It’s the middle of a regular workday. Consult for “VRE in urine” here, consult for “staph in blood ?contaminant” there. What a bore. I go about my business. Dragging, since I haven’t eaten breakfast and I really should make it to the cafeteria for lunch.
Routine consult pops up on computer screen for patient in emergency room for FUO. FUO standing for “fever of unknown origin”. To be a true “fever of unknown origin/FUO” the patient should have had fevers (by that we mean greater than 101F/38.3C and not any piddly “aaah, I have a fever”) for more than 3 weeks during which time intense workup has been done yet etiology of said fever cannot be found. So I roll my eyes, because chances are that this patient doesn’t have an FUO, but rather a fever with no diagnosis because no workup has been done…YET.
So I continue about my business. I usually try not to go down to the emergency room if I can help myself. Last time I was there, a male nurse remarked, “you must be ID – with your arms all crossed, strolling along”. Yeah, I guess, no place for strollers like me in an emergency department. I need time. Time to be in tune with my surroundings, time to listen to a patient, time to review a medical record. Emergency rooms don’t have time for people like myself.
But an hour later, the patient is still in the emergency department so I reluctantly make my way down there. Man, I tell you, I gained all kinds of energy from this patient encounter. It was an exhilarating experience for me, which means the patient was quite sick, unfortunately for them. Why?
The patient, elderly but otherwise healthy, had Babesiosis. Ba-be-wha you ask? Ba-be-si-o-sis. It’s an illness caused by the parasite Babesia microti that infects our red blood cells and is transmitted to us by the bite of an infected Ixodes tick. I guess you can call it the malaria of Northeast/Midwest United States.
Usually, people don’t get too sick from this infection. Some might get a flu-like illness with fevers, body aches, fatigue and the like. But then there are some, like this patient, who are quite ill. The patient had a very high babesia parasite burden and hemolytic anemia which made the urine look like chocolate! Now before you start to think of me as sadistic, let me explain. It was an exhilarating experience because once I realized what was going on I started to move at “ER speed”. Yes it’s possible. I cancelled the patient’s pending transfer to a medical floor and insisted upon an ICU admission with priority. I called the hematologist asking for plasmapheresis to be done – a process where a person’s blood is removed and replaced. I called the surgeon asking for a central line to be placed. I went back and spoke to family at bedside, non-English speaking by the way thus young adult grandchild provided translation per family request. I went to the pathology office to review the slides with the pathologist. Très belle! Then when all was done, I called the hospitalist to let him know what was happening with his patient. Ha! Ha!
It was my first case of babesiosis as an attending. My last encounter with this illness was as a resident, and that patient was not too ill. In short, I felt like I had directed the greatest orchestra of the day and made a difference in this patient’s life. I had done my good deed for the day and it made me happy. This is why I went into medicine. This is why I love infectious disease.
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