" The dispute between populate or break can breathe on whether or not the doctor knows about a particular circumstance . "
While one might think it’s something that only exists on TV, medical mysteries pop up every day. Whether it’s an emergency or a chronic problem, these “unsolvable” cases cause a medical professional’s instincts to kick into overdrive…
1.“During my second year of residency, I was called in to cover another resident for the weekend. One of the patients on the list was in her 80s and being transitioned to hospice due to ‘terminal delirium.’ She had come in confused and had been in the hospital for two weeks with mostly normal test results. Initially, doctors thought it was a UTI and treated her, but she didn’t get better. Her mental status worsened, and her fevers continued. No one could figure out what it was, but, because there was no answer, the family ultimately decided to try to take her to hospice rather than put her through more invasive testing.”
“When she initially came in with a UTI, she was confused, so someone started her on a nightly antipsychotic to help with the ‘agitation’ and kept giving her the medicine because they thought it was helping. In reality, she was having a rare but potentially life-threatening reaction to the medicine calledneuroleptic malignantsyndrome. I checked a few labs, and her creatine kinase was high, which supported the diagnosis.”
" We stopped the medicine , and she walk out of the infirmary a week later on . I kept an middle on her chart for a prospicient sentence , and she eventually passed forth due to other case . This was and still is one of my best catch .
As lofty as I was for this one , it terrorise me . It play up how the difference between someone be or dying occasionally rests on whether or not a doctor knows about a particular circumstance . fortunately , in her suit , I had latterly attended a lecture that included videos of those side effects , so I immediately recognized it . It does n’t make me a better physician than the the great unwashed who saw her before . It was just mean to be that I cause to treat her at that time . "
— u / Numerous_Birds
2.“This case wasn’t wildly mysterious, but it had the biggest impact: I was a psych intern doing rotations. As a psych rotation, you are guaranteed to get assigned the patients the attending doctors dread. So, in this particular situation, the attending doc hands me the folder with the oft-quoted, ‘Oh, this one is perfect for you.'”
" The patient was a female in her 40s and had been witness a PCP for over a decade for ' random stuff . ' She was described as anxious , dramatic , and aid - seeking . I find she had experienced fugacious intermittent neurological symptom that ostensibly affect random areas of her body . Over time , she put forward that instalment happened more often , and she did n’t feel like she was bounce back the same as before .
I lecture with the attending and told him I think we need to do an MS workup . He wander his center and said , ' She got to you , huh ? ' He said I could order a workup if the affected role were uncoerced to pay . So I did . It was the last week of that rotation , so I could n’t follow up with her .
A span of weeks later , I was on another revolution , but got a notification for a lab result . Since I ordered the entire workup , the results were get off to the attend doc and me . The patient role was positive for MS . This misfortunate adult female had been sell with untreated MS for over a decade . Her description of the symptoms would have been easy for even a first - year med student to put MS near the top of their differential . It still makes me furious for her . "
— u / Eshlau
3.“Paramedic here: I was on a transfer for a kid with unspecified ‘Altered Mental Status.’ He was a young male patient who had become strangely altered without a known cause. The patient was hypotensive and tachycardic, and had rapidly lost weight since his last primary care appointment. The ER had drawn labs, all showing normal, so they had decided to send him to the pediatric center for further testing and monitoring.”
" I got on scene and looked at the affected role , puzzled as to what was making him sick . While hooking him up to the cardiac varan , I noticed he attend like my buddy did as a kid . My pal was diagnosed with adrenal insufficiency and had almost the same symptoms . As we were driving down the route , the patient was getting bad , so I give him a dose of IV Dexamethasone ( the only sex hormone we carried at the time ) . The female parent and I waited for a change , and for certain enough , the kid started to get secure .
Later tests affirm at the pediatric centre that it was , in fact , an adrenal crisis , and he had undiagnosed Addison ’s Disease . The doctor gave me airscrew for project it out , but truthfully , I doubt I would have recognized it without knowing what to seem for in my buddy . "
— u / ThatGingerEMT
4.“I’m a genetic counselor who works in pediatric oncology, and this was one of my biggest ‘trust your gut’ situations: I saw an infant with a brain tumor who I was originally told had no family history of cancer. Upon talking to the baby’s mom, I learned she had breast cancer in her 20s, and her own mother had died from a rare sarcoma in her 20s. Moreover, all of their maternal relatives had cancer at a young age.”
