I am moonlighting this weekend. It's for an Infectious Diseases group, so I like it. I get to see some interesting cases, learn from those great MDs how they are managing the cases, and I get to make some extra cash. The only downside is I have no day off for weeks and weeks. Oh, well, there are pluses and minuses to everything.
I had a patient today who was really interesting. I think I've said this before, but a patient's wife once told me, "You never want to be an 'interesting case' - it doesn't usually bode well for the patient!" She's right. "Interesting" to doctors usually means rare, bizarre, and usually portends a bad outcome.
This super cute, elderly patient had a bone infection in his ankle and foot, because he's bed bound after a massive stroke. He got a pressure ulcer on his ankle with an infection that eventually settled in to the bone. That, in and of itself, is not interesting at all. That's run-of-the-mill infectious diseases. Dime a dozen stuff. His stroke, however, produced a fascinating symptom. I'm pretty sure "fascinating" can be added to "interesting" in the list of things you never want to be called by a doctor.
The patient is aphasic. Wikipedia has a great chart that describes a bunch of different language disorders often resulting from stroke or brain injury. This patient has Wernicke's aphasia. He probably doesn't understand me much, but I can't tell because I can't understand him at all. He has no trouble enunciating. His words are just a bunch of garbage for the most part. Some are real words. Some are made up. Most just don't go together at all.
I asked him how he was doing. He said, "Well, the angels all go in a row, and then baddle and baddle, and then it's done." He then looked at me and asked, "How diddy come splot and biggin to know?" I had no answer, so I just said, "I'm not sure..." It was terrible, because I didn't know if he comprehended that he made no sense and that I had no idea what he said. He seemed happy enough, "pleasantly demented" as we usually say. But, in this case, he's not demented, he just has a problem with the language center of his brain.
I'm assuming he didn't realize that he was not making any sense, or he would've gotten frustrated with my lack of a response. So, I guess that's a silver lining in his case. I told him his antibiotics were working, and that he'd be out of the hospital soon.
He said, "There you go."