know what your thoughts are. First, your lungs sound clear and your throat and ears don’t appear infected, so I don’t want to use an antibiotic that is just going to give you some other side-effect symptom to worry about a couple of days from now – besides if you were shopping for antibiotic you would have gone shopping at Urgent Care, right? [we both have a chuckle at Urgent Care’s expense]. Continue to use the ibuprofen as you are for comfort; it is working. Don’t use any cough syrups, but you can use cough drops for comfort if the coughing begins to irritate your throat. I still want to take chest x-rays because there is a chance it could be bacterial pneumonia and maybe I just can’t hear it; if so, I will call in an antibiotic to your pharmacy at that time as it would then be considered appropriate. And lastly, before you leave, we will do a quick blood draw and check your WBC to make sure that nothing too nefarious is going on – then you can sleep better at night. What do you think?

“It all sounds appropriate, but do you think the blood-work is necessary? If I had not mentioned it, would leukemia be something you would consider or are you simply appeasing me?”

If you didn’t have this cough, and your fever was high this morning, and had been for 3 days straight, I would get the blood work done. But, Keith – I think you’ve got it wrong. You call it ‘appeasing’, I call it ‘working with my patient.’ You have symptoms that indicate that blood work is appropriate, so we are going to do blood work. Tomorrow morning, you will get the results. If I am correct and this is viral, you may have symptoms for the next 2-3 days and the blood work may save you a trip to the emergency department, don’t you think?

“Well, I appreciate that, and your willingness to work with me, sir.”

And I appreciate all the care you provide to my patients. Please continue the great work. You are an asset to your company and the community…Ronnie will be back in a couple of minutes to draw your blood and I will call you this afternoon with the results of the chest x-ray, okay?

“Yes, sir. And thank you again.”

You’re welcome.

.     .     .     .

At 1530, I received a call on my cell phone from Dr Kors. “Well, Keith. I was wrong. I couldn’t hear it, but you have pneumonia. So that accounts for all of your symptoms and it is now most appropriate to consider an antibiotic….”

.     .     .     .

Ronnie called me the next morning after we exchanged stories of anxiety and fictitious maladies while she drew blood the day before. “You are fine, but you knew that already, right?

“Yes,” I replied, “but I appreciate your calling. Thank you.”

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