5.“A cool call I had as a paramedic many years ago initially annoyed my partner and me. A twenty-something-year-old male woke up with nausea and vomiting (it was a Sunday morning in a neighborhood known for partying). The call notes said there was a small amount of blood in the vomit, so it got up-triaged to paramedics responding.”
" When we make it , the affected role ’s lady friend was freaked out , but guided us to the patient role , who was white as a sheet , drenched in stew , honk gross stock into a meth can that was already full of it .
We start our assessment and learn he has always had digestive outlet — continuing looseness of the bowels , ugly hemorrhoids , etc . — and has to consume an passing low-spirited - fatness diet . We asked if he had been party the dark before . He said no because he ca n’t have more than one beer , or he ’s a mess for days . He smoked some skunk , but no more than common , and he had smoked from the same suitcase to begin with and was fine . He had never thrown up parentage before . But , because he did n’t have insurance , he ’d go anywhere other than urgent care . He had an upper gilbert bleed , but something clicked in my lizard brain , and I realized precisely what was happening . His liver was SCREAMING for aid . "
“He can’t digest fat, can’t process alcohol, and what seemed like an innocuous comment was the key to the whole thing — his hemorrhoids. If the circulation through your liver gets backed up, it causes pressure in the blood vessels that come in and out to build up. If enough pressure builds up, your anal veins balloon out causing a hemorrhoid. If that pressure goes north, you can get esophageal varices, essentially the same as hemorrhoids, but in your throat. They can rupture and bleed profusely.”
" Despite our effort , he lost a ton of blood and speedily decline . Upon arriver at the vital section of the ER , he passed out before being intubated and given rake transfusions .
The attending doctor was always aloof and did n’t play well with nurses or EMS . However , we hark back later in the day with another patient role , he pulled me away to ask , ' What on the button is the ambit of your grooming ? That was wild , you caught that ! ' I reflected on that moment for the residue of my career . "
— u / sam_neil
6.“I was on night shift when one of my junior colleagues called me to come help him with a puzzling patient. The patient’s oxygen saturation was fine while lying down without any supplemental oxygen, but when he would sit up, his saturation went to the 70s. Everyone thought it had to be an infection, a pulmonary embolism, etc. It had been going on for a while, but no one seemed to know what it was.”
7.“I’m not a ‘medical’ doctor, but I am a psychologist who made a life-changing diagnosis for my patient. This particular patient, a 67-year-old woman, came into my practice one day after her physician referred her to me about having anxiety alongside vertigo that had lasted for over a decade. The doctors couldn’t figure it out, so they thought it was psychosomatic. After a brief interview, she told me her symptoms had improved while she visited her sister for a week, but immediately returned when she got home.”
" I call for her who dwell with her , and she told me she lives with her son , daughter - in - police , and their cat . properly then and there , I think , ' This is n’t anxiety but allergies . '
I suggested she move the bozo out of the house for a few week and do a deep cleaning . She returned a month later , tell me that she was no longer fatigued and all of her symptom had go away , including the vertigo . She managed to get off the meds that she had remove for over a decade , all because of a computerized axial tomography ..
I matte up like I was Dr. House at that moment . It might not have been a huge medical mystery , but image her quality of life story improve was worth it . "
— u / ArcPsy
8.“Not a doctor, but an EMT: I was called to the scene of a car accident. A man had crashed into a fence near a reservoir. He had vomited down the front of his shirt and had a large red mark on his forehead. The police were going to arrest him for a DUI, but asked me to check him out first.”
“That explained the crash and the breath, but what about the vomiting and bizarre story? While I was puzzling that out, the patient asked to go to a small local hospital. Normally, a reasonable request, unless I have a trauma patient. I looked at the red mark on his forehead and decided to check his pupils — that’s when alarms went off.”
" With help from the police , we loaded him into the ambulance and expedited transportation to the nearest trauma meat . En itinerary , he complain of severe header infliction , said he could feel his pulse ram down in his head , and initiate screaming . His blood pressure was climbing every time I checked it .
When we arrived , the triage nanny tried to send him to ecumenical triage . I insisted he needed an immediate head CT . She pushed back . I take hold of a doctor , explained the post , and he ordered a charge CT . As I suspect , the patient role had a nous bleed . He went directly from CT into emergency surgery to break off the haemorrhage .
