Lessons From A Dramatic Save

by Dr. Thomas Lundberg, MD 22. June 2014 13:45

dr. thomas lundberg

S.M., a 30 something nurse, left a message for me complaining of diarrhea. I asked my usual questions... she had non-bloody diarrhea, low-grade fever, no significant abdominal pain, and no history of exotic travel.  Her symptoms were suggestive of simple viral gastroenteritis, and I advised fluid replacement and Imodium.

Next, S.M. asked for something for her "yeast infection."

I immediately became concerned.  There is an application of "Occam's Razor" that relates to the practice of internal medicine.  Very simply, Occam's Razor is the tenet that the simplest solution of a puzzle is the most likely.  It’s application to medicine, is that there is usually a single diagnosis causing multiple symptoms, as opposed to multiple diagnoses causing the multiple symptoms.

Back to S.M. I became concerned that a single diagnosis might be responsible for both her diarrhea, and vaginal symptoms, as opposed to her simultaneously having both viral gastroenteritis and a yeast infection.

I inquired why she thought she had a yeast infection. She replied "vaginal redness."

I inquired if she was menstruating. "Yes." Tampon? "Yes."

I instructed her to immediately remove her tampon and proceed to the emergency room. 

Upon arrival to the emergency room her blood pressure was 60/__.  The application of a simple tenet, Occam’s Razor had saved her life.   Instead of her having viral gastroenteritis and a vaginal yeast infection, she had toxic shock syndrome causing her diarrhea and rash.  Admittedly, the rash associated with toxic shock syndrome is usually a head to toe redness.  Unfortunately for my colleagues and I, patients don’t always present with the "usual" symptoms.    

Now the lessons:

  1. Only by the grace of God go I. It would have been very easy for most physicians to miss this diagnosis. This case reaffirmed my faith in God.
  2. Your best medical care is in the office.  Period. It is not the most convenient or inexpensive, but it is the best care. An experienced physician can tell in a glance if someone is very ill. Even if I didn't put all of the pieces of the puzzle together, a simple blood pressure would have indicated the gravity of S.M.'s situation.

Never succumb to the temptation of soliciting advice from a physician outside of the office. You're going to get LOUSY care, and you place the physician in a medical legal conundrum i.e., he or she becomes liable for their advice, even though it was based on very limited information.

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Health From The Inside

Comments (1) -

7/19/2015 10:54:32 PM #

This story is a great example of the importance of the relationship between the physician and patient.  Having the "concern"  for the patient, prompted Dr. Lundberg to ask more questions.   Using your God-given talents to bless patients has to be very rewarding.  Thanks for sharing how your medical training and your faith worked together in solving a mystery.  

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