Tasty Lesion Café (A fictional story)

 

“I’ll have the pancakes with whipped cream, three sausage links and three eggs over easy.”

“Damn Mike, you’re going to have to double your Crestor after that mess of artery clogging chow!”

“Whatever, it’s been a long night on call and I deserve it Sam. Tell you what; I’m shaking after working with this patient last night and for the last couple of days.  Sometimes I wish I wasn’t an internist and I could just cut on hearts like you do; fix’em and be done with it.  Slam bang, thank you ma’am.”  The waitress was clearly impatient, rolling her eyes, waiting for the next order.

“Sir, what will you have?”

“Coffee, orange juice, oatmeal and granola.”

“You wuss,” said Mike.  “Be a man and order some real food.”

“Not after operating on those hearts all day.  Makes ya stop and think.  So tell me about this interesting patient.”

 

“Well, first she came in to the ER with stridor and a fever.  Took a look at her larynx with a laryngoscope and sure enough, it was a case of Cherry Red Epiglottis, so I put her on antibiotics and intubated her.”

“Haemophilus influenza?”

“Cultures negative, but broad spectrum antibiotics worked. Next day she developed pulmonary edema and her liver was huge.  She was a modest drinker, but due to her rheumatoid arthritis and possible Lupus, we biopsied her liver.”

“What did the biopsy show?”

“Nutmeg Liver with an area of Anchovy Paste.”

“Ah, congestive heart failure causing congestive hepatopathy with superimposed Amebic liver abscess.  Did she have fingernail clubbing too from all her smoking?”

“No clubbing but huge Sausage Fingers.”  He downed his last pork link, then licked the grease off his lips.

“Her rheumatoid arthritis must’ve been severe.  Was she immunosuppressed from her RA treatment?”

“Well, that’s why she had the liver abscess and epiglottis.  Damned if she didn’t develop acute abdominal pain and I called for a surgery consult.  Said he wouldn’t operate because she had multiple surgeries in past and she had a hostile abdomen.”

“Ah, Hostile Abdomen Syndrome.  Reminds me of some of the nasty lungs I’ve operated on.  I call them Snarly Lungs.  Soon as you go in you know you are in trouble.”

“Yeah, stick with hearts.  They’re cleaner.  So anyway, she gets better with the grace of God and I think she’s walking out of the hospital but she develops Exploding Head Syndrome.”

“What the hell is that?  I’m just a surgeon and if you can’t operate on it, I’m clueless.”

“It’s an auditory hallucination occurring with the onset of sleep, kinda like an earthquake noise or a loud bang like a gun going off.  Occurs with fatigue or withdrawal from medications.  She wanted lots of morphine, so we treated her with narcotics because she feared going to sleep.”

“You fleas just chase your tails with medications, using one medication to treat the adverse reactions from another.”

“Whatever.”  The whipped cream dollop remained above his upper lip but Sam decided not to tell him. “So, that goes away and I get ready to kick her out of the hospital, but she refuses because she looks in the mirror and says she’s dead.”

“What?”

“Yeah, she thinks she’s dead and doesn’t know who that is in the mirror.  She says we drained her blood and her organs are out of her body.”

“Again, thank God I’m a surgeon.”

“What did the psychiatrist say?”

“Thought you’d never ask.”  The whipped cream dollop oozed stealthily down Mike’s chin but he was so exhausted, he lost all concern about appearance. “Well, he diagnosed her with Walking Corpse Syndrome or Cotard’s Syndrome.  She had a delusion she was dead both literally and figuratively and the face she observed in the mirror she thought didn’t exist.  While it occurs in schizophrenia, turns out it was secondary to the valcyclovir she was taking for her herpes, compounded by a severe migraine headache, both of which can do it.”

“No wonder you’re a damn mess Mike.  Wipe off your mouth please, you’re making me sick.”

With that, both docs got up and left and Sam paid the bill, feeling sorry for his beaten colleague.

“So Sam, we meet again next week for breakfast?”

“Um, I don’t think so Mike, I don’t think I can take anymore of your medicine stories.  Rather just cut it out and cure it.”

“For a blood and guts guy, you’re a wimp.”

 

SRC