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From: mmm@weitek.UUCP (Mark Thorson)
Newsgroups: net.med
Subject: Re:  Medical Case History
Message-ID: <344@weitek.UUCP>
Date: Thu, 12-Dec-85 15:28:46 EST
Article-I.D.: weitek.344
Posted: Thu Dec 12 15:28:46 1985
Date-Received: Sat, 14-Dec-85 23:38:51 EST
Organization: Weitek Corp. Sunnyvale Ca.
Lines: 58
Keywords: fear and loathing in CCU

> A 55 year old moderately obese male with a 40 pack year history of cigarette 
> smoking but no significant medical disease was quietly sitting on his porch 
> attempting to complete the Sunday NY Times crossword puzzle in ink.  While 
> pondering over a definition for an "oxymoronic large crustacean", he suddenly 
> experienced anterior chest pressure, shortness of breath, and diaphoresis 
> which lasted 10 minutes and then spontaneously dissapeared.

Reject patient's self-diagnosis.  Prescribe spoonful of bicarbonate of soda.

> One hour later, the original symptoms recurred after he threw the uncompleted 
> crossword puzzle down in disgust.  Severe chest pain persisted until he 
> arrived at the hospital 4 hours after the second onset of symptoms.  He was 
> immediately rushed to the CCU and stabilized.  EKG revealed acute ischemic 
> changes in the anterolateral leads, and the CPK level was elevated to 200 IU 
> (normal 110) with an MB fraction of 7.0%  Within 2 hours he was taken to the 
> cardiac catheterization suite.  Catherization revealed total occlusion of the 
> proximal LAD coronary artery and hypokinesia of the anterior left ventricle.

This guy's really trying to look sick.  If he whines again, put him on a
respirator.  Check his medical coverage.

> Following the coronary angiogram, the cardiologist perfused the affected 
> vessel with streptokinase, and performed an angioplasty by placing a balloon 
> catheter across the lesion and dilating the vessel.  Good flow was 
> reestablished and the patient was returned to the CCU.

No insurance.  Good thing he's okay for now.  Prepare to transfer him to
County Med.  Tell them he's got indigestion.

> On the day following the coronary angiogram, the patient developed new chest 
> pain different in character from the previous precordial pain. The pain was 
> relieved when the patient sat up. A rub was heard to the left of the sternum.

Got him over there just in time!  Nobody buys the farm on my shift.

> 6 days later the patient was clinically improved and was transferred from the 
> CCU to a private bed.  While watching Dwight Gooden pitch out of a 9th inning 
> bases loaded, he suddenly clutched his chest and expired with ever finding 
> out if the Mets won the game. An autopsy was performed.

Oh shi*, those losers at County are saying my diagnosis was faulty.  Call on my
department head to back me up.

> Unexpectedly, the autopsy revealed that a small branch of the left middle 
> cerebral artery was occluded by a recent embolus, and that the right kidney 
> and spleen had several small, acute infarctions.

Department head testifies that patient couldn't describe symptoms due to stroke
to speech areas of brain.  A certain nurse is quietly told in no uncertain
terms to keep her own speech centers shut up.  My a** is covered.  Whew!

> 				Craig Werner
> 				!philabs!aecom!werner
>           "It's hard to argue with someone who knows what he's talking about."

Mark Thorson   (...!cae780!weitek!mmm)

"It's even harder to argue with someone who's right!"