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Medical Mystery: A True-Life What-Done-It

medical-mystery-bookHe was the patient every doctor dreads. And it was my job to save his life.

by Eva F. Briggs, M.D.

“I just don’t feel well,” said Mr. Baker* on this nippy fall New York morning. I was filling in for a doctor at an urgent-care center.

I grilled my new patient thoroughly, but he denied everything: no weight loss, no pain, no rash, no new life stresses. It was the case every doctor dreads: an unfamiliar patient whose vague complaint has a thousand possible causes. Sometimes, there’s nothing wrong. Other times, the problem is deadly.

I dove in with a physical exam and a bevy of questions. “What do you do for a living, Mr. Baker?”

“I’m the maintenance guy at an office building.” No occupational diseases there.

“Do you smoke?”

“No, never have.”

“Drink?”

newsletter-graphic“I have a beer every once in a while. Not too often.”

He was simply a typical male in his mid-50s—a little overweight, balding and gray, but nothing medically significant. He had no questionable past medical problems. No weird diseases ran in his family. His wife and two daughters were well.

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Going Through the Options ... and the Tests
Speaking of things he didn’t have, Mr. Baker also had no primary-care doctor to whom I could send him to figure out this medical mystery. And the doctors he’d called had told him there would be a two-month wait.

Could I refer him to a specialist? Well, which one? We family doctors are the specialists when it comes to just not feeling well! So I ordered blood work, looking for the usual suspects: anemia, renal failure, thyroid disease, inflammation. But that wouldn’t be back until the next day.

“One more thing,” Mr. Baker remembered. “I think I might have a fever at night.” Hm. Could it be a hidden infection like tuberculosis? HIV? A tumor? A rheumatic disease like lupus? I decided to order a chest X-ray too.

Alas, no luck. The X-ray looked normal to me. But it was a quiet day at the urgent care, so I took a few minutes to call the radiologist, Scott,* for an official reading.

“Well, the mediastinum may be just a hair wider than normal,” he said. That’s the area that holds the heart and part of the esophagus. “I’d say try a chest CAT scan?”

It came back normal … except …

“Look at the lowest picture,” Scott said. “There might be something going on in the abdomen there.”

Four hours into his marathon urgent-care stay, I sent Mr. Baker back down to radiology for an abdominal CAT scan.

Finally.

 
Medical Mystery: Solved

The scan uncovered large lymph nodes in the abdomen and pelvis. We had found the problem at last. And there was a specialist for this one: an oncologist.

Turned out, Mr. Baker's medical mystery was non-Hodgkin’s lymphoma, a form of cancer that begins in the lymph nodes. Usually, signs include swollen lymph nodes in areas you can see or feel, like the neck or armpits—or the disease isn’t uncovered until it has spread and caused symptoms like weight loss or profound fatigue.

Chemotherapy and surgery eventually cured him. But if I hadn’t taken his vague complaints seriously and followed up on each test, his diagnosis could easily have been delayed for weeks or months. And it’s a good thing Mr. Baker listened to his body and came to the doctor rather than delaying care.

We ended up agreeing we’d developed a working relationship over the course of that day. I became his official regular family doctor—without a two-month wait.


EVA F. BRIGGS, M.D., is a board-certified family doctor with Cayuga Medical Center, which has urgent-care centers in Ithaca and Cortland, N.Y.

*Names and details have been changed.


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Last updated and/or approved: January 2012.
Original article appeared in September/October 2009 former print magazine. Bio current as of that issue. This general health-care information is not meant as individual advice. Please see our disclaimer.

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