Having finished my family practice residency, and not being tied down by friends or family, I thought a round of working locum tenens would be a good way to see some different styles of practice.
I contacted a company called Locum-motion, filled out my paper work and was on my way. I had graduated from the University of Hamlin a few weeks earlier, armed with stethoscope and hammer. Dr. Claudio Prince (that’s me) was ready to stamp out disease and save lives.
There were several practice options available, but I chose a small hospital in Bremen. The three doctors who ran the hospital were going on a musical cruise for a week, and I would cover the entire facility for that time—ED and floor. I met with Drs. Baker, Butcher, and Maker briefly before they left for a trip. There were only a few inpatients, and one patient in the ICU. Then they were gone, and I was on my own.
My First Patient: I thought I’d start with the inpatients. The first was a Mr. B.B. Wolfe. He had been admitted for myalgia.
I was shocked when I walked into the room. He had severe hypertrichosis, prominent dentition, and proptosis. I briefly considered porphyria. I noted his history of muscle aches, high fever, facial swelling, and visual disturbance. His admit lab had showed a high CPK and LDH.
It sounded like an infestation of Trichinella to me. I questioned him about the ingestion of raw pork. He looked me in the eye and asked if his answer would be part of his medical record. I told him he needed to tell the truth for me to help him. Finally, he admitted he had eaten several portions of uncooked pig. I began to explain to him about the workup, the need for a muscle biopsy, and treatment options like mebendazole or steroids. I described the intestinal stage, which occurs between two and seven days after ingestion, when encysted larvae are liberated from the meat by gastric juices. I told him how the larvae mature into adult worms that burrow into the intestinal mucosa. I described the muscle stage, which develops after the first week and represents the period when adult-derived larvae in the intestines enter the bloodstream and disseminate hematogenously, then enter skeletal muscle causing pain.
He jumped out of bed and said he was leaving AMA; he had an appointment with a red-hooded girl. Whatever. I let him go; not much I could do to prevent his departure.
In the ED: I got a call from the ED about an old lady who had come in, having nearly choked on a bug. She looked fine to me, and I let her go. While down there, another older woman came in—in active labor. She admitted to having taken her friend’s Clomid, and had had little antepartum care secondary to a dearth of health insurance. Before I knew it, we were in the labor suite. First came one boy, then another, then another. I thought I was done, then two girls, another boy, then another girl. Seven babies—incredible! She moaned, not knowing what she was going to do with all these children.
I headed back to the floor to see more patients. The second one for the day was simple: a scrotal burn on a Mr. J.B. Nimble, who had been injured jumping over a flame. He was ready for discharge. The third patient was interesting, a Mrs. Spratt. I had been called by the lab with word that her serum looked like mayonnaise. She had abdominal pain, hepatosplenomegaly, memory loss, dyspnea and eruptive xanthomas. It sounded like type V hyperlipoproteinemia with chylomicronemia syndrome. What an interesting case, probably worse secondary to her very high-fat diet.