Diagnosis: Rule out future litigation.

Yesterday was busy but again, I was blessed with cute patients. Adorable.

Although, one of them smelled, well... a little ripe.

Apparently our friend, Herb (his name isn't remotely Herb, but he strikes me as a Herb, so that's what I'll call him) was admited for a "fever" of 98.4 and ROMI for chest pain, which clearly was pleuritic and secondary to his raging bronchitis.

He also, according to my nurse's-desensitized-to-all-but-the-most-foul-odors nose, smelled like rotten goat cheese. Seriously. I've cleaned up umpteen GI bleeds, C-diff poop, raging, cheesy yeast infections, purulent sputum, urine, liver abcess drainage the consistency of a milk shake, bilious vomit--all of which would qualify for inclusion in national bio-warfare arsenals-- and nothing has made me want to lose my cookies the way that pervasive funkiness did.

I didn't get the pleasure of scrubbing him down until after he came back form his rule-out-future-litigation stress test (I joked to a friend of mine that our cardiac department should boast the slogan, "Thanks to our multimillion dollar diagnostic equipment and respected team of health care providers, we are able to diagnose a healthy heart years and years before it never becomes a real issue!" ).

He was so bad I actually said the hell with the bed bath, put him in the shower stall, and scrubbed him thoroughly from head-to-toe, including two bar-soap-hair-shampoos and a complimentary foot soak.

When I got to the peri area, I finally figured out that part of his odd funk was due to a raging yeast infection in his groin, which was beefy red and very tender looking.

JAMIE:
[to patient]
My God, Herb, did you know you had this rash here?

PATIENT:
[chuckling]
Oh yes! That! I've had that.

JAMIE:
Uh, does your doctor know about this?

PATIENT:
Yup.

JAMIE:
Did he give you anything to put on it?

PATIENT:
Oh yeah. Some powder. [in extra-inspired tone of voice] Hey, do you think I can just use talcum
powder and it'll go away?

JAMIE:
No, Herb. That's gonna need some serious Nystatin powder.
[patient's living circumstances suddenly crystal clear]
Say, Herb, say, do you have anyone to help you at home?

PATIENT:
[Good naturedly]
Oh yes, my girlfriend. She lives in the building next to mine.

JAMIE:
[concealing note of disbelief]
Your girlfriend? Uh, does she help you bathe?

PATIENT:
Oh yes, all the time. I can do the rest myself.

JAMIE:
[thinks to self]
I can see that, clearly.

So the irony of the situation was manifold. Not only did the guy come to our floor on a bullshit ROMI (rule out heart attack) admission, with a faked "fever" for bronchitis (bronchitis we were treating with oral antibiotics, even)... but we did the five star, million dollar work up on him negative despite negative cardiac enzymes, only to find out that his heart was perfectly normal, thank you very much. What the guy really needed was a couple hot baths, nystatin powder on his groin, physical therapy, and social service to figure out how in the hell it is he's managed to live on his own without a) falling down b) going septic from his lack of personal hygiene.

None of his actual issues, note, needed a hospitalization, still more more to the point, none of them required thosands of dollars worth of an extensive cardiac work up.

He could have gone to the doctor as an outpatient, gotten an Xray, a prescription for the bronchitis, and a referral to a visiting nurse service, who would come to his home and do a throrough evaluation.

But, as Paul Simon once pointed out, "Who am I to blow against the wind?"