Geek mythology

St. Elsewhere Veterinary School

10:30 a.m. Monday

Dr. Janet Miller sits and nervously listens to rounds moderated by hersenior professor.

She half-listens as she thinks about the morning disaster.

Dr. Miller had admitted an animal named "Pete" with liver problemsthe night before. The referring veterinarian had sent the animal up witha continuous IV in place and the owner had dutifully hung the fluid containerfrom the coat hangers in the back of their new SUV. A complete report accompaniedthe admission.

It seems that liver failure secondary to drug interaction was the tentativediagnosis by the referring vet, Dr. Jim Blount. Dr. Miller had decided thatgeneral anesthetic might have been too risky but Pete still died duringa liver biopsy done under light sedation and a local. What killed Pete?

Entering spin zone

Preliminary blood tests indicated high white cell count and various elevatedliver tests; Dr. Miller now faces talking to the owners in an exam roommomentarily. What she told the owners was right out the "spin zone".

"Hello, Mrs. Wheeler, I am afraid we lost Pete." (A descriptionof the ensuing scene is unnecessary for our readers.)

Finally, after several minutes, Mrs. Wheeler composed herself enoughto ask what he died from. "Well, Mrs. Wheeler, it appears that theremust have been some septic shock likely induced by the IV."

Mrs. Wheeler asks for a clearer explanation.

"Well, your doctor left the IV catheter in too long, and by thetime we got around to helping Pete, it was too late. Dr. Blount should haveplaced another catheter Sunday morning. The catheter had been in since Saturdaynoon and this is Monday. My personal limit is 24 hours max for each catheter,"she pronounced with granite-eyed authority.

"What about the liver like Dr. Blount was talking about?"

"We went ahead with the biops,y but I'm positive that we are dealingwith a septic shock from the IV."

"Must be Elsewhere" Animal Clinic

9:30 a.m. Monday

In central New England Dr. Blount just finished telling Mrs. Smith thather cat must have died from a stroke or heart attack. Mrs. Smith did notwant an autopsy but did want to know the likely cause of death-Dr. Blountgave her one. A few minutes later Dr. Blount opened the exam room doorand was presented with a serious abdominal distention in "Rufus,"an obese German Shepherd, owned by Bucky Shannon.

Dr. Blount ordered X-rays, and the results were inconclusive. To Dr.Blount there appeared to be gas distension and a small radio-dense shadowin the anterior abdomen.

"Mr. Shannon," Dr. Blount intoned, "Rufus has somethinggoing on in the abdomen at this time. This almost always requires surgery.Rufus has eaten something, and it is likely caught in the stomach. Thisshadow could be a piece of metal." Mr. Shannon was impressed by theserious tone of Dr. Blount's pronouncements and authorized surgery thatmorning.

While making a midline incision in Rufus, the fatty omentum and falciformligament boiled out onto the surgical drapes. As Dr. Blount continued theincision, it became quite apparent that Rufus was filled with an enormousamount of abdominal fat. The exploration continued. Nothing was found inthe stomach but a small amount of food. The rest of the celiotomy was withoutany significant findings save the intestines that were a bit reddened.

Rationalize

In his mind Dr. Blount was quick to note this as a potential "cause"for what must be going on. He had to find causation beyond the mountainof adipose tissue lying in front of him.

After surgery he called Mr. Shannon.

"Mr. Shannon, Rufus did fine. What we found was an inflamed gutthat was giving him all the trouble. I found something in the stomach thatprobably was the object. It could be metal, but I think that if it is metalit will pass through with no problems.

"Dr. Blount, what was causing all the swelling in the abdomen then?"

"Oh, the inflamed intestines for sure were a good part of it,"the doctor replied.

"Did you do anything that will help him?" queried Mr. Shannon.

"Oh, yes, we'll put him on antibiotics and keep him on fluids throughthe night. Oh, and by the way, we ought to look at putting him on a diet."

Dr. Blount added this as if it was an "afterthought".

Just then an assistant named Mary opened the door and said that the universitywas on the phone. Dr. Blount excused himself and put the receiver to hisear.

"Dr. Blount, this is Dr. Miller. Your patient expired this morning.It appears that a septicemia developed before we could ascertain the causeof death. We started stupendo-flutixicin ASAP but it was too late. I seethat you had the patient on a 4th generation cephalosporin developed a fewyears ago. We feel at the university that the brand new stupendo-flutixicinis a better choice for these septic situations. I also noticed that thecatheter was placed Saturday noon and Pete arrived Sunday evening withouta new IV placed on Sunday. The newest protocols call for every 24 hoursin potential septic situations. I feel that without a sterile dressing andantibiotic ointment on the IV site during transit that the IV was contributoryto the patient's death."

Dr. Blount was confused.

"Dr. Miller, was a blood culture done?"

"Yes, it came back negative, but I feel that there are many falsenegatives," she said evenly.

"Didn't you do a biopsy? What was the result?"

"The preliminary report shows acute hepatitis, but this could befrom the septicemia."

"But all my tests showed liver problems Saturday morning."

"We can't rule it completely out, but septicemia is our best definitivediagnosis."

"Did you notice that I had taken Pete in on Saturday from anotherveterinary hospital and that he had been on 'stupendo-flutixicin'* priorto his liver enzymes skyrocketing?"

"Yes, doctor," she intoned condescendingly, "but we reallycan't make the correlation can we now? Besides, the manufacturer has neverreported any liver problems."

Dr. Blount hung-up the phone and was depressed. He had tried his best,and the university wasn't really helping much.

"Must be Elsewhere" Animal Clinic

1:30 p.m. Monday

Mary was at the door again. She came over and whispered that an attorneywas on the phone and that she was representing Mr. and Mrs. Wheeler. A lumpformed in Dr. Blount's throat.

St. Elsewhere Veterinary School

4:00 p.m. Monday

Janet Miller was wondering about her car that she dropped off at thedealership earlier in the morning. Her car just hadn't been running right.As if the shop was communicating by telepathy, the mechanic called as shecompleted her last thought.

Shoe on other foot

"Doc, this is Jimmy Adams down at the dealership. Your car needsa complete overhaul plus some of the other maintenance items are overdue."

"Can I get my car back tonight?" she naively replied.

Jimmy laughed under his breath-(she didn't realize that Jimmy was oncommission.)

"No, doctor, your car will be in the shop for about two weeks andthe cost will be over $2,000."

Dr. Miller felt her temperature rise very quickly.

"What on earth do you mean? What could have caused such a big issuewith my car?" she fumed.

"Well, Doc, my best guess is that your last mechanic sold you thewrong motor oil. Ya should'a come to the dealership in the first place."

Dr. Miller unknowingly had just entered someone else's spin zone.

*Author's note: This story and the antibiotics described here arefictitious. It does not imply a problem with a particular drug from anyreal pharmaceutical company. This story is partially autobiographical. Inmy case, the director of clinics at the university later apologized.