I Wish It Were Cat Scratch Fever
A tale of black cats and clear vodka in multiple acts. The chief complaint is a cat bite. I go in to talk to the patient, and sure enough, she has a tiny cat bite on her shin that looks to be healing well, but is exquisitely tender along the tibia and up around the knee.
Cat bites are a favorite of medical students because they can cause Cat Scratch Fever due to Bartonella henselae; one of the cooler diseases by name and because there's a Ted Nugent song named after it. Short of that disease, cat bites are notorious for causing infection because, as one attending put it, 'their teeth are like hypodermic needles for injecting bacteria'. One more reason cats are cute...from afar. I'll stick with Golden Retrievers, thanks.
The patient is dressed in jeans, hiking boots, an old sweater. She has a calligraphic tattoo on her neck. Any other symptoms? Speech is slurred. Well, diarrhea, she says. Green, the color of the paint on the wall (no, we don't have poop colored walls. Kelly green). And I throw up like clockwork every day at 5 or 6 am, and again at 7 am, so I can't take my medicines.
Were you sick before you had the cat bite? Well, yes. Part of me is disapointed, in a fit of moral obfuscation I'll talk about in a later post. No Cat Scratch Fever. But she has had fevers, and chills. And abdominal pain. And shortness of breath. Her exam reveals lungs that sound like a hyperactive gnome playing with tin foil. Her abdominal exam shows marked guarding (muscles tense with any pushing) under the ribs on the right and just below the bottom edge of her sternum.
Sometimes I go into a room without reading the chart a lot in order to simulate my future life with its total lack of any sort of continuity with the exception of drug seekers and cold homeless people.
So, I was thinking, gosh, could this be pancreatitis? Ulcer? Sepsis secondary to the cat bite was unlikely, no matter how much I wanted the cat bite to be something interesting.
To be safe, I read the chart. She had presented with exactly the same thing, minus the cat bite, three weeks ago, and again before that, so on and so on for years. Further questioning revealed that she had also been drinking a liter of Vodka, again. She has had elevated lipase levels and acute pancreatic attacks before. Probably was pancreatitis again. But it wasn't from the cat. The poor cat bit her because she was ataxic from the vodka and about to step on her kittens. And, oh yeah, the meds she couldn't take were psych meds.
My first car was a 1974 Volvo station wagon that couldn't get over 50 MPH even on a downhill, but somehow managed to keep running for years. Every once and a while I would change a hose, change the oil, get in a fender bender, have a friend jump on the roof at a party and dent it irreparably. The steering wheel lost it's cover one day. It just fell off. But eventually we sold it, still running. I saw it one day downtown, still going.
Some patients are like that. I can't for the life of me figure out how they keep going, but they do, with their panaloply of ailments, dragging through life. I haven't solved them yet. I wonder if I will. Until then, it'll be easy to form compassion for them. I used to love that old car too, even when it didn't work so well.