It ’s probably the call I ’m most proud of . If I had done one matter otherwise : if the police had apprehend him , if I ’d taken him to the wrong infirmary , if I had n’t argue for priority discussion , or if I had n’t taken the time to really talk to him , his chances would have been so much bad . He might not have survived . "
— u / KunSeii
9.“Psychiatrist here: I moonlighted at a standalone Psych ER in residency. Emergency services brought in a man who didn’t speak English due to psychosis. With the help of an interpreter, we could identify that he was from Bhutan and had been a Freedom Fighter. But the interpreter told us that most of the patient’s words were incomprehensible.”
10.“A young person came into the ER in an ambulance, unconscious. They were septic and losing two organ systems at the time of presentation (kidneys and liver). They can’t give a medical history because they are so out of it.”
" An IV line was n’t much help because the patient did n’t have sufficient nephritic function . The images looked like faint grey slop : oedema everywhere . I see four lowly gas bubbles : one in the portal vein , one in a tributary of the superior mesenteric vein , and two next to the pubic symphysis . These gas bubbles do not belong to there and are a dingy prognosticator . I have to make some variety of wild guess because this person is closelipped to dying .
I look nigher and see wearing away on the left pubic dead body . I call the surgeon and tell him to cut out the pubic symphysis ( where the two pubic bones meet ) . I make the diagnosing in 20 minutes : infected arthritis .
They foreshorten out the offending joint , and the patient walk out of the infirmary a week later . A follow - up CT record hundreds of liver abscesses from bacteremia — those clear with continued antibiotic drug . My co - worker who understand the follow - up CT congratulate me on a smart as a whip diagnosis . "
— u / Spiteblight
11.“Not the doctor, but I was taking care of a patient who was hospitalized for multiple days because of massive swings in her blood glucose. The doctors couldn’t figure out why her BG would be over 350 and climbing, and then 20 minutes later, it would crash into the 40s. She was [taking] nothing by mouth for reasons I don’t recall, possibly a gastrointestinal infection, so we were pumping IV dextrose multiple times a shift to keep her alive. We were down to our last vial, and I was freaking out because I was working alone that night.”
12.“Not me, but my attending doctor. We had an older guy with new severe hip pain, but his X-ray and MRI were normal. It didn’t add up, and she felt something else was happening to him. We got an MRI of his spine, and he had a huge abscess on it. Most of the time, you would expect to see weakness or sensory changes with a spinal abscess — he had none of that.”
" We imaged his whole vertebral column and found a dyad more stain of infection . Then we scanned his brain and found a large abscess . We also got an echocardiogram that designate a massive infection sit on one of his heart valves . He had NO symptoms other than this sudden oncoming of hip pain .
Long story short , we call up his diverticulitis rent bacteria into his blood , and he was unlucky enough to have it touch his heart valve . After a truckload of antibiotic drug , he did big ! "
— uranium / WoodsyAspen
13.“Not sure if this is a mystery, but I connected the dots in the last year of my residency: An 8-year-old kid came into the ER with fever, shortness of breath, and a small lower leg wound after falling two days before. He didn’t want to walk due to the pain in his leg (besides the wound, he had a bad limp).
14.“It is not the biggest medical mystery I have solved, but the first that comes to mind: I was once moonlighting in an urgent care when a 5-year-old kid came in for cold symptoms. We talked about upper respiratory infections, supportive care, etc., I examined the kid, and when he was getting ready to leave, I noticed one nostril was putting out purulent drainage, and the other was clear. I asked his mom about it, and she told me that his nostrils always drained; she had been told it was allergies. You don’t get allergies in just one nostril.”
" I also noticed that the room smack foul ( it smelled this mode frequently , so it was n’t noteworthy , however , it was in particular terrible in this lawsuit ) . So I get a little bulb syringe and suction out as much as possible . I see something in the tyke ’s nostril , but could n’t determine what it was with all the mucous secretion , so I snaffle some forceps , reached in , and pull out a 3 - inch chunk of Ellen Price Wood .
The kid ’s mommy part crying . She recount me he had had this problem for a few years and had regard multiple doctors , but no one had fixed his problem . He had been unrelentingly made playfulness of at school because of the smell . It only took 15 minute of my time , but it made a bountiful wallop on them . "
— u / Outrageous_Card7308
15.“I’m a dentist and this isn’t a huge mystery, but one that drove me nuts for four years: I had a patient with severe acid erosion on all of his teeth, but one area in particular was the worst. I figured he had to be obsessively eating something acidic and chewing it with one side of his mouth. I would interrogate him every visit to determine what was causing it. I probably asked him 50 times if he liked to eat sour candy, and he always replied, ‘Not really.'”
Note : Some responses have been edited for distance and/or clarity .
